ABSTRACT Background Children with special healthcare needs (CSHCN) experience higher unmet dental treatment needs than their healthy peers (NSHCN). Aim We compared dental treatment received by CSHCN and NSHCN at academic dental hospitals in South Africa (SA). Design Clinical records of 1‐16‐year‐old children who had dental treatment under general anaesthetic (GA) between 2017 and 2023 were reviewed. Descriptive analyses were performed, and the Chi‐square/Fisher's exact test used to analyse the categorical variables. Results Four hundred records (CSHCN: 116 [29%] and NSHCN: 284 [71%]) were analysed. The median age at assessment was 5 years (IQR: 3–6.5). CSHCN were older than NSHCN, ( p < 0.001). More CSHCN (52.6%) than NSHCN (25.4%) were referred from primary health centres, ( p < 0.001). Caries was the main dental diagnosis. Multiple extractions were done in 54.7% of CSHCN < 6 years and 52.8% of 6‐11‐year‐old NSHCN. Restorative treatment was performed in 26.1% of 6–11‐year‐old CSHCN and 27.2% of NSHCN < 6 years. Conclusions Most of the CSHCN and NSHCN who needed GA were young with extensive caries. Treatment provided to both groups was primarily extractions, perhaps due to late presentation and limited resources. Timely preventative strategies for children at risk of caries could enhance oral health and reduce the burden of GA in SA.
Cleft lip and palate (CLP), one of the most common congenital anomalies of the craniofacial complex, has a worldwide prevalence rate of 1 in 700 live births. In South Africa, a middle-income country, the CLP prevalence rate is 0.3 per 1000 live births in the public health sector. The complexity of the condition requires that individuals with CLP be treated by a multi-disciplinary team of health professionals, with the integral involvement of caregivers and families.Between 2015 and 2018, we conducted a cross-sectional study entitled: The epidemiology and care of individuals with cleft lip and palate in South Africa, in fulfilment of a Doctor of Philosophy degree. The study setting consisted of 11 specialized academic centres (nine central hospitals and two specialized dental hospitals) that are situated in six of South Africa's nine provinces. The study used a combination of quantitative and qualitative methods and consisted of four distinct but inter-linked components. The first component consisted of a record review of CLP data over a 2-year period to determine the prevalence of CLP in the public sector of South Africa. The second component consisted of a survey of the leaders or heads of the health care teams in the 11 specialized centres to determine the current approach to CLP care provision. The third component consisted of a survey among CLP team members to measure inter-professional collaboration. The fourth component consisted of interviews with parents or caregivers on their perceptions of health service provision and support for children with CLP.We draw on the findings of this large empirical study on CLP in South Africa's public health sector and the theory and principles of health care service coproduction to present the Ekhaya Lethu model for the management of CLP.The conceptual design of Ekhaya Lethu derives from the findings of each of the study components. We describe the possible application of the model in the coproduction of health care to examine the roles, relationships and aims of the multidisciplinary team in CLP management. We highlight both the implications and challenges of coproduction in the care and management of CLP for multidisciplinary health teams, the caregivers and families of individuals with CLP, and for health managers and policy makers.The proposed Ekhaya Lethu model introduces a discourse on coproduction in the design and implementation of quality health care to individuals with CLP in South Africa and other low-and middle-income countries.
One of the many factors inherent in a good occlusion is the balanced proportionality in the sizes of the upper and lower teeth. Disproportion in the size of individual teeth may result in a malocclusion related to this discrepancy. It is therefore important in diagnosis and treatment planning to determine the amount and location of any tooth-size discrepancies that may exist. Bolton in 1958 developed two equations to calculate the mesio-distal crown size ratios between permanent maxillary and mandibular teeth. Bolton's anterior and overall ratios were 77.2% (SD +/- 1.65) and 91.3% (SD +/- 1.91) respectively. These ratios were used to identify areas of space deficiency or excess in the maxillary and mandibular arches. Individual teeth may differ in size in relation to gender and population groups; Blacks, for example, having generally larger teeth than Caucasians. The purpose of this study was to obtain measurements from a sample of Black South Africans and to compare the ratios derived from these when using the method described by Bolton, with those measurements that were obtained in Bolton's study of 55 Caucasian subjects having ideal occlusion. One hundred study models with excellent occlusion, were selected from the archives of patient records of the Department of Orthodontics, Medunsa Oral Health Centre, University of Limpopo. An equal number of males and females were selected. The anterior and overall tooth-width ratios were calculated from the data of this sample. The ratios obtained for the male and female groups did not differ significantly, although the teeth of males were significantly larger than those of the females. The anterior ratio was found to be 77.26% (SD +/- 2.65), equivalent to Bolton's anterior ratio of 77.2% (SD +/- 1.65), whereas the overall ratio was 92.31% (SD +/- 2), significantly larger than Bolton's overall ratio of 91.3% (SD +/- 1.91). The results indicate that the anterior ratio may be particularly useful when assessing and planning aesthetic alignment of the anterior segment. The overall ratio may be considered less clinically significant and its use in orthodontic treatment planning may require further investigation using the peer assessment rating.
HIV / AIDS is a global public health concern with more than 30 million deaths having been reported. Over 70% of the 35 million people with HIV / AIDS live in sub‐ S aharan A frica. The current available antiretroviral treatments are limited because they do not cure but slow the progression of disease. Therefore, care and treatment for HIV / AIDS and its related research, especially in HIV ‐preventive vaccine trials, require stringent ethical guidelines because of the vulnerability of the affected individuals as it with all clinical trials. These guidelines should incorporate the basic principles in ethics which include autonomy of individuals, beneficence, non‐malfeasance and justice in the care and participation of individuals in research. With at least one in five African adults infected with the disease living in sub‐ S aharan A frica, this review will discuss the current ethical issues in HIV care and HIV research based on the S outh A frican context as well as exploring some of the issues globally.
Objective The study was conducted to determine the epidemiology and clinical profile of individuals with cleft lip and/or palate (CLP) utilizing specialized academic treatment centres in South Africa's public health sector. Materials and methods The Human Research Ethics Committee of the University of the Witwatersrand in Johannesburg provided ethical approval for the study. We conducted a retrospective record review of all cases of CLP treated at the specialised academic centres for the two-year period from 1 January 2013 until 31 December 2014. We used a structured, pre-tested record review form to obtain demographic, clinical and treatment information on each CLP case. We used Stata 13 to analyse the data and conducted statistical tests at 5% significance level. Results We analysed 699 records of individuals with CLP. The estimated prevalence of CLP in the South African public health sector was 0.3 per 1000 live births, with provincial variation of 0.1/1000 to 1.2/1000. The distribution of clefts was: 35.3% cleft palate; 34.6% cleft lip and palate; 19.0% cleft lip and other cleft anomalies at 2%. Of the total number of CLP, 47.5% were male and 52.5% female, and this difference was statistically significant (p<0.001). The majority of clefts occurred on the left for males (35.5%) and palate for females (43.4%), with a male predominance of unilateral cleft lip and palate (53.3%). Conclusion The study findings should inform the implementation of South Africa's planned birth defect surveillance system and health service planning for individuals with CLP.
Introduction: Evaluation of facial proportions and shape is one of the most important steps in determining treatment options and outcomes for the orthodontist and maxillo-facial surgeon. Balancing the position of the lips in relation to the nose and chin has a direct relationship with the patient's aesthetic preference.
Objectives: The purpose of this study was to analyse the soft tissue profile preferences in a sample of South African Blacks and to establish a Index for bimaxillary protrusion.
Methods: An earlier study by Beukes, Dawjee and Hlongwa was undertaken to determine facial profile perceptions by a group of South African Black evaluators. Adjudicators were drawn from Black students from Medunsa campus, University of Limpopo, the Holy Trinity secondary school and the Mphwe secondary school, and had to evaluate silhouetted facial profiles of 30 bimaxillary dento-alveolar protrusive patients. After an initial group of 128 Black evaluator chose 13 profiles as the most attractive and most unattractive, a second group of 605 Black evaluators (also drawn from the same academic institutions) chose three profiles as acceptable and four profiles as unacceptable. From this final selection, a soft tissue analysis was undertaken to evaluate the nasolabial angle, nasofacial angle, the facial contour angle, the lower lip-chin-throat angle and the lower and upper lip prominence in relation to the Burstone B- line. A Fisher exact test was done to determine the statistical difference between the mean values for the acceptable and unacceptable profiles.
Results: The three acceptable profiles, which were chosen by more than 69% of the evaluators, had a lip prominence of 5 to 6mm more than their African American counterparts. The angular measurements of the nose, lip and chin were in close proximity to the values given by Naidoo and Miles and Flynn et al. The three acceptable profiles had normal overjet, overbite, minimal incisor visibility and efficient lip function.
Conclusion: A Profile index for bimaxillary protrusion has been concluded from this study and proposes acceptable soft tissue values for bimaxillary protrusive Black South Africans.
A thesis completed by published work
Submitted to the School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of
Doctor of Philosophy
Johannesburg, South Africa
2019
One of the many factors inherent in a good occlusion is the balanced proportionality in the sizes of the upper and lower teeth. Disproportion in the size of individual teeth may result in a malocclusion related to this discrepancy. It is therefore important in diagnosis and treatment planning to determine the amount and location of any tooth-size discrepancies that may exist. Bolton in 1958 developed two equations to calculate the mesio-distal crown size ratios between permanent maxillary and mandibular teeth. Bolton's anterior and overall ratios were 77.2% (SD ± 1.65) and 91.3% (SD ± 1.91) respectively. These ratios were used to identify areas of space deficiency or excess in the maxillary and mandibular arches. Individual teeth may differ in size in relation to gender and population groups; Blacks, for example, having generally larger teeth than Caucasians. The purpose of this study was to obtain measurements from a sample of Black South Africans and to compare the ratios derived from these when using the method described by Bolton, with those measurements that were obtained in Bolton's study of 55 Caucasian subjects having ideal occlusion. One hundred study models with excellent occlusion, were selected from the archives of patient records of the Department of Orthodontics, Medunsa Oral Health Centre, University of Limpopo. An equal number of males and females were selected. The anterior and overall tooth-width ratios were calculated from the data of this sample. The ratios obtained for the male and female groups did not differ significantly, although the teeth of males were significantly larger than those of the females. The anterior ratio was found to be 77.26% (SD ± 2.65), equivalent to Bolton's anterior ratio of 77.2% (SD ± 1.65), whereas the overall ratio was 92.31% (SD ± 2), significantly larger than Bolton's overall ratio of 91.3% (SD ± 1.91). The results indicate that the anterior ratio may be particularly useful when assessing and planning aesthetic alignment of the anterior segment. The overall ratio may be considered less clinically significant and its use in orthodontic treatment planning may require further investigation using the peer assessment rating.
Introduction: oral diseases (OD), common dental caries and periodontitis are a major public health problem. Poor oral hygiene has been associated with OD, causing tooth loss, which leads to disability and compromised patients' oral health. In Rwanda, OD is among the leading causes of morbidity at the health center level. Therefore, the purpose of this study was to assess the knowledge, attitude, and oral health practices among adult participants in Rwanda.
Orthodontic bracket adhesion involves multistep procedures which are technique sensitive to various factors within the oral environment. RelyX Unicem is a restorative/prosthodontic adhesive material which by virtue of its one step adhesion procedure may prove to be suitable for efficient orthodontic bonding. The objective of this study was to compare the SBS of RelyX Unicem with six other known orthodontic bonding materials. Seventy extracted human premolar teeth were divided into seven groups of 10 teeth each. On each group, metal orthodontic brackets were bonded using one of the seven bonding materials: (A) Transbond XT primer and Transbond XT luting cement (B) F2000 compomer primer/adhesive (C) Transbond Plus and Transbond XT luting cement (D) RelyX Unicem (E) Prime & Bond NT and Calibra cement (F) Xeno III and Calibra cement (G) NRC + Prime & Bond NT and Calibra cement. Shear bond strength evaluation of each tooth was tested and recorded using the Instron materials testing machine. The results show that the mean SBS for RelyX Unicem is 5.38 MPa and NRC is 4.70 MPa which rates weak compared to all the other materials where the means for the SBS are within the acceptable range of 5.9 to 7.8 MPa. It appears that by reducing the number steps followed for orthodontic bracket adhesion, the SBS of the orthodontic adhesive materials becomes significantly compromised to the extent where such materials can be rejected as suitable for orthodontic bracket adhesion. RelyX Unicem and NRC were found to be unsuitable for orthodontic bracket adhesion.
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