Research Outputs (Oral Health Sciences)
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Item Airway status in civilian maxillofacial gunshot injuries in Johannesburg, South Africa(2002) Tsakiris, P.; Cleaton-Jones, P. E.; Lownie, M. A.BACKGROUND: Airway management of the maxillofacial gunshot injury constitutes a critical decision and an area that requires review in the context of civilian injuries. Most of our knowledge is extrapolated from military experience, which constitutes a different trauma patient group. This paper reports a retrospective survey of airway status in relation to maxillofacial gunshot injuries. The objective is to correlate clinical findings with treatment decisions. METHODS: A survey was done of 11,622 archived maxillofacial surgery records (1987-1992) in the three academic hospitals in Johannesburg. RESULTS: There were 211 maxillofacial gunshot injuries, for which 92 patient records had sufficient detail for inclusion in the analysis. The typical patient was a black male aged 20-29 years, shot with a low-velocity bullet of 0.38 calibre, admitted to hospital the day of the injury, operated on within 4 days, and discharged 4 days later. The airway was threatened in 20/92 cases at admission; 12/20 cases were treated with oro-or nasotracheal intubation, and 9/12 later had elective tracheostomies; 8/20 needed immediate surgical airways, 5 tracheostomies and 3 cricothyroldotomies (all later converted to tracheostomies). Three of thirty-seven patients with normal airways on admission later required emergency tracheostomy. CONCLUSIONS: An abnormal airway was significantly more likely after a high-velocity injury, and when the tongue, floor of mouth, midline or bilateral facial skeletal bones were involved.Item Clinical, histological and microbiological study of hand-excavated carious dentine in extracted permanent teeth(2003) Bönecker, M.; Grossman, E.; Cleaton-Jones, P. E.; et alChanges in cultivable flora in dentine samples collected before and after hand excavation were examined in association with clinical status of the cavity surface, light microscopy and scanning electron microscopy (SEM). Thirty-five extracted permanent molar teeth with an occlusal caries lesion were excavated with hand instruments according to the atraumatic restorative treatment (ART) approach. Excavation pressure, dentine colour and consistency were recorded at the dentine-enamel junction (DEJ) prior to carious dentine removal and at the cavity floor after the final excavation; a microbiological sample of dentine was taken at both stages. Twelve restored teeth; six with positive and six with negative bacterial growth on the second sample, were selected for light microscopy and SEM. The hand-excavation removed tooth structure was soft, irreversibly damaged, dark and highly infected. Hand excavation reached dentine of increased hardness with a more normal colour to provide a sound structural base for restoration. Light and SEM examination of the cavity floor showed infected dentinal tubules in all 12 teeth examined. Linear logistic analysis showed a statistical association between light-yellow dentine on the cavity floor and an absence of bacterial growth (P = 0.006). This short-term in vitro study showed that caries-producing bacteria remained in dentine close to the cavity floor in 26/35 teeth despite clinical observations that indicated a suitably prepared cavity floor.Item Analysis of attendance rates at Soweto dental clinics 1995 - 2002(2004) Harkison, B. N.; Cleaton-Jones, P. E.BACKGROUND: Patient attendance rates at Soweto dental clinics increased during the year after the implementation of free primary oral health care in 1995. OBJECTIVE: This study was performed to examine if the attendance rates continued to increase between April 1995 and March 2002. MATERIALS AND METHODS: Monthly clinic records were used to record casual (pain and sepsis treatment) and booked patient attendance (restorative, prosthetic and orthodontic treatment) and number of dental operators in the nine primary health care clinics and one hospital clinic in Soweto. Data were analysed with SAS and Prism software. RESULTS: Total patient attendances in the primary health care clinics significantly increased from 6,161 in 1995 to 10,519 in 2002 (P<0.05) due to an increase in casual patients Booked patients decreased and patients treated per operator increased. In the hospital clinic the casual patient attendances decreased but booked patients significantly increased (P<0.005). CONCLUSIONS: Patient attendance rates increased between 1995 and 2002 with an increase in dental operator workload.Item Surface roughness of aesthetic restorative materials: an in vitro comparison(2001) Rosen, M.; Grossman, E. S.; Cleaton-Jones, P. E.The purpose of this study was to compare the surface roughness of three types of aesthetic restorative material. Six standard samples of two brands of each type of material were prepared namely: hybrid composites (Prodigy, Z100), compomers (Compoglass F, Hytac Aplitip) and glass ionomer cements (Photac-Fil, Vitremer) in a perspex mould (N = 36). Upper and lower surfaces were covered with Mylar strips which, in turn, were covered with glass slides and compressed to express excess material. After light curing, specimens were stored in distilled water for 14 days. Thereafter, one side of each specimen was polished sequentially with medium, fine and super fine Soflex discs (treatment). Untreated surfaces served as controls. All surfaces were examined with Talysurf and the surface roughness (Ra) of each specimen was recorded. Three measurements were made of each specimen. A 4-way ANOVA and Tukey's Studentised range test were used to analyse the data. Statistically significant effects were found for both type of material (P = 0.0001) and for treatment process (P = 0.0065). Among unpolished specimens: Compoglass F is significantly rougher than Vitremer, Z100, Prodigy and Hytac Aplitip, and compomers are significantly rougher than hybrids. Among polished specimens: Photac-Fil is significantly rougher than Z100 but does not differ from Compoglass F, Vitremer, Prodigy and Hytac Aplitip, and glass ionomers are also significantly rougher than hybrids. The smoothest surface is obtained when curing materials against a Mylar strip.Item Accurate diagnosis of occlusal carious lesions - a stereo microscope evaluation of clinical diagnosis(2002) Grossman, E. S.; Cleaton-Jones, P. E.; Côrtes, D. F.; et alThis study was undertaken to validate the caries status of 214 teeth by serial sectioning and microscopy after caries diagnosis using four methods. Two hundred and fourteen extracted human teeth with varying degrees of caries were mounted in the jaws of nine training manikins. All tooth surfaces were examined and recorded for caries by four dentists using bitewing radiographs, fibre-optic transillumination (FOTI), mirror alone and a mirror and sharp probe on two separate occasions. Thereafter the teeth were serially sectioned and assessed microscopically for depth of caries lesion on a graded score of 0-7. This report assessed the diagnostic outcome of 2,183 observations for occlusal surfaces. Sound diagnoses predominated over unsound until caries was present in the inner half of dentine. Specificity was between 90% and 95% and sensitivity 26% and 50% depending on which diagnostic method was used and where the sound/unsound threshold was set. Negative and positive predictive values were similarly influenced and varied between 53% and 80% and 73% and 90%, respectively. Probit analysis showed no significant differences (P < 0.05) between examiners and diagnostic methods. Diagnosis of occlusal caries undertaken in an in vitro simulated clinical situation is inaccurate until the caries lesion extends deep into the dentine no matter which of the four methods was used.