*School of Oral Health Sciences (ETDs)

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Caries prevalence amongst pre-school children in Windhoek, Namibia
(2020) Aluteni, Moses
Background: Early Childhood Caries (ECC) has been recognised as a disease of serious consequences in both industrialised as well as undeveloped nations of the world. Its widespread prevalence among children makes it ideal for assessing the risk factors and identifying specific strategies that could be implemented to prevent the disease. Aim: The aim of the present study was to determine the prevalence of dental caries and its untreated consequences among 2-6-year-old preschool children in Windhoek, Namibia. Objectives: The objectives were; (i)To determine the prevalence of caries amongst 2-6-year-old children attending selected crèches in Windhoek, Namibia. (ii)To assess the clinical consequences of untreated tooth decay amongst 2-6-year-old children attending selected crèches in Windhoek using the pufa index.(iii) To investigate the strength of correlation between the dmft and pufa indices amongst 2-6years-old children attending selected creches in Windhoek, Namibia. (iv)To evaluate the correlation between oral hygiene practices and early childhood caries amongst 2-6-year-oldchildren attending selected crèches in Windhoek, Namibia. Methods: The study design used was cross-sectional and descriptive. A random sample was used to select children between the age group of 2-6 years attending selected creches represented within the 9 urban constituencies of Windhoek, Namibia. The sample size comprised 250children whose parents had consented to be part of the study. Data was collected by means of a dental clinical examination which focused on the diagnosis of dental caries using a World health organization (WHO) criteria for caries through the dmft and pufa indices. The dental examination was conducted at the respective crèches of the participants. An accompanying complementary oral health questionnaire was completed by the parents/care givers of the participants prior to the clinical dental examination and data was collated accordingly. The examinations were done by a single examiner and the examiner was calibrated by a team from the Department of Community Dentistry at the Wits Oral Health Sciences School. Ten percent of each examination sample was randomly selected and re-examined as a means of ensuring intra examiner reliability and consistent clinical judgment. Results: The caries and pufa prevalence amongst the study cohort was established at 55.77% and 6.54% respectively. The mean age of the children was 4.7 years, the mean dmft index score was 2.38 and the mean pufa score was 0.11. There was an increase in caries prevalence from 30.77% amongst the 2-year-old children to 66.67% amongst the 6-year-old children thus indicating an increase in caries prevalence with increasing age in both girls and boys. Conclusion: The caries and pufa prevalence of 55.77% and 6.54% for pre-school children of Windhoek is high compared to similar studies from other countries and it was directly proportional to increasing age
A 5 year review of paediatric maxillofacial & oral surgery procedures performed at the Wits oral health centre
(2021) Vally, M.
Aim: To review paediatric maxillofacial and oral surgery procedures performed at the Wits Oral Health Centre (WOHC) over a 5-year-period. Materials and Methods: This was a retrospective record review study at WOHC, University of the Witwatersrand, Johannesburg. Records of paediatric patients who had treatment from 2013 to 2017 were included in the study. Data collected included the age of patients, gender, distribution of scope and type of treatment. Data was analysed and results presented as frequencies and percentages. Results: A total of 694 paediatric patients presented for treatment during the study period. There were more males (54.2%) than females (45.8%), and the majority of patients were in the 11-17-year age category. Oral surgery, treatment of pathoses and management of trauma were the most common procedures at 34%, 29% and 20.5% respectively. There was a statistically significant difference between the number of surgical procedures carried out under general anaesthetic and that under local anaesthetic (p < 0.001). The removal of third molars was more common than other oral surgical procedures. A high occurrence of paediatric trauma was observed in males aged between 11-17 years. Mandibular fractures, followed by dentoalveolar fractures, were the most common fracture types. The most commonly diagnosed pathological conditions were odontogenic cysts (23.15%), benign odontogenic tumours (22.31%) and fibro-osseous lesions (19.02%). Mucous extravasation cyst was the most common salivary gland pathology. Conclusion: Most oral and maxillofacial surgical procedures in paediatric patients are performed in the 11-17-year category. The removal of impacted 3 rd molars was the most common surgical procedure and the management of ameloblastomas appears to be the most common odontogenic tumour in this age group. Future studies are required to provide insight into the reasons, patterns and distribution of paediatric maxillofacial surgery. Results from such studies, especially prospective ones, will form the basis for design of educational campaigns and preventive strategies aimed particularly at the 11-17-year age group
Correlation of maternal age to their children born with orofacial cleft treated at Wits Oral Health Centre
(2024) Ravat, Naseeba
Objectives: Orofacial Clefts (OFC) are the most common congenital malformations of the craniofacial complex. OFC affects 1/700 live births globally with extensive variability across geographic origin, racial and ethnic populations. In South Africa the prevalence of OFC is 0.3 per 1000 live births. Advanced maternal age has been associated with cell division errors, that can predispose to the occurrence of OFC. This study evaluated the correlation of advanced maternal age with the occurrence of OFC and the types of OFC. Methods: A retrospective cross-sectional study was conducted to review records of 105 children with OFC from 1 January 2013 to 31 December 2019. The clinical information reviewed included the child’s sex, race and type and laterality of OFC. The mother’s demographic information including the age at birth to the child with OFC, race, marital status, education level, number of children that the mother gave birth to as well as the familial history of OFC was documented. Stata version 17.0 was used to analyse the data and statistical tests were conducted at a 5% significance level. Results: The mean maternal age at the birth of a child with OFC was 26 years, with a range of 17-46 years. The majority of the mothers were Black (64.76%) followed by White (14.29%), Indian (11.43%) and Coloured (9.52%). There were more female children with OFC (51.43%) compared to male children (48.57%). Most of the children were Black (63.81%) followed by White (12.38%), Indian (11.43%) and Coloured (10.48%). The predominant type of OFC was the unilateral cleft lip and palate (CLP) occurring on the left side of the face (39.05%) compared to the right side (23.81%). Bilateral CLP was observed in 28.67% of children, and 0.57% of children had a cleft palate only. Mothers who gave birth to children with right CLP were older (over 30 years old) compared to those who gave birth to children with left CLP (under 25 years old). No statistical significance was found between maternal age and OFC. Conclusions- The clinical appearance of OFC highlighted the maternal age differences to type of OFC in our study sample. Children with right CLP were born to older mothers whilst the youngest mothers had children with CP. The majority of the mothers were unemployed, single parents with low level of education. This signified the burden of care these single parents have in caring for their children with OFC.
A comparison between bone grafting and non-grafting of immediately placed implants in the molar area
(2024) Van der Linden, Wynand Johan
Aim: This study aims to investigate the outcome of placing a bone graft material into the residual socket space of a fresh molar extraction socket, treated flapless after an implant has been placed compared with a control group at three months. Methodology: This prospective, randomized, control, double-blind clinical trial will evaluate the difference in ridge width between a control and intervention (grafting) group at baseline and three months postoperatively. All cases were evaluated using pre-operative (T0) and three months postoperative (T1) impression models. Horizontal measurements were taken at 3 levels (2, 4, and 6mm). Vertical point measurements were done at 3 points (A, B, and, C) and compared between the two groups. Results: The study consisted of 22 participants, 11 in the control and 11 in the grafting group with a mean age of 49.5 years. Majority of the cases presented in the mandible (64%) with one case of implant failure. Bone loss was perceived to be greater in the control group after 3 months compared to the loss observed in the grafting group. The difference in the loss of ridge width between the control and grafting groups was insignificant (p-value>0.05). Conclusion: The difference in the loss of ridge width between the control and grafting group was insignificant (p-value>0.05), owing to the study’s small sample size. Less bone resorption was observed in the grafting group at 3 months post– implant placement, however, the long-term follow-up would be required to determine the effectiveness of the bone graft. Further studies with larger population samples and increased follow-up time (6 months, 12 months, and 24 months) should be considered to determine the long-term benefit of bone grafting done simultaneously with tooth extraction and immediate implant placement.
Retention force and fatigue strength of mandibular singleimplant overdenture attachment systems
(2024) Van der Linde, Schalk Jacobus
Purpose- A single mandibular implant-retained overdenture is now recognised as a viable alternative to the more conventional two implant-retained overdenture. Historically, ball abutments and high performance synthetic polymers for the matrix have been used as the attachment system, but regular prosthetic maintenance can be a significant drawback. This in-vitro study aimed at determining the mechanical properties of a novel prototype matrix designed with ease of replacement in mind to reduce the prosthetic maintenance burden. Method- Custom test bases with a simple holding device were made, to enable tensile and fatigue testing for the experimental prototype (OBZ abutment and a polyetheretherketone (PEEK) matrix) and control attachment system (OT-Equator® abutment with standard nylon matrix). Each assembled sample was subjected to 10 tensile pull tests to determine initial retention values. For fatigue testing samples were immersed in saline after which they were manually pulled apart and re-seated, whilst being re-immersed in the saline after a designated number of cycles. Tensile test values were measured until a pre-determined retention force value of 20 N was reached, representing clinical failure. Volunteers (five clinicians/technicians and five non-trained individuals) were recruited to replace both attachment systems, and the replacement time taken, and perceived ease of replacement were recorded for each participant. Results- The prototype PEEK matrix system was significantly more retentive (p < 000.1) than the control system after initial tensile testing. Simulated fatigue testing following saline immersion revealed no significant difference (p > 0.05) after 100 cycles; saline immersion reduced the values in both attachment systems. There was no significant difference (p > 0.05) in mean retention force value at point of failure, but there was, however, a significant difference (p < 0.05) in failure point between the two attachment systems, with the OBZ abutment with prototype PEEK matrix failing much earlier. Participants found replacement of the prototype PEEK matrix significantly easier, regardless of their level of experience. Conclusion- For a mandibular single implant-retained overdenture the clinically acceptable retention values of the OBZ abutment with prototype PEEK matrix, together with its ease of replacement, mean that it can be considered a viable alternative to the current OT-Equator® abutment with standard retention nylon matrix.
Factors associated with hospitalization outcomes in patients with orofacial sepsis
(2024) Scheepers, Ruan
Background: Orofacial infection is an easily preventable disease which if left untreated may spread to the deep neck spaces, resulting in life-threatening complications. The purpose of this study was to review the clinical features of patients admitted with orofacial infections in patients presenting to Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH). The objective was to identify anatomical, patient and hospital- level factors that influence the clinical outcome of orofacial infections. Methods: This was a prospective cross-sectional study performed in the Department of Maxillofacial and Oral Surgery at CMJAH and CHBAH over a 12-month period. All patients over the age of 18, admitted with the diagnosis of orofacial infections were included in the study. Data were collected at admission and during the course of patient stay in hospital. The data were categorised as demographic, health status, clinical presentation at admission, special investigations performed, anatomical and treatment variables. A multivariable linear regression analysis was used to examine the association between hospital stay (outcome variable) and the predictor variables. Comorbid bivariate conditions were tested using simple linear regression analysis and were included in the final multivariable linear regression model. A Spearman‘s correlation coefficient was calculated to determine the strength of association between length of stay and comorbidity burden, fascial space involvement and individual comorbidities. Results: A total of 152 patients were eligible for inclusion in the study. Fifty-seven-point 2 percent (57.2%) were male, mean patient age was 35±12.8 years, 13.8% were HIV positive and 9.9% of patients were diabetic. Furthermore, 75% of patients had multiple facial spaces involved in the infection, with trismus being the most prevalent presenting clinical finding (80.9%). Hospital outcome and duration of hospital stay was correlated with C-reactive protein (CRP) level, white blood cell count (WBC), comorbid conditions such as hypertension, diabetes mellitus (DM) and metastatic cancer, multiple-fascial spaces involved and clinical signs such as third molar iv involvement and dysphagia at admission. Conclusions: Orofacial infections involving 3rd molars and multiple fascial spaces should be treated aggressively to enhance clinical outcomes, in particular those presenting with comorbidities such as diabetes. Future prospective studies, involving larger sample sizes, are recommended to further substantiate and provide statistical support for the role of cost-effective biological factorssuch as CRP and comorbiditiesin predicting clinical outcomes and length ofstay for patients with orofacial sepsis.
The prevalence of malocclusion and orthodontic treatment needs of patients treated by students at Wits Oral Health Centre
(2024) Rawat, Ameera
Objectives: To assess the prevalence of malocclusion and orthodontic treatment needs of patients treated by undergraduate students at Wits Oral Health Centre. Materials and Methods: 124 pre-treatment orthodontic study models were reviewed. The Angle’s classification was used to classify malocclusion and the Dental Aesthetic Index (DAI) scores categorised the severity of malocclusion and orthodontic treatment needs. The prevalence of malocclusion was determined by the percentage of patients in the sample who were categorised by DAI as definitive, severe and handicapping malocclusion. Stata version 16 was used to analyse the data and statistical tests were conducted at 5% significance level. Results: The prevalence of malocclusion was estimated to be 92.74%. The mean DAI score was 39.54, ranging from 23 to 94. Handicapping malocclusion requiring mandatory treatment presented in 60.48% of the sample. Severe and definite malocclusion presented in 19.35% and 12.9% of the sample respectively, indicating a need for treatment. Minor malocclusion requiring minimal or no orthodontic treatment was in 7.26%. Angle’s classification showed that most of the study sample (n=101; 81.45%) had a Class I malocclusion, followed by Class III (n=12; 9.68%) and Class II (n=11; 8.87%). There were no statistically significant differences between the DAI scores and the Angle’s classification of malocclusion, p=0.9. Conclusion: Angle’s classification and the DAI scores showed that all patients in the study sample presented with malocclusion. However, 92.74% of the sample was deemed requiring orthodontic treatment by the DAI.
Retrospective analysis of pan-facial fractures at Wits Oral Health Centre
(2024) Gumede, Ntokozo Bhekisisa
Aim: This study aimed to retrospectively analyse the characteristics and treatment outcome of pan-facial fractures over five years at Wits Oral Health Centre. Materials and methods: We designed and implemented a retrospective study composed of patients with pan-facial fractures treated at Wits Oral Health Centre. All records from January 2015 to December 2019 were analysed. Primary predictor was pan-facial fracture. Aetiology, location, type and distribution of pan-facial fractures were recorded. Perioperative variables included in the study were patient demographics, comorbidities, associated injuries and treatment outcomes. Results: A total of 34 patients (32 M, 2 F) were included in the study. The mean age of patients was 36 years. The most common aetiology was assault (n=17) followed by road traffic accidents (n=12). Traumatic brain injury was the most common associated injury. All 34 patients had involvement of upper and lower midface fractures. 52 mandibular fractures were recorded in 34 patients. Only two of the 34 patients (6%) had complications. Conclusion: Timing and stepwise management of pan-facial fractures in conjunction with neurosurgical team, focused on restoration of function and facial form, is required for optimal results.

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