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Item Antibiotic prescribing patterns among dentists in the Durban metro region, South Africa(University of the Witwatersrand, Johannesburg, 2024) Rampersad, Yuvti; Premviyasa, VinayagieAntibiotic resistance is a rising global phenomenon which challenges the delivery and efficacy of both simple and complex medical treatments. While the development of resistance is a natural progression for organisms, evidence suggests that there is a correlation between misuse and overuse of antibiotics and the subsequent development of resistant organisms. The aim of this study was to analyze the antibiotic prescribing patterns among dentists in the Durban-metro region. Methods This was a cross-sectional analysis of the antibiotic prescribing patterns among dentists in the Durban metro region, South Africa in 2022.The inclusion criteria adopted in this study were qualified dentists in the Durban metro region who are currently registered with the HPCSA. A sample size of 183 participants was calculated. The survey was sent to dentists on a closed-dental groups of 210 participants. Ninety-one responses to the survey were received. The survey was distributed on Microsoft forms and responses were recorded and captured in excel and exported to Stata for analysis. Results Amoxicillin was the most prescribed antibiotic (48%) while the most common antibiotic prescribed for patients who are allergic to penicillin was Clindamycin (58%). Seventy one out of ninety-one dentists prescribed antibiotics for a 5-day course (78%). The most common reason for prescribing antibiotics was facial swelling 89% (81/91 dentists). More than half of dentists did not report any adverse effects after prescribing an antibiotic to a patient (57%). Seventy-three out of ninety-one dentists believed that dentists are contributing to antibiotic resistance (80%). Of the 80% that believe that dentists are contributing to antibiotic resistance, sixty-five out of ninety-one (71%) stated the most common reason for dentists contributing to antibiotic resistance to be unclear guidelines on antibiotic prescribing. Conclusion Most dentists in the study had a fairly good knowledge on how to prescribe antibiotics. However, a significant number of dentists (62%) incorrectly prescribed antibiotics for irreversible pulpitis. There was an overall good attitude towards antibiotic resistance with more than half of the dentists being aware that dentists are contributing to antibiotic resistance (80%)Item Knowledge, attitudes and practices of patients towards root canal treatment in the Mopani district, Limpopo(University of the Witwatersrand, Johannesburg, 2024) Nkosi, Mokgadi Michille Veronica; Mothopi-Peri, MM; Patel, EThe South African National Oral Health Strategy’ is a document that was drafted and last modified in 2015 by the South African Department of Health and several oral health stakeholders. The authors of the document acknowledge that dental extraction is the primary form of treatment offered in the public health sector, outside of the academic oral health centres. This is supported by several studies conducted in the Western Cape, Gauteng, Kwa-Zulu Natal and Limpopo provinces of South Africa; which highlighted a greater adult tooth extraction statistic in public health institutions compared to the number of teeth being saved (Mthethwa et al., 2020; Smit and Osman, 2017; Thema and Singh, 2017b). Additionally, the document further highlights that the burden of untreated tooth decay remains unacceptably high in South Africa. The prevalence of dental caries in South Africa has shown a rising trend over time (Chikte et al., 2020a; Thema and Singh, 2017b), therefore the strategies and treatment modalities formulated were aimed towards restoring the carious teeth of patients’ consulting at these public dental departments. ‘The tooth loss goal’ is one of the national oral health goals for 2030 that aims to preserve a minimum number of patients’ natural dentition (e.g., 20 teeth in a 40-year-old patient) (National Department of Health, 2010). The key target area for the goal was to reduce the dental extraction ratio from the current level of 20:1 to 10:1. A tooth may be restored using conservative restorative approaches, or additively root canal therapy when indicated (Erazo etal., 2024). Root canal therapy (RCT) is a tooth-saving treatment procedure in dentistry for teeth presenting with an irreversibly inflamed or necrotic pulp with possible periapical pathology (Walton and Torabinejad, 2009). The treatment involves a sequence of meticulous clinical techniques. This is completed as either a one visit appointment or over multiple visits, based largely on clinical factors. Since RCT could require multiple visits, patients must be motivated and willing to commit to keeping appointments for the duration of the treatment. Alternatively, another option would be to have the tooth extracted, with the option of a prosthesis to replace the missing tooth if indicatedItem The types and prevalence of patholgies related to impacted mandibular third molars based on panoramic radiographs(University of the Witwatersrand, Johannesburg, 2024) Hari, Anisha Anil; Mabaso, E.T.Introduction An impacted tooth may be defined as a pathological situation where the tooth is prevented from attaining a typical functional position. Impacted mandibular third molars are a frequent dental concern worldwide that may lead to a variety of other pathologies. This study aims to determine the prevalence and types of pathologies related to impacted mandibular third molars based on panoramic radiographs within a South African setting. Methods Panoramic radiographs were utilized to analyse pathologies related to impacted mandibular third molars through a cross sectional retrospective study. 600 radiographs were assessed. Patients of any age who were referred from the Maxillofacial and Oral Surgery department to the Radiology department for a panoramic radiograph relating to impacted mandibular third molars at Wits Oral Health Centre during a 5-year period from (2016 to 2020) were included in this study. Data was extracted by a single examiner to ensure diagnostic reproducibility. Results A total of 271 (45,0%) patients were female, and 329 (55,0%) patients were male. The patients' ages varied from 15 to 79 years old, with a mean age of 29,55 years. The age group between 20 and 29 years old (n = 288, 48,0%) had the highest frequency of pathology, followed by the 30-39-year-old age group (n = 219, 36,5%). Among all age groups, those over 50 represented the lowest percentage of pathology, with 8 individuals (1,3%). In terms of pathologies found, caries on the impacted third molar was the most prevalent (n=169, 28,1%) followed by caries on the adjacent second molar (n=136, 22,6%) while 72 patients presented with both caries on the impacted mandibular third molar as well as the adjacent second molar. 128 radiographs presented with peri-coronal radiolucent lesions. Periodontal bone loss accounted for 40 patients. Root resorption was the least prevalent pathology detected with a total of 4 patients. Conclusion The findings of this study along with parallels from the literature, indicates that caries is the most frequent pathology associated with impacted mandibular third molars. Caries may be seen on both the impacted third molar itself as well as the adjacent second molar and may be seen mostly between the ages of 30-49 years, with a higher predilection for males. Seeing that caries is so prevalent within the South African population, treatment or intervention of impacted mandibular third molars would be advisable.Item Spectrum of glaucomatous disease at Charlotte Maxeke Johannesburg Academic Hospital: A retrospective clinical audit(University of the Witwatersrand, Johannesburg, 2024) Walters, Ingrid; Williams, Susan E. I.Background: Glaucoma is the second most common cause of blindness worldwide. A disproportionately high number of these patients live in low- and middle-income countries, placing a huge burden on the health care system. The purpose of this study was to describe how glaucoma patients presented to a dedicated glaucoma clinic at a large referral centre/tertiary hospital in central Johannesburg, South Africa. The objectives were to describe the spectrum of glaucomatous disease in these patients as well as the demographics, risk factors and severity of disease in this patient population. The secondary objective was to describe how glaucoma was being managed in the glaucoma clinic patient population. Methods: This study was a retrospective descriptive study which was a clinical audit of the Charlotte Maxeke Johannesburg Academic Hospital’s (CMJAH) glaucoma REDCap database. 787 patient records were included in the study which were patients seen and managed in a 5-year period. This study and the database had valid ethical clearance. Results: Of the 787 patients assessed the mean age at presentation was 59 years (n=739, SD=16), 50.3% were female and 49.7% male. The majority (74.9%) were black African, and the most common diagnosis was Primary Open Angle Glaucoma (POAG) (59%). Patients with secondary glaucoma (excluding exfoliation glaucoma) were significantly younger (49 years +/-18years) whereas patients with exfoliation glaucoma were older (68 years +/-10 years), P<0.001. Black African patients with POAG were significantly younger than other racial groups, p<0.001, with 7% being younger than 35 years. 23.3% of patients had a family history of glaucoma. The median intraocular pressure (IOP) was 15 mmHg (n=690) and median vertical cup to disc ratio (VCDR) was 0.9 (n=605). Using World Health Organisation (WHO) definitions, 32.2% patients had visual acuity (VA) ≤6/120 in the better seeing eye fulfilling criteria for blindness (n=686) and 64.6% of patients had VA≤6/18 in the better eye fulfilling criteria for visual impairment. 68% (n=722) patients were on medical therapy and most patients received on average three agents. There were 426 laser procedures performed, selective laser trabeculoplasty (SLT) accounting for the bulk (65.3%) and 210 glaucoma surgeries were performed. Conclusion: This study supports and reinforces the notion that black South African glaucoma patients are most likely to have POAG, present at a younger age and have more advanced disease with very high rates of visual impairment and blindness. The management of these patients is largely medical with more than one medication. Glaucoma surgery is an important management tool in advanced glaucoma and is being underutilisedItem Epidemiological analysis of temporomandibular joint dislocation cases treated at the University of the Witwatersrand, Johannesburg(University of the Witwatersrand, Johannesburg, 2023) Boitumelo, Motshoane; Rikhotso, R. E.Background: Temporomandibular joint (TMJ) dislocation is a rare and debilitating condition of the facial skeleton. The condition manifests itself in acute, recurrent or chronic forms, and with bilateral or unilateral expressions. The purpose of this study was to report on the epidemiological characteristics and management of patients with TMJ dislocation in our unit. Methods: A retrospective analysis of the demographical and clinical risk factors of TMJ dislocations treated in the Maxillofacial and Oral Surgery Departments, from January 2015 to December 2019, at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwaneth Academic Hospital (CHBAH), University of the Witwatersrand. Results: There were 46 TMJ dislocation cases, with a bimodal age distribution with peaks at 20 to 25 and above-45-year-old age groups. Acute, chronic and recurrent dislocations were observed in 13 (28%), 9 (20%) and 24 (52%) patients, respectively. Yawning was the commonest cause of dislocation (28 cases, 61%), followed by trauma and spontaneity (both 6 cases, 13%). The type of TMJ dislocation was significantly associated with aetiology, frequency of TMJ dislocation, duration between dislocation and treatment, and type of treatment received (p<0.001). Manual reduction was frequently used to treat acute and recurring cases, whereas manual reduction with general anaesthesia was used to treat chronic cases. Conclusion: Data provided by this retrospective study indicate that the majority of the TMJ dislocations are recurrent and are related to yawning. Most dislocations can be reduced manually under local anaesthesia however, the more prolonged the dislocation, the higher the need for reduction under general anaesthesia and surgical intervention.Item A comparison between bone grafting and non-grafting of immediately placed implants in the molar area(2024) Van der Linden, Wynand JohanAim: 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.Item Factors associated with hospitalization outcomes in patients with orofacial sepsis(2024) Scheepers, RuanBackground: 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.Item Correlation of maternal age to their children born with orofacial cleft treated at Wits Oral Health Centre(2024) Ravat, NaseebaObjectives: 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.Item The prevalence of malocclusion and orthodontic treatment needs of patients treated by students at Wits Oral Health Centre(2024) Rawat, AmeeraObjectives: 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.Item Retention force and fatigue strength of mandibular singleimplant overdenture attachment systems(2024) Van der Linde, Schalk JacobusPurpose- 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.Item Retrospective analysis of pan-facial fractures at Wits Oral Health Centre(2024) Gumede, Ntokozo BhekisisaAim: 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.Item Caries prevalence amongst pre-school children in Windhoek, Namibia(2020) Aluteni, MosesBackground: 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