Electronic Theses and Dissertations (Masters)
Permanent URI for this collectionhttps://hdl.handle.net/10539/37977
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Item Caregiver's oral health knowledge, attitudes and practices towards children with special health care needs in Harare Province, Zimbabwe(University of the Witwatersrand, Johannesburg, 2023-11) Mashanda, Vimbai; Tootla, Saidah; Malauy, CathrineBackground: Children with Special Health Care Needs (CSHCN) are prone to oral diseases such as dental caries and periodontal disease. This is due to limitations in oral hygiene practices because of their debilitating conditions. Therefore, caregivers play a major role in the maintenance of CSHCN’s oral health. As a result, caregiver’s oral health knowledge and attitudes are important to ensure that the oral health of CSHCN is maintained. Aim and Objectives: The aim of this study was to describe the caregiver’s oral health knowledge, attitudes, and practices (KAP) towards CSHCN. The objectives of the study were to determine the caregiver’s demographic profile, to assess the caregiver’s oral health KAP towards CSHCN and to assess whether there is a relationship between the caregiver’s level of education, demographic characteristics, and oral health KAP and factors related to oral health practices. Methods: A quantitative cross-sectional study design and convenience sampling method was utilised. Caregivers above 18 years of CSHCN who attended support group meetings in Harare Province, Zimbabwe and were willing to participate, took part in the study. A modified self-administered questionnaire (SAQ) was used for data collection. The SAQ comprised of a demographics section for the caregiver, child’s disability type and oral health KAP questions. Two sample t-tests and Analysis of Variance (ANOVA) was used to compare the means of caregivers KAP. Multiple linear regression model was used to assess the association between caregivers’ KAP and demographic characteristics. Only the variables with p<0.15 in the univariate model were included in the multiple linear and multivariate logistic regression models. Multivariable logistic regression was used to assess the association between caregivers’ oral health practice and demographic characteristics. Apriori variables such as age, level of education, knowledge and attitude were selected for all multivariable logistic models. All variables with p<0.05 were considered to be statistically significant and statistical analysis were performed using Stata. Results: The response rate was 76.8% n=295). Almost 90% (89.2%, n=263) of the caregivers were females and nearly three quarters (72.5%, n=214) were mothers. A third (33.6%, n=99) of the caregivers were aged between 31-40 years. Fifty-three percent (n=157) of the caregivers were unemployed and 61.7% (n=182) were educated up to high school level. Forty-six percent (n=135) of the CSHCN had cerebral palsy. Out of the 295 caregivers, 45.4% (n=134) had fair oral health knowledge, 79.7% (n=235) had a good attitude towards oral health and 62% (n=183) had fair oral health practices. Conclusions: Most of the caregivers had good oral health attitude, however their knowledge and practices were fair. Factors associated with caregivers’ attitude were their knowledge and level of education, and the caregivers’ practices were associated with knowledge and attitude.Item Factors associated with delayed presentation among patients with oral cancer in Malawi central hospitals(University of the Witwatersrand, Johannesburg, 2023-10) Lungu, Nathan; Sekhoto, M.G.; Turton, M.Background: Oral cancer patients are prone to delays in visiting healthcare facilities resulting in delayed diagnosis, poor prognosis, disfigurement of patients, and increase in management costs. Objective: The aim was to assess factors related to health-seeking delay among patients with oral cancer in Malawi's central hospitals. Methodology: This research was a descriptive cross-sectional study of patients with oral cancer. The study was conducted in all Malawi referral hospitals' dental clinics from April to June 2023 using a closed-ended, structured questionnaire. Results: Thirty-six (52.94%) patients visited the hospital when in pain, and 66.18% (n=45) were not aware of oral cancer. A significant, statistical relationship (p=0.042) was identified between the delay and reporting to the nearest health care facility. Conclusion: Lack of awareness, pain and distance to the nearest health care facility were associated with delays. Education and awareness in primary health care can help prevent treatment delays.Item A retrospective study of histologically diagnosed intra-oral lesions within Ugu district, KZN, South Africa(University of the Witwatersrand, Johannesburg, 2023-10) Reddy, Larisha Yashoda; Premviyasa, VinayagieIntroduction: The oral cavity is exposed to a magnitude of physical and chemical trauma, carcinogenic agents and microbial pathogens that may cause a wide spectrum of oral lesions. These oral lesions may appear as benign, potentially malignant, or malignant thereby requiring biopsies to determine histopathological features to confirm a diagnosis. Oral lesions have the potential to hinder the quality of life for the afflicted patient. The patients’ speech, mastication, swallowing may be affected with the occurrence of oral dysesthesia. With the confirmation of a positive malignant biopsy, the afflicted individual will have to endure the possible side effects of chemotherapy and radiation. In global studies, the prevalence of oral lesions may vary amongst different countries, geographical areas, ethnicities, cultural practices, and social habits. Aim: To identify the different types of intra-oral lesions and the prevalence of malignant oral lesions within UGU district, Kwa- Zulu Natal (KZN). Objectives: 1. To identify the different types of intra oral lesions and characterise by demographics. 2. To determine the prevalence of malignant oral lesions within UGU district, KZN. 3. To determine the association between patients’ social habits and the development of the most common intra oral lesions, with the differentiation of malignant vs non-malignant oral lesions. 4. To assess the concordance of a clinical differential diagnosis and histopathological diagnosis. Study design and Methodology: A quantitative, retrospective case review of dental patient files and histopathological reports of the four selected hospitals in UGU were analysed from January 2016 to August 2022. One hundred and thirty-four patient records were reviewed. Data collected included patients’ age, gender, comorbidities, social habits, differential diagnosis, and histological diagnosis. The data was analysed using a free open-source statistical software program called “R”. Study results: One hundred and thirty-four patients met the criteria of this study. The age of patients ranged between seven and eighty-seven (M= 46.37; SD= 20.77). There were 81 females (60.4%) and 53 males (39.6%). Benign lesions had represented 67.2% (N: 90) of the intra oral biopsies, with the remaining 32.8 %, (N:44), representing malignant lesions. The most common lesions presenting in UGU district were fibrous epulis (N: 15, 11.2%), pyogenic granuloma (N:36, 26.9%) and squamous cell carcinoma (N:37, 27.6%). No statistical relation was proven between ethnicity, sex, and social habits with the benign lesions of fibrous epulis and pyogenic granuloma. Statistical relation was proven between squamous cell carcinoma and ethnicity, gender, and social habits. A substantial level of concordance (agreement) was proven with the Kappa Statistic of 0.7437, hereby indicating a good general knowledge of intra-oral lesions amongst the dentist performing the intra oral biopsies within UGU district. Conclusion: Fibrous epulis, pyogenic granuloma and oral squamous cell carcinoma had been identified as the three most common lesions in UGU, KZN, representing 65.7% of the confirmed biopsy results. Fibrous epulis and pyogenic granuloma had shown no statistical association to ethnicity, gender, alcohol consumption and smoking. In this study, oral squamous cell carcinoma had shown statistical association to white males and consumption of alcohol and smoking. This study has demonstrated the diversity and prevalence of intra-oral lesions within the rural district of UGU, KZN, South Africa as compared to global studies.Item The patterns and distribution of maxillofacial fractures at Pelonomi hospital(University of the Witwatersrand, Johannesburg, 2023-10) Mvala, Boyisile Stephen; Rikhotso, Risimati EphraimBackground: Despite large volumes of trauma patients treated, no study has analysed the epidemiology of craniofacial trauma at Pelonomi Hospital. Such studies could provide insight into the aetiologies and treatment modalities of maxillofacial injuries; and allow for development of strategies to ensure efficient and optimal utilization of limited health resources. Aim: To analyse the patterns and distribution of maxillofacial fractures at Pelonomi Hospital (PH). Methods: We designed and implemented a retrospective, descriptive cross-sectional study whose sample consisted of patients treated for maxillofacial fractures at PH, Frees State, South Africa, between January 1, 2017, and December 31, 2019. Data was collected from the patient’s clinical and radiographic records. Variables recorded included demographic data (gender, age), aetiology of the trauma, type of fractures and type of treatment provided. The delay in treatment was determined from date of injury to the day of treatment. The referral letters were assessed to determine district from which the patients were referred. Descriptive statistics of frequency and percentage were used to analyse the data. Fischer’s exact test was used to determine the association between the independent and dependent variables. The level of significance was set at a p-value less than 0.05. Results: A total of 307 patients with craniofacial fractures were included in the study. Females constituted 21.8% (n=67) and males were by far the majority of the participants at 78.2% (n=240). Individuals in the 20-29 age group had the most maxillofacial fractures (41.2%) and majority of patients in the study were Black (81.1%). The major cause of these injuries was interpersonal violence (60.9%). Alcohol contributed in 64.50% of the injuries. The most frequent fracture was a mandible fracture (70.7%). Majority of fractures in the study were treated with closed reduction (52%) and the waiting period prior to treatment was found to be 2 weeks. Conclusion: Blunt trauma sustained under the influence of alcohol in young individuals is responsible for majority of maxillofacial fractures at Pelonomi Hospital. Future prospective studies with large patient numbers and post treatment follow up are recommended.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.