Theses and Dissertations (Community Dentistry)

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Knowledge, attitudes and practices of South African oral healthcare workers regarding COVID-19 and its vaccine
(University of Pretoria, 2023-07) Nkambule, N.R.; Bhayat, Ahmed; Morule, M.; zarachothia@gmail.com; Chothia, Zahra
Introduction Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a recently discovered virus, responsible for causing Coronavirus disease 19 (COVID-19). COVID-19 is an infectious disease that emerged in December 2019. The virus has infected millions of people globally and continues to affect dental communities worldwide. This study aims to evaluate the level of knowledge and attitudes around COVID-19 and its vaccine among South African oral healthcare workers (OHCWs) and also assess their practices around COVID-19. It also assesses the willingness of OHCWs to administer the COVID-19 vaccines in their practices. Materials and Methods An online survey was designed and distributed to OHCWs across South Africa (SA). It consisted of four sections and the questions were designed to assess the participants’ demographics, knowledge of COVID-19 and its vaccine, attitudes towards COVID-19 and its vaccine and practices regarding COVID-19. The link to the questionnaire was sent out via email and social media platforms. Results A total of 327 OHCWs participated in the study and the mean age of the participants was 43 (SD= ±12.23; 20-76) years. Majority of the participants (60%) were general dentists. Of the entire sample, 136 individuals had additional postgraduate qualifications and of these, 32% held a Master’s degree and 13% had a recognised specialisation. The private sector employed 57% of study participants and 24% were employed by the academic sector. The knowledge of COVID-19 and its vaccine was combined and then scored. This study found that 60% of the respondents had good knowledge score while 40% had an average score. No one scored poorly regarding COVID-19 and the vaccines. There was no statistically significant difference in the mean age between the knowledge categories (p=0.165). Those with good knowledge had graduated more recently than those with average knowledge. The OHCWs with good knowledge tended to have more diplomas, Master’s and specialties compared to those with average knowledge. Overall, OHCWs displayed positives attitudes towards COVID-19 and the vast majority implemented appropriate infection control protocols at their place of work. Attitudes towards the COVID-19 vaccine varied as some of the participants displayed concerns around the adverse side effects, among other factors, which led to vaccine hesitancy. More than half of the respondents said they would treat a symptomatic patient prior to referring them for a COVID-19 test. This study included those individuals who were not willing to receive the COVID-19 vaccination. There were also participants who were qualified to administer vaccines but were not willing to vaccinate the public if authorised to do so. Conclusion Majority of the OHCWs demonstrated ‘’good’’ knowledge around COVID-19 and the vaccine and an overall positive attitude towards COVID-19 was displayed. The study reported a vaccination rate of 87% with side effects experienced by 58% of participants. The results of the study reported that vaccination hesitancy was prevalent among some of the participants. Preventative measures against the virus have been implemented by most of the respondents. The vast majority of the participants who were qualified to administer vaccines were not willing to vaccinate the public if allowed to do so. Taking the above into account, there were gaps that need to be addressed. Hence, health officials and policy makers should develop interventions to improve these gaps.
Comparative evaluation of the compressive strength surface hardness and porosity of a selection of capsule-mixed versus hand-mixed Glass lonomer cements
(University of Pretoria, 2019) Brandt, Paul Dieter; samantha.arnold@up.ac.za; Arnold, Samantha
Introduction: Glass ionomers are available in sets of powder and liquid constituents, which are dispensed using a scoop and dropper bottle system prior to hand-mixing by an operator. Glass ionomers are also available in capsulated form, which is mixed in a suitable mechanical mixing machine prior to clinical use. Capsulation enables uniform proportioning of the powder and liquid. In this context, mixing time will be correct as an automated process is utilised, resulting in a cement mixture that is optimal and reproducible, with minimal air entrapment. Manufacturers promote the capsulated form as being time saving, and easy to dispense, with more accurate adaptation because of the use of an applicator to place the material. Aim: The aim of this in vitro study was to compare the performance of hand-mixed glass ionomer materials with their capsule-mixed equivalents in terms of compressive strength, surface hardness and porosity. Materials and Methods: Four groups of 10 cylindrical specimens were manufactured for each of the four specified hand-mixed posterior glass ionomers for each test that was performed: Riva Self Cure (RSCH) (SDI Limited); GC Fuji IX GP (FIXH) (GC Corp); Ketac Universal (KUH) (3M ESPE) and Ketac Molar Easymix (KMH) (3M ESPE). Similarly, four groups of 10 cylindrical specimens were manufactured for each of the four equivalent capsule-mixed posterior glass ionomers for each test that was performed: Riva Self Cure (RSCC) (SDI Limited); GC Fuji IX GP (FIXC) (GC Corp); Ketac Universal Aplicap (KUC) (3M ESPE) and Ketac Molar Aplicap (KMC) (3M ESPE). The compressive fracture strength of each specimen was determined after 24 hours using a universal testing apparatus. A compressive load of 1 mm/min was applied to the 6 mm long axis of each specimen. The load to fracture was recorded and the compressive fracture strength was calculated. Within one hour after compressive strength testing, a selection of fragments from each specimen was examined by Scanning Electron Microscope (SEM). Fragments were vacuum gold-sputter-coated prior to SEM examination. The fragments were observed at an operating voltage of 10kV, and over a range of magnifications to investigate crack propagation. The surface hardness of each specimen was measured with a digital micro-hardness tester with Vickers diamond indenter. The indenter was set at a load of 500mN at five predetermined regions of each specimen, with a dwell-time of five seconds. The five readings for each specimen were computed and the mean VHN in N/mm2 for each specimen was determined. Each specimen was observed and analysed for porosity using Micro-CT. Three-dimensional reconstructions were made of each specimen and the number of voids per volume (mm3) of specimen, the total volume of voids (mm3) per volume of specimen and the volume percentage of voids per volume of specimen were calculated. Results: RSCH and RSCC showed statistically significant differences when compressive strength (p=0.027), volume of voids (p=0.005) and volume percentage of voids (p=0.005) were compared. No statistically significant differences were found between RSCH and RSCC when surface hardness (p=0.124) and number of voids (p=0.221) were compared. When compressive strength (p=0.254) and number of voids (p=0.210) of FIXH and FIXC were compared, no statistically significant differences were found. Statistically significant differences were found when surface hardness (p=0.031), volume of voids (p<0.001) and volume percentage of voids (p<0.001) of FIXH and FIXH were compared. No statistically significant difference was found when compressive strength (p=0.090) of KUH and KUC were compared. Statistically significant differences were found when surface hardness (p<0.001), number of voids (p<0.001), volume of voids (p=0.004) and volume percentage of voids (p=0.004) of KUH and KUC were compared. Statistically significant differences were found between KMH and KMC when compressive strength (p<0.001), surface hardness (p=0.006), number of voids (p=0.001), volume of voids (p=0.010) and volume percentage of voids (p=0.010) were compared. Conclusion: The current study suggests that RSCC is more advantageous for clinical use compared to RSCH. The results as to whether the capsule-mix or the hand-mix product are superior for the examined properties for GC Fuji IX GP are inconclusive. KUC surpassed KUH in tests performed and is therefore recommended for clinical use. KMC out-performed KMH in all tests conducted, and is therefore advocated for use in clinical practice.
Determination of the Cariogenic Potential of Sugar Substitutes
(University of Pretoria, 2020) Potgieter, Nicoline; nadine.moelich@up.ac.za; Moelich, Nadine
Early Childhood Caries (ECC) is a burden worldwide which has a negative impact on children’s wellbeing and affects aesthetics, speech and mastication. It may lead to loss of space, creating problems that are difficult and expensive to manage in future. The International Association of Paediatric Dentistry (IAPD) declared that more than 600 million children worldwide are affected by ECC. Caries is a multifactorial disease and frequent excessive sugar consumption is noted as a major risk factor in the development of caries. It also contributes to other non-communicable diseases (NCDs) such as diabetes, obesity and cardiovascular disease. The well-established link between dental caries and dietary sugar, specifically sucrose, can be explained due to the fact that it can be fermented by microorganisms. The use of sugar substitutes may be justified as an effective way to prevent dental caries by modifying the metabolism of microorganisms which will lead to a reduction in lactic acid production in the mouth. This study explored the cariogenic potential of sugar substitutes. The aim of the study was to determine and compare the cariogenic potential of commercially available sugar substitutes namely: xylitol, erythritol and stevia. The data collected could be useful in finding a suitable substitute for sucrose, one of the main causative factors of ECC. A total of 52 enamel slabs were prepared from the surfaces of extracted primary teeth and placed in growth media before being inoculated with Streptococcus mutans (S. mutans). The enamel slabs and growth media were used to determine the Colony Forming Units (CFUs) of S. mutans after exposure to xylitol, erythritol and stevia and to determine the acid production of S. mutans in the presence of these sugar substitutes by measuring the acidity (pH) of the growth media. Biofilm formation in the presence of sucrose, xylitol, erythritol and stevia was confirmed by means of Scanning Electron Microscopy (SEM). Considering the CFUs, pH and SEM analysis, this study suggests that xylitol, erythritol and stevia are all less cariogenic alternatives to sucrose. Stevia has been shown to have the lowest cariogenic potential, followed by erythritol and then xylitol. These substitutes should however be used with caution as they still produced a drop in pH close to the critical demineralization level. From the literature studied, it is clear that ECC is a preventable disease. It is the dental professional’s duty to raise awareness with parents, caregivers, other health care professionals and all relevant stakeholders. Parents and patients should be educated to limit sugar intake and to substitute sugar with healthier alternatives such as xylitol, erythritol or stevia, which all proved to be less cariogenic than sucrose.
Knowledge Attitude and Perception of Pregnant Women about Early Childhood caries in Tshwane District Gauteng South Africa
(University of Pretoria, 2019) Ayo-Yusuf, Imade J.; tshepiso.mfolo@up.ac.za; Mfolo, Tshepiso
Introduction: Early Childhood Caries (ECC) is a serious public health concern globally especially in developing countries like South Africa. The main source from which infants acquire the causative bacteria - Mutans Streptococci (MS) is their mothers. The mothers with high levels of MS have a greater chance of transmitting the bacteria, particularly if they are involved in practices such as tasting the infant’s food and/or sharing eating utensils. Current research indicates that dental public health programmes fail to prevent ECC because of late intervention. Objective: This study sought to determine the existing knowledge, attitudes and perceptions (KAP) of pregnant women about ECC in a population in Tshwane district, Gauteng province, South Africa and to compare these KAP across socio-economic groups (SES). Methodology: A cross-sectional analytical study involving consenting pregnant women recruited from selected private and public antenatal healthcare facilities in the Tshwane District area was conducted. This study involved the use of a validated self-administered structured questionnaire and an oral epidemiological clinical examination (modified by WHO Oral Health Assessment 1997 Guidelines). One calibrated examiner using a dental explorer and a mouth mirror under natural light carried out the oral examination. Data analysis included descriptive statistics, principal component analysis to obtain a composite score for participant’s attitude towards ECC; and chi-square and independent student’s T-test to compare different groups. Significance level was set at p<0.05. Results: Response rate was 88.9% (n=353). Respondents’ age ranged from 18-44years (Mean age=31years). Only 18.7% of the respondents had complete knowledge of the cause of dental caries i.e. both sugar (diet) and biologic agent (bacterial plaque) whilst over half of the respondents (55.5%) mentioned only one factor. The participants’ knowledge of the cause of ECC was significantly associated with SES. A few mothers-to-be (13.9%) believed in the caries transmission from mother to child. Reported mean age for the child’s first dental visit was 2 years and 8 months. Only a quarter of respondents received oral health education for their unborn child during the antenatal visits. The majority of the pregnant women (93.8%) expressed the desire to receive information during the antenatal visit. The participants’ attitudes towards ECC was significantly associated with SES. The caries prevalence of the pregnant women was high at 64.3%, with mean DMFT of 2.97(SD 3.20). High participant DMFT was significantly associated with reports of ‘rotten teeth’ in their other children. Only 19.3% mothers-to-be had visited a dental care provider in the last 6-months. Conclusion: The knowledge of the pregnant women studied on ECC is incomplete and limited, while their attitudes and perceptions towards ECC was satisfactory. Therefore there is a need for the integration of oral health education with maternal and child health activities in both antenatal and post-natal clinics. There is a need for the oral health professionals to collaborate with other health works to reduce the prevalence of ECC.
Double inferior alveolar nerve canals and mental foramina in the mandible : a computed tomography study at a private dental clinic in Kenya
(University of Pretoria, 2017) Marnewick, J.C. (Johan); Van Zyl, Andre W.; josegaks@gmail.com; Gakonyo, Joseph Mutahi
Aberrant inferior alveolar nerve canals (IANC) and mental foramina (MF) have been well documented and can have significant implications if injured during invasive procedures of the human mandible. Geographical and ethnic differences have been observed in the occurrence of these variations. The primary objective of this study was to determine the pattern of occurrence of double IANC and MF among a sample of patients attending a dental clinic in Kenya through cone beam computed tomography (CBCT) image analysis. The occurrence, location, configuration and morphometric measurements of double inferior alveolar canals and mental foramina were recorded in a data extraction form (Appendix 1). Data was captured in a Microsoft Excel 2010 data sheet. With the use of Bayesian statistics, exploratory and inferential data analysis was done in R (R Development Core Team, Vienna, Austria) software version 3.1.2. The results were presented as posterior distributions of means and mean differences including standard deviations (SD), Credible Intervals (CrI) and effect sizes (ES). In all outputs, the 95% most credible values (CrI) were shown as a High-Density Interval (HDI) in the respective histograms. Gender and side differences were rated. A total of 800 images were included in the present study of 347(43.38%) male and 453(56.62%) female patients. The mean age was 39.18 years+12 SD while median age was 39 years (range: 19 to 67 years). Double IANC were observed in 26 (3.25%) of the 800 images (29 of 1600 sides, 1.81%). The most frequently encountered type of double IANC was type 1 (23 / 29, 79.31%), followed by type 3 (4 /29, 13.79%) and then type 2 (2 / 29, 6.9%). The double IANC were more in the angle region than at the body area of the mandible. The mean diameter and length of the double IANC were 1.57+0.41mm (95% CrI: 1.40, 1.73) and 13.10 +3.45mm (95% CrI:11.60, 14.5) respectively. In total, 21 double MF were found in 19(2.4%) patients, with 11 being posterior, seven anterior and three superior to the main mental foramen (MF). The mean diameter of double MF was 1.27 [95% CrI: 1.05, 1.47] mm with a standard deviation of +0.41mm. The mean distance between double MF and the main MF was 4.69mm [95% CrI: 3.47, 5.59] with a standard deviation of 2.26mm. Based on the findings reported in this study, the rate of occurrence of double IANC and double MF was typically low in the study population. The diameter of the main MF was always smaller than that of the side without the double MF. This was not the case with the IANC. There was also no gender predilection elicited in any of these occurrences. CBCT imaging is recommended as it has better resolution to enable detailed analysis of structures that are less than a millimeter in diameter. Ensuring a safe distance of 9 mm from the walls of the main MF would greatly reduce the risk of injury to the neurovascular contents of the double MF in case CBCT imaging is not available.
The effectiveness of a tooth brushing programme for children in the Ehlanzeni district Mpumalanga and the relationship between body mass index (BMI) and odontogenic infections
(University of Pretoria, 2017) Van Wyk, Philippus J.; MARIUSENLIEZL@HOTMAIL.COM; Van der Walt, Marius
1. Introduction Dental caries is the most frequently occurring non-communicable disease world-wide and the most common disease found in children. Although dental caries in South Africa reduced significantly during the last 3 decades, the high levels of untreated caries in all age groups is an alarming cause for concern. Experts are of the opinion that the dramatic decline in caries is mostly due to the use of fluoride toothpaste. Whilst water fluoridation had been proven as effective in reducing caries prevalence and severity and promoted as a major public health intervention by the World Health Organisation (WHO), no water fluoridation schemes exist in South Africa. There is little evidence that caries in South African children is addressed adequately through policy and service provision efforts. Due to persistent oral health inequalities in access to care the South African public sector is under constant strain to deliver equitable, cost effective primary oral preventive services. As children spend a considerable proportion of their lives in education, schools can play a significant role in promoting children's health and oral health. Although several studies indicated that caries prevalence and severity can be reduced by brushing programmes, very little is known on the effectiveness of such interventions in the South African public school set up. Odontogenic infections may influence the ability of a child to ingest food which in turn could have a negative impact on the development of the child. Despite the pandemic character of dental decay, particularly in children, there are only a few studies that have examined the relationship between the severity of dental decay and the Body Mass Index (BMI). Rob Ferreira Hospital, Dental Department, under supervision of the author of this dissertation, introduced the Colgate Bright Smile Bright Future tooth brushing programme in low socio-economic areas in the Ehlanzeni district of Mpumalanga for children in Grades R to three in June 2012. Teachers supervised children that participated in the programme to ensure they brushed daily at school according to the prescribed methods. This provided an ideal opportunity to evaluate the effectiveness of a three year tooth brushing programme in primary schools (community trial) in a South African public school setup and to evaluate the relationship between odontogenic infections and BMI of the children. 2. Objective The purpose of the study was to evaluate the effectiveness of the tooth brushing programme in a community trial in the Ehlanzeni district of Mpumalanga. The idea was to evaluate the impact of this programme on dental caries by comparing the caries status of children who took part in a brushing programme since 2012, with the caries status of a comparable group of children from the same district who did not take part in the brushing programme, in the three years prior to the survey. The purpose of the second part of the study was to investigate the relationship between odontogenic infections and BMI of eight to ten year old children. 3. Study methodology Two samples of 250 children each, in the age group eight to ten years old, were randomly selected from children in Grade three. The first sample was drawn from children who took part in the brushing project and only the six schools that were part of the brushing project since the commencement of the project in 2012, were included. The second sample was drawn from children in six schools, in the same district, who did not participate in the brushing programme, but who were in the proximity of the intervention schools. DMFT/dmft index was used to measure caries experience and PUFA/pufa index used to measure odontogenic infections due to untreated dental caries according to standard procedures. Anthropometric measurements were performed and this information was used to compute the BMI. PUFA outcome was assessed using logistic regression while the data analysis for the evaluation of the effectiveness of tooth brushing compared intervention versus nonintervention groups using independent samples T-tests.
A micro-computed tomographic evaluation of curved maxillary molar root canals using different root canal instrumentation techniques
(University of Pretoria, 2017) De Wet, Francois A.; peetv@iafrica.com; Van der Vyver, Petrus Jacobus
Preservation of the original anatomical shape following instrumentation of root canals is essential for endodontic success. Procedural errors created during glide path enlargement might be exacerbated or initiated during subsequent shaping. The aims of this study were to: (1) compare canal centering ability and transportation of pre-curved Senseus K-FlexoFiles (stainless steel), ProGlider file (M-Wire) and One G file(NiTi alloy) after glide path enlargement in curved root canals micro-computed tomography (micro-CT) scanning; (2) compare canal centering ability and transportation of OneShape (NiTi alloy), ProTaper NEXT (M-Wire alloy) and WaveOne Gold (Gold wire) instrumentation techniques in the same canals; (3) compare the change in root canal volume between uninstrumented canals, canals after glide path preparation, and canals after root canal preparation. One hundred and thirty-five curved mesio-buccal root canals of human maxillary molars were randomly divided into three groups. These groups were (1) glide path enlarged using pre-curved size 10, 15 and 20 stainless steel Senseus K-FlexoFiles (n=45); (2) manual glide path enlargement with a size 10 K-File followed by One G (n=45); and (3) manual glide path enlargement with a size 10 K-File followed by the ProGlider (n=45). Micro-CT was used to scan teeth before and after glide path preparation. Each glide path specimen group was randomly assigned to three equal groups (n=15) resulting in nine glide path/shaping groups of fifteen canals each: Group 1 (K-FlexoFile + OneShape)(K/OS); Group 2 (K-FlexoFile + ProTaper NEXT)(K/PTN); Group 3 (K-FlexoFile + WaveOne Gold)(K/WOG); Group 4 (One G + OneShape)(OG/OS); Group 5 (One G + ProTaper NEXT)(OG/PTN); Group 6 (One G + WaveOne Gold)(OG/WOG); Group 7 (ProGlider + OneShape)(PG/OS); Group 8 (ProGlider + ProTaper NEXT)(PG/PTN); and Group 9 (ProGlider + WaveOne Gold)(PG/WOG). After canal preparation with the shaping instruments, all the specimens were scanned again by means of micro-CT. The three-dimensional images obtained before instrumentation, after glide path preparation, and again after final canal preparation were reconstructed and interpreted. Centering ratio values, canal transportation and change in root canal volume were recorded and compared between the three glide path- and nine root canal preparation groups. Canal transportation and centering ability were evaluated over the apical, midroot, and coronal levels (2 mm, 5 mm and 9 mm from the root apex). The results were statistically analysed using a one-way ANOVA for parametric and Kruskal-Wallis H test for non-parametric comparisons. Statistical significance was set at p< 0.05. One G and ProGlider displayed statistically significantly better mean centering ratios than stainless steel K-FlexoFiles at each level examined and for the combined results of the three levels (p<0.05). Apical canal transportation ratio values after glide path enlargement were significantly higher for the K-File group compared to One G and ProGlider (p<0.05). At the midroot and coronal levels and for the combined results of the three levels, the canal transportation results were statistically similar for all glide path groups (p>0.05). The volume of dentine removed by the three glide path groups was statistically significantly similar for K-FlexoFiles, One G and ProGlider (p<0.05). No statistically significant difference was found in the mean centering ratios at the apical and midroot levels of the various glide path groups in combination with the shaping instruments (p>0.05). However, at the coronal level, centering ratio results following glide path preparation with K-FlexoFiles appeared to affect shaping outcomes for both PTN and OS groups. One Shape performed poorly following all glide path techniques with OG/OS and significantly displayed the worst centering ratio at this level. The results for the combined centering ratio values of the various glide path/shaping groups displayed no statistically significant differences between the different combination groups (p>0.05). Apical canal transportation after shaping was significantly highest for K/OS followed by K/PTN. At the midroot level canal transportation was significantly higher for K/PTN than K/OS and OG/OS, which were statistically similar to each other. Coronal canal transportation after canal shaping was significantly highest for K/PTN followed by K/OS. The most favourable mean combined transportation ratio values of the various glide path/shaping groups were observed in OG/WOG and in PG/WOG groups and the least favourable for the K/OS and the K/PTN groups. The three groups shaped with ProTaper NEXT exhibited the highest volume of dentine removed with the highest displayed by the PG/PTN group. Statistically, the lowest mean volume of removed dentine was by the PG/WOG group. In general, results were more favourable after canal preparation with the WaveOne Gold Primary file following any of the three glide path preparation techniques.
A comparison between the band-and-loop space maintainer with a loop-design fibre-reinforced composite space maintainer
(University of Pretoria, 2017) Brandt, Paul Dieter; ; Mohamed, Nadia; nicoline.potgieter@gmail.com; Potgieter, Nicoline
The band-and-loop space maintainer (BLSM) is a non-invasive device commonly used to maintain space after the early loss of a single deciduous tooth until the permanent tooth erupts. Unfortunately, however, these devices are difficult to fabricate, require laboratory work and are expensive. Clinically, they tend to fracture, bend or debond under occlusal forces and they are not considered aesthetic. These obvious limitations and challenges warrant the investigation of new materials and device designs for the treatment of premature single tooth loss. The fibre-reinforced composite space maintainer (FRCSM) has many advantages and has been suggested as an alternative to the BLSM. This study considers the clinical failure rates and reasons for failure for a loop-design FRCSMs, as placement techniques have not yet been standardised. The aim of the study was to comparatively investigate the in vivo failure rates (as well as the reasons for failures) of the loop-design FRCSM and the metal BLSM over a 6 month period. The data collected could be useful in the development of more successful FRCSMs. A total of 20 space maintainers were placed – 10 BLSMs and 10 loop-design FRCSMs. For each BLSM placement, an orthodontic band was fitted around the anchor tooth and an alginate impression was taken. This impression, with the band in position, was sent to the dental laboratory for fabrication of the device. At a second appointment, the BLSM was fitted and cemented with glass ionomer cement. For each FRCSM placement, a unidirectional glass fibre bundle was positioned in a continuous loop design extending from the buccal to the lingual surface of the anchor tooth. The fibre bundle was secured in position with a flowable composite, light-cured, and subsequently finished and polished. Monthly follow-up appointments were scheduled over a six-month period and parents/ patients were instructed to report immediately for an emergency appointment if any problem or failure occurred between these arranged appointments. This ensured that the timing of (and reasons for) the failures of both types of device were accurately recorded. With respect to the BLSM, the main reason for device failure was bending of the wire and subsequent impingement on the soft tissue. With respect to the FRCSM, the main reasons for device failure were debonding at the enamel-composite interface and fibre loop fracture. Within the six month follow-up period, both space maintainer types exhibited a 50% failure rate, but 30% of the failed FRCSMs could be repaired chairside whilst the failed BLSMs had to be refabricated in the laboratory. Although the results of this study do not show a significant statistical difference between the failure rates of the two space maintainer types tested (p=0.53), the FRCSM performed well clinically in that it was more easily repairable and remained clinically effective even in cases where the device broke. From the data gathered during this study, it is recommended that further research be done on the effectiveness of the loop-design FRCSM when it is bonded to permanent teeth, and on whether this device would prove more successful if mechanical retention were enhanced when bonding the device to deciduous tooth enamel. Whilst this study has generated valuable new clinical information, the FRCSM cannot yet be confidently recommended as a reliable alternative to the BLSM. Further research on this topic (based on a larger sample size and with a longer follow-up period) is necessary.
Association between diet dental caries and body mass index amongst grade six learners at selected primary schools in Tshwane
(University of Pretoria, 2017) Bhayat, Ahmed; zdnkambule@gmail.com; Nkambule, Ntombizodwa Rosemary
Introduction: Childhood obesity and dental caries (DC) have increased worldwide and are continuing to pose challenges to public health. The increasing risk of obesity for children is of particular concern because research has suggested that childhood obesity predicts adult obesity. Children experiencing DC early in their lives have a much greater probability of subsequent caries in their permanent dentitions and adulthood. Studies have reported a strong association between the nutritional intake and DC and reported a direct link between DC, sugar consumption and obesity. Objectives: to assess the association between dental caries (DC), the Body Mass Index (BMI) and diet among grade six learners at selected primary schools in Tshwane West District. Methods: A cross-sectional analytical study of grade six learners was carried out in Tshwane. The data collection consisted of a questionnaire, clinical oral examination and anthropometric measurements. All clinical data was collected by a single calibrated examiner. A validated questionnaire was used to collect the demographic data and the type of diet consumed. The SPSS version 23 software was used for analysis. Descriptive statistics, Chi-Square test to test for significance for categorical data and logistic regression analysis were used to determine statistical significance. Results: The response rate was 83% (440) and of these 53% were male. The mean age of the participants was 11.8yrs. The majority of the participant’s fathers (71%) and 50% of mothers were employed. The DC prevalence was 43% with a mean DMFT score of 1.19 (SD= ±1.79). The PUFA score was zero. Less than half (47%) of the participants reported to brush their teeth twice daily. The majority (71%) claimed to drink between one and one and a half glasses of sugar-sweetened beverages (SSBs) with 67% eating between one and three sweets per day. While most of the participants reported having a balanced meal at supper, a third reported eating junk food. The majority (71%) of participants had a BMI score that was within the normal range with 19% being overweight. There were no significant associations between the mean DMFT, BMI scores and the SES of the participants. Conclusion: The DMFT was low, but the decayed component was relatively high. The PUFA score was zero. Most participants were classified as having a “normal” BMI with almost a quarter being classified “overweight”. There were no significant associations between the DMFT and the mean BMI scores and SES of the learners. More than half of the participants were from a medium SES and had a slightly high DMFT score than their counterparts. Less than half reported to brush their teeth daily, most of them had a balanced diet at supper.
Root canal treatment outcomes at the University of Pretoria Oral Health Centre
(University of Pretoria, 2015) Postma, Thomas Corne; Jonker, Casper Hendrik; vanessa.mostert@up.ac.za; Mostert, Vanessa
Aim: The University of Pretoria Oral Health Centre (UPOHC) is inundated by patients who demand emergency pulpectomies. The demand for service however exceeds the capacity to treat, which may be problematic in terms of treatment outcomes. The aim of this study is therefore to measure the outcome of emergency pulpectomies at the UPOHC. Method: The electronic and paper records of 498 randomly selected teeth that received an emergency pulpectomy at the UPOHC from 1July 2012 until 30 June 2013 were examined to determine the outcome of the treatment. The completion rate over time was calculated in combination with the percentage of teeth that was eventually extracted or referred for extraction. In the case where the root canal treatment (RCT) reached the obturation phase, the post-operative radiographs were analysed in terms of the technical quality of the obturation. Results: Forty-five percent of the sample size of 498 teeth for which an emergency pulpectomy was performed returned to have the RCT completed. Of these, 43% were inadequately obturated. Eight percent of teeth observed referred for extraction. Seven percent of teeth had the initial phase of treatment repeated while 40% were never seen again after the initial pulpectomy. A total of 46.96% of the teeth were still incomplete after 16.56 months. Conclusion: The results of the study indicate that the UPOHC has a limited capacity to complete RCTs. A strategy is needed to expand the region’s resources and to incorporate a preventative dental focus. However, this will require an intervention in the functioning of the dental health system with regard to government funding in order to achieve success in both service delivery and education. An audit of the current undergraduate endodontic curriculum is perhaps necessary to improve students’ skills and efficiency in the service learning environment.
Can an orthopantomograph be used as an indicator of vertical jaw relations?
(University of Pretoria, 2014) Dawjee, S.M.; Suliman, Mohamed Faried
Introduction: Clinicians have long been interested in the multitude of differences in the diagnosis, treatment, and the treatment response between the hyperdivergent or dolicofacial types and hypodivergent or brachyfacial types. Since its introduction by Broadbent in 1931, the cephalometric radiograph is used as the golden standard in orthodontic diagnosis and treatment planning. Many analyses have been created by which to compare skeletal and dental relationships. Lateral cephalometry is an important tool in orthodontic diagnosis of the vertical jaw relationships, treatment planning, prediction of growth and the evaluation of these different facial forms. Little research has been undertaken to evaluate how valuable an orthopantomograph radiograph is in diagnosing and treatment planning orthodontic patients with regard to facial types. Purpose: The aim of this study was to evaluate the use of the measurements taken from the orthopantomograph as compared to that of the lateral cephalogram for investigating the vertical jaw relationship patterns of individuals. Materials and Methods: The sample size consisted of ninety patients, equally divided into the three different growth patterns namely dolicofacial, mesofacial and brachyfacial. Lateral cephalograms and orthopantomographs of these patients were compared The patients were categorized as vertical, normal and horizontal. The cephalogram was used as the gold standard for the three different categories The gonial angle which is the angle between the tangents of the inferior border and posterior border of the mandible was measured on the lateral cephalogram and the orthopantomograph. The upper and lower facial heights was measured on the lateral cephalogram, as well as the Y axis. The condyle angle which is an angle formed at the intersection of the ramus height and a line parallel to the posterior tangent line was measured on both the orthopantomograph and the lateral cephalogram. The ramus height was also measured on both the lateral cephalogram and orthopantomograph. Results: Comparisons were made of the mean and standard deviation and the median values from the gonial angle, the ramus height and the condyle angle, measured for the three different growth types. With respect to the normal growth pattern and the horizontal growth pattern the mean and median for the gonial and the condyle angles, there was no significant difference. However there was a significant difference in the mean and median values for the ramus height. The results were different for the vertical patient. The mean and median values for both the gonial angle and the ramus height differed significantly for the two radiographs. While the mean and median values for the condyle angle did not differ significantly. The results with respect to the correlations showed significant correlations between the gonial angle and the condyle angle for all three growth patterns. However this was not the case for the ramus height. Conclusion: Based on these findings it can be concluded that angular measurements could be correlated between the two radiographs. There is however, little consistency between the linear measurements taken from an orthopantomograph and that of a lateral cephalogram.
Occlusal bite force measurements in different malocclusions
(University of Pretoria, 2014) Dawjee, S.M.; Dawjee, Maryam Mohamed
Dento-facial anomalies have been diagnosed for centuries. The diagnosis or observation thereof is reported to date back to the Fifth Century AD where Hippocrates observed and noted numerous craniofacial deformities (Moyers, 1988) Through a complex process of reception, selection and categorizationthe human form particularly the cranium, jaws and related soft tissue structures, have been studied and categorized over the years (Moyers, 1988). Dockrell (1952) focused on the aetiology of malocclusion and through extensive work on the topic, established an equation for the improved identification of aetiology of malocclusion. This equation essentially communicates that a causative factor will act at a specified time, on an identified tissue, to produce particular results. Thus resulting in a deviation from the accepted “normal” relationship. This will result in the development of an archetypally defined, classifiable malocclusion. These so termed causative factors as elicited to in the equation play a pivotal role in the outcomes or resultant malocclusions (Dockrell, 1952). The plasticity in aetiology and resultant Skeletal or dental positional discrepancy should not be overlooked. Multiple factors may act together stabilising each other thus lessening the severity of the expected effect. This research project aims to identify the potential of occlusal bite forces as a causative factor in the “orthodontic equation” and shed light on timing as well as resulting Skeletal and growth effects of variance in occlusal force. Occlusal force is a combined and quantifiable measurement of contributory muscle strength. Through this study a comparative analysis of the occlusal force will be carried out amongst subjects exhibiting differences in age, gender, race, and growth pattern. This study aims to elucidate the influence of occlusal forces and masticatory muscle strength in relation to the resulting craniofacial development. Data was collected from patients exhibiting various dental classes namely Class I, Class II and Class III dental and Skeletal patterns. Bite force strength of patients in primary, mixed and permanent dentition was measured using an occlusal force meter. The occlusal force meter was sourced from a Japanese based company, Nagano Keiki Co. LTD. The readings were done in Kilo newton, which is the standard international (SI) measurement of force. The study population consisted of 180 male and 180 female subjects. This group was split into Skeletal Class I, II and III subjects and then further divided into the three directions of growth (Horizontal, normal and Vertical). The relationship of bite force to Skeletal Class and growth direction was analysed using mean readings from five points of reference on each subject. Analysis of covariance was carried out on the data set with a mean age of 15,33 years (covariant). There was a significant difference found in the bite forces between growth direction and Skeletal Class P<0,05. There was also and interaction found between Skeletal classes and direction of growth. These findings are supportive to the hypothesis that a relationship exists between bite force and malocclusion.
An In-vitro Comparison of Microleakage Between Three Calcium Silicate Cements and Amalgam
(University of Pretoria, 2014) Van der Vyver, Petrus Jacobus; Seedat, Hussein Cassim
Periapical endodontic surgery may be indicated when orthograde retreatment of failed endodontic therapy is unsuccessful, unfeasible or contraindicated. The sequence of procedures during the surgery includes exposure of the involved apex, root-end resection, root-end cavity preparation and placement of a root-end filling. The root-end filling is necessary in order to provide a hermetic seal, thereby preventing the egress of micro-organisms into the periradicular tissues from the root canal system. The purpose of this in-vitro study was to compare the microleakage of three calcium silicate cements and amalgam when used as retrograde filling materials. One hundred and twenty single rooted, single canal, human teeth with closed apices were collected and stored in Phosphate Buffered Saline after extraction. All root canals were instrumented using ProTaper rotary instruments and obturated by warm vertical condensation using gutta-percha with Topseal Root Canal Sealer. Access cavities were sealed with Fuji IX glass ionomer restorative material. The apical 3mm of each root was resected perpendicular to the long axis of the root and root-end cavities were prepared to a depth of 3mm using ProUltra surgical ultrasonic tips. The teeth were randomly divided into four groups (n=30): Group 1 - ProRoot MTA (Dentsply/Maillefer) Group 2 - MTA PlusTM (Prevest Denpro Limited) Group 3 – BiodentineTM (Septodont) Group 4 – Permite Amalgam (SDI) The materials were manipulated according to the manufacturer’s instructions and used to fill the root-end cavities. The specimens were then coated with two layers of clear varnish, except the resected apical surface. Teeth were stored in gauze, moistened with Phosphate Buffered Saline for 24 hours and thereafter submerged in Indian Ink dye for 48 hours. The excess dye was rinsed off the specimens under running water. Specimens were then sectioned horizontally in one millimetre increments from the apical end of the root. The extent of dye penetration was measured to the nearest millimetre using a stereomicroscope. Data for different groups was collected and summarised in terms of percentage for the outcome vector (no leak, 1 mm leak, 2 mm leak and 3 mm leak). Furthermore pairwise comparisons between each of the calcium silicate materials to amalgam were done at the 0.017 level of significance, using Fisher’s exact test. Amalgam showed significantly more leakage than the calcium silicate materials (p<0.001). No significant differences were found among the calcium silicate materials, namely, BiodentineTM vs ProRoot (p=0.776), BiodentineTM vs MTA PlusTM (p=0.667) and ProRoot vs MTA PlusTM (p= 0.350).
Prevalence of oral and oropharyngeal human papillomavirus (HPV) in a sample of selected South African males : a pilot study
(University of Pretoria, 2014) Boy, Sonja Catharina; Richter, Karin Louise; christylanadavidson@gmail.com; Davidson, Christy Lana
Oral human papillomavirus (HPV) infection and its association with head and neck cancers (HNCs) have been established by many studies. The characteristics of HPV-associated HNCs are distinguishable from those of non HPV-associated HNCs. HPV-associated HNCs are related to sexual behaviour, particularly the lifetime number of oral sex partners. The oral and oropharyngeal HPV epidemiology in South African men has not yet been researched. The objective of this study was to determine the oral and oropharyngeal HPV strain prevalence and associated factors in a selected male population in Pretoria, South Africa. Male factory workers were recruited on a voluntary basis to be part of this study. Oral rinse and gargle samples were tested for 37 HPV types using the HPV linear array genotyping kit (Roche Molecular System). A questionnaire was utilised to obtain information regarding age, medical conditions, substance and alcohol use and sexual behaviour. HIV testing was optional. The HPV prevalence was 5.6% among the men (n=125) aged 17-64 years. High risk HPV (hrHPV) types 16 and 68 were found in two men. Amongst the majority of the participants oral sex seemed to be an uncommon practice however, those participants with hrHPV did practice oral sex. A statistically significant association between HPV infection and an increased number of sexual partners (p=0.027) was seen but not between substance use, HIVstatus or clinical mucosal pathology. Considering the oral and oropharyngeal HPV prevalence found in this study compared to those reported in other countries. It is therefore proposed that a larger nationwide study be conducted to give a more representative view of the burden of oral and oropharyngeal HPV infection in South Africa.
Managing oral health in the Oral Health Service of the South African Medical Service : A Systems Approach
(University of Pretoria, 1993-10-02) Rossouw, L.M.; Snyman, Willem D.; ; Viljoen, Johannes Hendrik
Problems concerning the planning and practicing of health care currently exist. Countries are spending more funds on medical care without making a discernible dent in the health status of their citizens. This lack of success in obtaining health is obviously a problem for everyone experiencing ill health or the effects thereof It also creates a personal problem for all health workers, because a halt is being called to profligate spending on health that will affect all. The problems underlying tl:e health care crisis are rising costs, unequal distribution, low productivity, poor heali..ii status, and a lack in sensitivity towards the communities it serves. The multi-disciplinary, complex nature of these problems in health care, their magnitude and their inter-relatedness indicate that traditional approaches to health care planning and management have been inadequate or have failed. An alternative approach to solve these problems is to adopt a holistic view, i.e., to see all parts (components) which contribute to the problem as parts of the whole. By viewing the problem as a whole, more enduring solutions may be formulated. The aim of this study was to employ and evaluate the adoption of a systems approach to solve "real life" problems. The Soft Systems Methodology of Peter Checkland was utilized to assess the situation within the Oral Health Service of the SAMS and to identify relevant systems to improve the situation. The need for a Preventive System and a Performance Measurement System was established. These two systems were planned, developed and implemented using and obeying systems rules and techniques. Both these systems were evaluated and found to be highly efficient, effective, cost-effective and made a positive net contribution to the Oral Health Service of the SAMS. It is finally concluded that the adoption of a systems approach to identify and solve "real life" problems was effective and efficient. It is therefore recommended that a systems approach to the management of oral health, and probably health too, should be embraced by the encumbered health industry.
Evaluation of dental emergency outcomes of the Oral Health Fitness Classification of the South African Military Health Service (SAMHS) in Gauteng - South Africa
(University of Pretoria, 2012) Van Wyk, Philippus J.; thommy.madiba@gmail.com; Madiba, Thomas Khomotjo
Background: The South African National Defence Force (SANDF) like other Defence Forces of the world, conducts medical classification on their members. This medical classification has, as one of the components, an Oral Health Fitness (OHF) classification which is done according to North Atlantic Treaty Organisation (NATO) standards. The aim of the Oral Health Fitness classification is to standardize dental readiness, assess oral health, prioritize dental care, minimize the number of dental emergencies (DE), and emphasize the importance of good oral health to all active duty and reserve forces. Medical classification is conducted by the South African Military Health Services (SAMHS). Aim: The aim of the study was to evaluate the dental emergency outcomes of the Oral Health Fitness classification of the SAMHS in Area Military Health Unit Gauteng (AMHU GT), South Africa Objectives: To determine dental emergency rate for the SAMHS, analyse the dental emergencies and to make recommendations regarding dental emergencies to the SAMHS Methods: A cross-sectional retrospective record analyses of members of the SANDF that received an OHF classification of 1 and 2 in AMHU GT in 2009. The AMHU GT members were followed up for a year to determine if they developed dental emergencies. Data analysis included frequency tables, chi-square tests and logistic regression analysis. The level of significance was set at p<0.05. Results: The dental emergency rate for AMHU Gauteng was 307/1000 per year. The type of dental emergencies were: 58.5% dental restorations, 13% extractions and related complications, 4.3% crown and bridge, 3.9% emergency root canals, 9.9% recementations, 3.6% denture related problems while other emergencies were 6.8%. Patients were more likely to experience a dental emergency if they were white, female, of OHF 2 classification and older than fifty years of age. Conversely they were least likely to experience a dental emergency if they were black, male, of OHF 1 classification and in the age group 31-40. Conclusion: The dental emergency rate of 307/1000 per year for the SANDF is high compared to military health units from other countries and it was influenced by race, age and gender. The types of dental emergencies were mainly preventable.
Determinants of self-reported periodontal health in South Africa : results from a national survey
(University of Pretoria, 2010-12-14) Ayo-Yusuf, Olalekan Abdulwahab; tuweyire@yahoo.com; Okagbare, Tuweyire Erherhebue
Background: Since self-reported periodontal or ‘gum’ health may be explained by the same factors that are associated with clinical periodontal health status, it has been suggested as a useful measure for service planning and for monitoring periodontal health in developing and resource-limited countries, where logistics and the costs of clinical oral surveys may be major barriers to risk factor surveillance. Objectives: To determine the systemic health and lifestyle factors associated with self-reported poor periodontal health status in South Africa. Data source: The second South African Demographic and Health Survey (SADHS) done in 2003. Methods: This secondary data analysis focused on data on dentate adults aged ≥15 years who participated in the 2003 SADHS (n=6,319). Information obtained included socio-demographic data, health risk behaviours (tobacco and alcohol use) and chronic diseases. Nutrient intake was computed based on food frequency items contained in a Nutrient Index (N-Index) developed for use in South Africa. Taking into account the complex sample design used in the SADHS, data analysis included the use of t-test, Chi-square and multiple logistic regression analysis. The level of significance was set at p<0.05. Results: Of the respondents, 4.6% (95% CI = 3.9 - 5.5) self-reported having had a ‘gum problem’ or poor periodontal health in the 6 months prior to the survey date. In the general dentate population, those who reported poor periodontal health were older than those who did not report poor periodontal health at a significant level (36.2% vs. 38.8%; p = 0.02); and they were more likely to be problem drinkers (2.53; 95% CI = 1.68 – 3.82), as compared to non-drinkers. Having suffered a stroke (4.13; 95% CI = 1.53 – 11.11) or suffering from arthritis (1.70; 95% CI = 1.00 = 2.90) were significant associated with higher odds of reporting poor periodontal health. Black South Africans have higher odds of reporting poor periodontal health (3.91; 95% CI = 1.38 – 11.05) than white South Africans. On further stratifying the study participants into younger (≤45 years) and older (>45 years) adults, factors associated with poor periodontal health were found to be different. In particular, reporting making yearly preventive dental care visits was significantly associated with reporting poor periodontal health only among younger adults (OR = 0.40; 95%CI = 0.18 – 0.90), while the racial gradient in reporting poor periodontal health remained significant only for older adults. Conclusion: The study’s findings highlight the need to integrate oral health promotion with general health promotion programmes, especially those targeted at chronic disease prevention and rehabilitation.
Periodontal disease during pregnancy and low birth weight of newborns at Chris Hani district of Eastern Cape
(University of Pretoria, 2013-02-18) Ayo-Yusuf, Olalekan Abdulwahab; pecazele@yahoo.co.uk; Agbeniyi, Olusola Charles
OBJECTIVE : This study sought to determine the association between periodontal disease in pregnancy and the delivery of low birth weight newborns in a rural population of South African women. METHODS : This case-control study involved 348 new mothers. All subjects were recruited post-delivery from three public hospitals in the rural Eastern Cape of South Africa. The cases (n=119) were mothers who delivered through normal delivery and whose babies at the time of delivery weighed <2.5 kg. Age-matched controls (n=229) were mothers who delivered ≥2.5 kg babies. Potential risk factors for periodontal disease and low birth weight were collected by means of a structured questionnaire and maternity record review. Using the WHO's community periodontal index, a trained dental clinician blinded to participants' birth-outcomes recorded the periodontal health status of each participant (intraexaminer reliability; kappa = 0.95). Mothers who presented with a probing depth ≥4 mm on more than four index teeth without the presence of gingival overgrowth were deemed to present with periodontal disease. Data analysis included conditional logistic regression analysis. RESULTS : Periodontal disease was diagnosed in 37.9%> (n=45) of the case group and 9.2°/o (n=21) of the control group. Low birth weight was also significantly more common among those who were unemployed, those who reported fewer than three antenatal visits and drinking on five or more days per week during pregnancy. After controlling for potential confounders, mothers presenting with a probing depth ≥ 4 mm on four teeth (OR = 4.12; 95°/o Cl = 1. 78 - 9.50) or more than four teeth (OR = 4.95; 95%> Cl: 1.52 - 15.81) were found to be significantly more likely to have low birth weight babies. CONCLUSIONS : The study findings suggest that there is a significant dose-dependent positive association between periodontal disease and low birth weight, independent of other risk factors measured in this study.
Mineralized tissues and the orofacial region: Morphology, composition and disease
(University of Pretoria, 2005-10-07) Lichthelm, A.J.; upetd@up.ac.za; Raubenheimer, Erich Johann
Please read the abstract in the section 00front of this document
Pathology of the head and neck : a retrospective appraisal
(University of Pretoria, 2005-10-07) Lichthelm, A.J.; upetd@up.ac.za; Van Heerden, Willem Francois Petrus
Please read the abstract in the section 00front of this document

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