Research Articles (Periodontics and Oral Medicine)

Permanent URI for this collectionhttp://hdl.handle.net/2263/49423

Browse

Now showing 1 - 20 of 52

The impact of Filifactor alocis on the severity of periodontitis among diabetic and non-diabetic patients : a narrative review
(Frontiers Media, 2024-05) Manenzhe, Shumani Charlotte; Koutras, Sandra; Zwane, Nompumelelo Benedicta; Masilana, Aubrey I.; Shangase, Sindisiwe Londiwe; sc.manenzhe@up.ac.za
The extensive studies on Filifactor alocis (Fa) show a positive association with periodontitis, demonstrating elevated Fa levels compared to traditional periodontal pathogens in severe disease. Periodontitis is a chronic multifactorial disease induced by a dysbiotic microbiota in a susceptible host whilst diabetes is an established risk factor for periodontitis. Diabetes has been shown to alter the subgingival microbiota into distinct microbial communities which favours the shift towards disease. It is these very distinct subgingival microbiota that are believed to contribute to the high prevalence and severity of periodontitis in diabetic patients. This dysbiotic microbiota constitute traditional periodontal pathogens which include among others the red complex triad (Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia), Aggregatibacter actinomycetemcomitans, the orange complex (Fusobacterium nucleatum, Prevotella intermedia etc.) and other emerging pathogens such as Fa that were previously unrecognised as role players in the pathogenesis of periodontitis. Fa is an asaccharolytic anaerobic gram-positive rod (AAGPR) currently considered to be one of the potential drivers of periodontitis progression and worsening through its unique virulence characteristics. Various mechanisms through which Fa contributes to the pathogenesis and severity of periodontitis have been reported. The mechanisms involved in the bidirectional relationship between periodontitis and diabetes are continuously being explored in order to enhance individualised preventative and management approaches in affected patients. This review aims to report on this emerging periodontal pathogen and its capacity to influence dysbiosis within a complex subgingival microbial community; including its potential role in the bidirectional relationship between diabetes and periodontitis. This review will highlight Fa as a potential prognostic indicator for disease worsening, which will help improve management protocols for periodontitis and diabetes.
Micro-XCT analysis of anatomical features and dimensions of the incisive canal : implications for dental implant treatment in the anterior maxilla
(BMC, 2024-10) Todorovic, Vladimir S.; Beetge, Mia-Michaela; Kleyn, Judy; Hoffman, Jakobus; Van Zyl, Andre W.
BACKGROUND: This study used micro-focus X-ray Computed Tomography (micro-XCT) to examine the anatomical differences and dimensions of the maxillary incisive canal (MIC) in a South African population. The accurate imaging yielded dependable results that support earlier research and enhance anterior maxilla surgery planning. Furthermore, these anatomical features are compared between various racial and gender groupings in the study. METHODS: Using a micro-XCT scanner, 108 human cadaver skulls from the Pretoria Bone Collection were scanned and included in the study. Advanced volume rendering software was employed for measuring the MIC length, diameter, shape, and the buccal bone wall measurements in relation to the MIC. RESULTS: Significant anatomical variation in the size and shape of the MIC was identified in the population, with variations seen between racial and gender groups. The incisive foramen (ICO) mean diameter was 6.61 mm, and the MIC length varied from 4.96 to 20.10 mm. There were significant differences in the buccal alveolar bone height between different ethnic groups and gender. Regarding morphological patterns in coronal and sagittal views, single canals were more common in the black population while Y-shaped canals were more common in the white population. The study also introduced a new metric by measuring the mean distances between teeth #11 and #21 and the ICO (1.83 mm and 1.88 mm respectively). CONCLUSIONS: The complex anatomical differences of the MIC in a South African population were clarified. Clinicians should be aware of tooth sockets in near proximity to the MIC and perform accurate preoperative assessment using sophisticated 3-D imaging and preferable guided implant placement in the anterior maxilla.
Exploring the association between erythema multiforme and HIV infection : some mechanisms and implications
(BMC, 2024-04) Manenzhe, Shumani Charlotte; Khammissa, Razia Abdool Gafaar; Shangase, Sindisiwe Londiwe; Beetge, Mia-Michaela; razia.khammissa@up.ac.za
Erythema multiforme (EM) is an immune-mediated mucocutaneous condition characterized by hypersensitivity reactions to antigenic stimuli from infectious agents and certain drugs. The most commonly implicated infectious agents associated with EM include herpes simplex virus (HSV) and Mycoplasma pneumoniae. Other infectious diseases reported to trigger EM include human immunodeficiency virus (HIV) infection and several opportunistic infections. However, studies focusing on EM and human immunodeficiency virus (HIV) infection are scarce. even though the incidence of EM among HIV-infected individuals have increased, the direct and indirect mechanisms that predispose HIV-infected individuals to EM are not well understood. In turn, this makes diagnosing and managing EM in HIV-infected individuals an overwhelming task. Individuals with HIV infection are prone to acquiring microorganisms known to trigger EM, such as HSV, Mycobacterium tuberculosis, Treponema pallidum, histoplasmosis, and many other infectious organisms. Although HIV is known to infect CD4+T cells, it can also directly bind to the epithelial cells of the oral and genital mucosa, leading to a dysregulated response by CD8+T cells against epithelial cells. HIV infection may also trigger EM directly when CD8+T cells recognize viral particles on epithelial cells due to the hyperactivation of CD8+T-cells. The hyperactivation of CD8+T cells was similar to that observed in drug hypersensitivity reactions. Hence, the relationship between antiretroviral drugs and EM has been well established. This includes the administration of other drugs to HIV-infected individuals to manage opportunistic infections. Thus, multiple triggers may be present simultaneously in HIV-infected individuals. This article highlights the potential direct and indirect role that HIV infection may play in the development of EM and the clinical dilemma that arises in the management of HIV-infected patients with this condition. These patients may require additional medications to manage opportunistic infections, many of which can also trigger hypersensitivity reactions leading to EM.
Situational awareness in the context of clinical practice
(MDPI, 2023-12-04) Feller, Shani; Feller, Liviu; Bhayat, Ahmed; Feller, Gal; Khammissa, Razia Abdool Gafaar; Vally, Zunaid Ismail
In the context of clinical practice, situational awareness refers to conscious awareness (knowledge), which is a mental model of a given clinical situation in terms of its elements and the significance of their interrelation. Situational awareness (SA) facilitates clinical reasoning, diagnostic accuracy, and appropriate goal-directed performance, and it enables clinicians to immediately adapt treatment strategies in response to changes in clinical situational actualities and to modify the course of goal-directed activities accordingly. It also helps clinicians prepare future operational plans and procedures based on the projection of situational developments. SA, therefore, is an important prerequisite for safe clinical procedures. The purpose of this narrative review is to highlight certain cognitive and external (environmental) situational factors that influence the development of situational awareness. Understanding the dynamic, adaptive, and complex interactions between these factors may assist clinicians and managers of healthcare systems in developing methods aimed at facilitating the acquisition of accurate clinical situational awareness and, in turn, may bring about a reduction in the incidence of SA, diagnostic, and operational errors.
Tumour genetic heterogeneity in relation to oral squamous cell carcinoma and anti-cancer treatment
(MDPI, 2023-01) Feller, Gal; Khammissa, Razia Abdool Gafaar; Ballyram, Raoul; Beetge, Mia-Michaela; Lemmer, Johan; Feller, Liviu; razia.khammissa@up.ac.za
Oral squamous cell carcinoma (SCC) represents more than 90% of all oral cancers and is the most frequent SCC of the head and neck region. It may affect any oral mucosal subsite but most frequently the tongue, followed by the floor of the mouth. The use of tobacco and betel nut, either smoked or chewed, and abuse of alcohol are the main risk factors for oral SCC. Oral SCC is characterized by considerable genetic heterogeneity and diversity, which together have a significant impact on the biological behaviour, clinical course, and response to treatment and on the generally poor prognosis of this carcinoma. Characterization of spatial and temporal tumour-specific molecular profiles and of person-specific resource availability and environmental and biological selective pressures could assist in personalizing anti-cancer treatment for individual patients, with the aim of improving treatment outcomes. In this narrative review, we discuss some of the events in cancer evolution and the functional significance of driver-mutations in carcinoma-related genes in general and elaborate on mechanisms mediating resistance to anti-cancer treatment.
Buccal and palatal alveolar bone dimensions in the anterior maxilla
(Wiley, 2023-04) Todorovic, Vladimir S.; Postma, Thomas Corne; Hoffman, Jakobus; Van Zyl, Andre W.
OBJECTIVE : Anterior maxillary immediate implant placement has become a popular procedure. It has aesthetic and functional risks. A prerequisite for success is sufficient alveolar bone for primary stability. Many cone-beam computed tomography (CBCT) studies have assessed alveolar bone dimensions in the anterior maxilla, with varying results. More accurate information on the alveolar bone dimensions in the anterior maxilla is required. The objective of the present study was to evaluate bone dimensions in the anterior maxilla using micro-CT, a high-resolution imaging tool. MATERIALS AND METHODS : Seventy-two human skulls were scanned using micro-CT at the South African Nuclear Energy Corporation. Specialized software was used for 3-D rendering, segmentation, and visualization of the reconstructed volume data. Axial planes were created over each alveolus/tooth from canine to canine. Buccal and palatal bone dimensions were measured at crestal, 3 mm, 6 mm, and 9 mm levels. RESULTS : Buccal bone rarely exceeded 0.5 mm, consisting of bundle bone only for all investigated teeth at all levels. Up to a third of teeth showed buccal fenestrations. Alveolar bone on the palatal side was thicker than buccal and increased from <1 mm at crestal level up to 3.77 mm, 4.56 mm, and 5.43 mm for centrals, laterals, and canines at the 9 mm level, respectively. CONCLUSIONS : Immediate implants in the anterior maxillae has anatomical risks. Alveolar bone on the buccal aspect is very thin, with fenestrations in certain positions. Therefore, a thorough planning and individual approach are needed to avoid possible complications and achieve stable aesthetic and functional results in the long-term.
Noma staging : a review
(BMC, 2022-06-13) Khammissa, Razia Abdool Gafaar; Lemmer, Johan; Feller, Liviu; razia.khammissa@up.ac.za
Noma is a bacterial, non-communicable, grossly destructive and disfiguring necrotising oro-facial disease. It is rare, but occurs most commonly in chronically malnourished children with other debilitating illnesses, in remote, povertystricken communities, mainly in sub-Saharan Africa, and much more rarely in central Latin America and in parts of Asia. In South Africa and in Zimbabwe, noma is observed, again rarely, in immunosuppressed HIV-seropositive subjects. The World Health Organization (WHO) has classified noma into five sequential stages: stage 1, acute necrotising ulcerative gingivitis; stage 2, oedema; stage 3, gangrene; stage 4, scarring; stage 5, sequela. In the opinion of the authors, this WHO classification requires fundamental re-appraisal. The purpose of this viewpoint article is to highlight the weaknesses of this classification, and to propose a simpler, more logical and practical evidence-based staging of noma, which if used should improve the quality and value of future epidemiological data about noma.
Is noma a neglected/overlooked tropical disease?
(Oxford University Press, 2022-10) Feller, Liviu; Lemmer, Johan; Khammissa, Razia Abdool Gafaar; razia.khammissa@up.ac.za
Noma is a debilitating orofacial necrotizing bacterial disease that disproportionately affects impoverished mal- nourished persons, particularly young children, the vast majority of whom live in tropical and subtropical areas in sub-Saharan Africa. It has a very high mortality rate; causes significant physical and psychological morbidity, stigmatization and social discrimination; could be prevented, controlled and indeed eliminated by common pub- lic health interventions; and is overlooked with regard to public health awareness, in-depth scientific research activities and allocation of funding for prevention, treatment and research. According to the WHO, noma comprises five sequential ‘stages’: (1) necrotizing gingivitis, (2) edema, (3) gan- grene, (4) scarring and (5) sequelae. This WHO staging of noma is contentious, leading to diagnostic confusion with misestimation of the number of noma cases reported in epidemiological studies. We therefore suggest a simpler, more practical and scientifically valid two-stage classification comprising only (1) acute noma and (2) arrested noma. Noma meets all the WHO criteria for classification as a neglected tropical disease (NTD). Most survivors of noma live with gross physical disfigurement and disability, and with impaired psychosocial functioning, so they are very often stigmatized and unjustifiably discriminated against. Owing to the paucity of evidence-based epidemiologi- cal data on noma, the relatively low number of people affected worldwide, and its apparently limited geographic distribution, noma does not yet feature on the WHO’s list of NTDs, or on any global health agenda, and thus has not become a health priority for global action. We strongly support the inclusion of noma within the WHO list of NTDs. Without doubt this will increase the awareness of noma among healthcare providers and promote the systematic international accumulation and recording of data about noma.
Burnout phenomenon : neurophysiological factors, clinical features, and aspects of management
(Sage, 2022-09) Khammissa, Razia Abdool Gafaar; Nemutandani, Simon; Feller, Gal; Lemmer, Johan; Feller, Liviu; razia.khammissa@up.ac.za
Burnout syndrome is a distinct “occupational phenomenon” rather than a medical condition, comprising emotional exhaustion, physical fatigue, and cognitive weariness. Both exogenous work-related and endogenous personal factors determine the extent and the severity of symptoms in burnout syndrome. Persistent burnout is a cause of reduced quality of life and is associated with increased risk of sleep impairment and with several medical disorders including mild cognitive impairment, diabetes, and cardiovascular disease. Active coping strategies promoting mental resilience and adaptive behavior, stress-reducing activities, improving work conditions, and reducing exposure to work stressors together may alleviate the distress of burnout and should be introduced early in the clinical course of burnout syndrome. The purpose of this review was to explain this complex and puzzling phenomenon and to describe burnout management.
Incidental pathologic findings from orthodontic pretreatment panoramic radiographs
(MDPI, 2023-02) Hlongwa, Phumzile; Moshaoa, Mpule Annah Lerato; Musemwa, Charity; Khammissa, Razia Abdool Gafaar; phumzile.hlongwa@up.ac.za
Panoramic radiography is frequently performed for new patients, follow-ups and treatment in progress. This enables dental clinicians to detect pathology, view important structures, and assess developing teeth. The objective of the study was to determine prevalence of incidental pathologic findings (IPFs) from orthodontic pretreatment panoramic radiographs at a university dental hospital. A retrospective cross-sectional review was conducted of pretreatment panoramic radiographs, using data collection sheets with predefined criteria. Demographic data and abnormalities (impacted teeth, widening of periodontal ligament, pulp stones, rotated teeth, missing teeth, unerupted teeth, crowding, spacing, supernumerary teeth, and retained deciduous teeth) were reviewed. SPSS 28.0 was used to analyze data with statistical tests set at a 5% significance level. Results: One hundred panoramic radiographs were analyzed with an age range of 7 to 57 years. The prevalence of IPFs was 38%. A total of 47 IPFs were detected with altered tooth morphology predominantly (n = 17). Most IPFs occurred in males (55.3%), with 44.7% in females. A total of 49.2% were in the maxilla and 50.8% in the mandible. This difference was statistically significant (p < 0.0475). Other abnormalities were detected in 76% of panoramic radiographs; 33 with IPFs and 43 without. A total of 134 other abnormalities detected showed predominantly impacted teeth (n = 49). Most of these abnormalities were in females (n = 77). Conclusions: The prevalence of IPFs was 38%, predominated by altered tooth morphology, idiopathic osteosclerosis, and periapical inflammatory lesions. Detection of IPFs from panoramic radiographs underscored the importance for clinicians to examine them for comprehensive diagnosis and treatment planning, especially in orthodontics.
Noma : a neglected oro-facial childhood disease
(Elsevier, 2021-10) Khammissa, Razia Abdool Gafaar; Lemmer, Johan; Feller, Liviu; razia.khammissa@up.ac.za
WHO's World Health Assembly 2021 has recognised the impact of certain oral diseases on general health, and consequently the need to incorporate oral health strategies into universal health care, particularly for remote poor rural communities. Noma is an opportunistic, necrotising oro-facial childhood disease prevalent particularly in remote poor rural areas of sub-Saharan Africa, causing gross oral and facial mutilation, and terrible facial disfigurement, requiring complex plastic surgical reconstruction.
The interrelation between aerobic exercise, mental well-being, stress response and epigenetics
(Open Access Text, 2021-08) Feller, Liviu; Nemutandani, S.M.; Feller, Gal; Jose, R.J.; Lemmer, Johan; Khammissa, Razia Abdool Gafaar; razia.khammissa@up.ac.za
Mental well-being is a subjective, adaptive state of mind arising from complex dynamic interactions between cognitive, emotional and psychosocial factors. Positive mental well-being may promote good physical health, occupational functioning and academic achievement. In the moderate-to-vigorous intensity of aerobic range, regular cardiorespiratory exercise of sufficient duration and frequency has the capacity to boost resources of mental energy, to improve sleep, mental alertness and social interactions, to buffer maladaptive upregulated emotional responses to psychosocial stressors, to decrease anxiety, to moderate depressive symptoms and to support or even improve cognitive functioning. Epigenetic modification is a biological mechanism by which environmental factors influence cellular phenotype and function. Psychosocial stressors, and regular performance of aerobic exercise have opposite effects on the central nervous system, mediated at least in part through epigenetic modifications that reprogram the expression of relevant genes. Generally, physically active persons are more resilient to stress and experience fewer depressive symptoms than do physically inactive persons; and, indeed, regular moderate to strenuous aerobic activity has a mood-enhancing effect and has been proven to mitigate negative affectivity stress responses. The purpose of this narrative review is to discuss the mechanisms that appear to play a role in aerobic exercise-induced improvement in mental well-being.
Dental students’ self-perceived competency and usage of the internet for learning and evaluation purposes - Part 2
(South African Dental Association, 2020-08) Sykes, Leanne M.; Postma, Thomas Corne; Uys, Andre; Brandt, Paul Dieter; Crafford, Elmine; leanne.sykes@up.ac.za
Many dental lecturers are moving away from providing hand-out notes to their students and are rather opting for posting lecture material and tutorials on the internet using the various university platforms such as clickUP. At the same time a number of students have queried the need to purchase the prescribed text books due to their high costs, and dated content. The presumption is that all students have unrestricted and equal access to this material, and are competent using digital technology for learning and assessment, however there has been no formal investigation into whether this is so. Student access and usage was reported on in Part I of this study. The present paper investigated students’ preferences with regards to the mode of learning material, and their self-perceived competencies in using the internet for various academic purposes. The project took the form of an anonymous, structured questionnaire that was given to all dental students from the second to the fifth year of study.
Yes, you can say no
(South African Dental Association, 2020-05) Sykes, Leanne M.; Crafford, Elmine; Fortuin, Alwyn; leanne.sykes@up.ac.za
Quality dental care begins with determining the patient’s understanding of the dental treatment, their expectations, attaining all the diagnostic information and compiling a treatment plan best suited to each individual.1 Once a decision has been made to undertake treatment, the clinician may adopt a paternalistic approach or could lean towards respecting patient autonomy.
The ‘digital access divide’ at a South African dental school – a cross-sectional study - Part 1
(South African Dental Association, 2020-08) Postma, Thomas Corne; Sykes, Leanne M.; Uys, Andre; Brandt, Paul Dieter; Crafford, Elmine; leanne.sykes@up.ac.za
This study sought to investigate the digital divide, from an access perspective, of dental students at the University of Pretoria. Second to final year students (n= 218 (87.2% response rate) completed a custom-designed survey at the end of 2017. The investigation enquired about the digital devices and infra-structure they owned and used for study purposes. They were also asked to reveal the networks and resources they used to access online platforms and to comment on any other related access issues such as the quality of the Internet, speed and reliability, as well as cost and personal implications related to usage. A clear divide could be detected for a minority of students (±1/7). Individually targeted interventions will be required to ensure an equitable and fair online learning experience.
Giant cell lichenoid stomatitis - an oral medicine case book
(South African Dental Association, 2020-11) Robinson, Liam; Kotze, Leande; Van Heerden, Willem Francois Petrus; willie.vanheerden@up.ac.za
A 53-year-old female patient presented with a two-week history of intermittently painful oral mucosal lesions when eating spicy, salty or sour foods. The patient reported a long-term history of psoriasis treated by topical corticosteroids only. The remainder of the patient’s medical history was unremarkable. On intraoral examination, lesions were noted bilaterally in the posterior buccal commissures, appearing as centrally erosive lesions bound by white striations (Figure 1). Additionally, there were areas of desquamative gingivitis in the anterior maxillary gingiva. The clinical suspicion was that of oral lichen planus or oral lichenoid lesions. An incision biopsy from the left buccal mucosa was performed and submitted for histological assessment.
Can an ethical question answered with a “Yes, but...” ever be defensible?
(South African Dental Association, 2020-03) Sykes, Leanne M.; Crafford, Elmine; Bradfield, Charles F.; leanne.sykes@up.ac.za
This paper will use the issue of sterility of medical equipment as an example, but the points discussed may be extrapolated to a number of other areas in the dental setting.
From pandemic, to panic to ‘pendemic’
(South African Dental Association, 2020-04) Sykes, Leanne M.; Crafford, Elmine; Bradfield, Charles F.; leanne.sykes@up.ac.za
Medical doctors and dentists working in private practice are generally faced with the situation of “no work, no pay”. Although most have some form of indemnity cover to ensure they will receive and income if they are injured or incapacitated, this will be of no benefit if they are unable to work due to non-medical conditions, or for other extraneous reasons such as a lack of patients.
Judgment and decision-making in clinical dentistry
(SAGE Publications, 2020) Feller, Liviu; Lemmer, Johan; Nemutandani, Mbulaheni Simon; Ballyram, Raoul; Khammissa, Razia Abdool Gafaar; razia.khammissa@up.ac.za
The development of clinical judgment and decision-making skills is complex, requiring clinicians— whether students, novices, or experienced practitioners—to correlate information from their own experience; from discussions with colleagues; from attending professional meetings, conferences and congresses; and from studying the current literature. Feedback from treated cases will consolidate retention in memory of the complexities and management of past cases, and the conversion of this knowledge base into daily clinical practice. The purpose of this narrative review is to discuss factors related to clinical judgment and decision-making in clinical dentistry and how both narrative, intuitive, evidence-based data-driven information and statistical approaches contribute to the global process of gaining clinical expertise.
Interrelations between pain, stress and executive functioning
(Sage, 2020-08) Feller, Liviu; Feller, Gal; Ballyram, Theona; Chandran, Rakesh; Lemmer, Johan; Khammissa, Razia Abdool Gafaar; razia.khammissa@up.ac.za
AIM: The purpose of this narrative review is to discuss the interrelations between pain, stress and executive functions. IMPLICATIONS FOR PRACTICE : Self-regulation, through executive functioning, exerts control over cognition, emotion and behaviour. The reciprocal neural functional connectivity between the prefrontal cortex and the limbic system allows for the integration of cognitive and emotional neural pathways and then for higher-order psychological processes (reasoning, judgement etc.) to generate goal-directed adaptive behaviours and to regulate responses to psychosocial stressors and pain signals. Impairment in cognitive executive functioning may result in poor regulation of stress-, pain- and emotion-related processing of information. Conversely, adverse emotion, pain and stress impair executive functioning. The characteristic of the feedback and feedforward neural connections (quantity and quality) between the prefrontal cortex and the limbic system determine adaptive behaviour, stress response and pain experience.

Browse

Recent Submissions