3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Studies on lactobacilli(1968-05) De Klerk, Henry Charles.The incidence of dental caries in South Africa is high (Ockerse, 1947) and in 1955 the Minister of Health and Nutrition instructed his departments to appoint a committee to investigate methods by which dental health in this country could be improved. In 1957 a report submitted by this committee emphasized, among other recommendations, the need for fundamental research into dental health. The report was accepted by the Minister and implementation of its proposals was begun in the same year by the establishment of the Nutrition and Dental Health Research Group of the South African Council for Scientific and Industrial Research under the honorary directorship of Professor C.L. de Jager, Head of the Department of Oral and Dental Pathology, and Dean of the Faculty of Dentistry of the University of Pretoria.Item Patient satisfaction with complete dentures received from an urban district hospital(2018) Naidu, KarmishaAim Edentulousness usually impaires a patient's ability to chew and perform other oral functions, resulting in a wide range of health and oral-helath-related quality of life impacts. Whilst implant-retained overdentures have clear benefits, for the majority of edentulous patients, implant retained dentures will never be a reality, and mucosa-borne dentures will be their only choice. [Abbreviated Abstract. Open document to view full version]Item Cemento-osseous dysplasia: a retrospective clinico-pathological study(2018) Benaessa, Mouna Mohamed SalimBackground: Cemento-osseous dysplasia (COD) is a non-neoplastic fibro-osseous lesion which occurs in the tooth-bearing regions of the jaw bones. In many instances the diagnosis of COD is based on the distinctive clinical and radiographic features of this disease. Since the affected bone in COD progressively becomes poorly vascularized, dental prophylaxis is of paramount importance to prevent pulpal and periodontal infection which typically trigger sequestrum formation in the affected bone. The aim of this study was to determine the clinico-pathological characteristics of COD in a South African population sample and to relate this to findings in the literature. Materials and methods: The study comprised a retrospective record review of archived documentation of COD. The histopathology reports of patients diagnosed with COD over the period spanning 1996 to 2015 were reviewed from the files of the Department of Oral Pathology, School of Oral Health Sciences, University of the Witwatersrand, Johannesburg. Results: Of the 23, 288 specimens submitted for histopathological examination 237 (1.02%) cases of COD were found. The mean age of the patients were 53.4 years ± 14.2 years with a 93.2% female predilection. COD mainly affected the mandible (62.4%), followed by involvement of both the maxilla and the mandible (24.5%), and maxilla (13.1%). Of the 143 patients with known COD subtypes florid COD predominated (65%) showing a clear trend of increasing with age, peaking in the 51-60 year age group and then decreasing thereafter. Cases of infected COD comprised 73.8% (174/237) of the COD study sample. Further 33% of all cases of chronic suppurative osteomyelitis (CSOM) in this study were seen in patients with COD. There was no significant association between any of the COD subtypes and CSOM (p > 0.05). Simple bone cysts presented as a complication of COD in 4.6% of cases. Conclusion: This study comprises the largest sample of COD cases thus far reported from South Africa. It showed a higher frequency of CSOM occurring as a complication of COD compared to earlier studies. No significant association was shown between any of the COD subtypes and CSOM.Item Quality of root canal treatment perfomed by undergraduate students at the Wits oral health centre(2018) Ehbesh, A.alaali MohamedPurpose: Following the changes to the undergraduate endodontic curriculum at the University of the Witwatersrand in 2012, there was a need to assess the impact of the changes on treatment outcomes. This study was an audit of root canal treatment performed by undergraduate students as shown in the postoperative radiographs. The study compared the root canal treatment performed by the 3rd, 4th and 5th undergraduate students. Methods: Postoperative periapical radiographs of patients treated by undergraduate students, were examined to assess length, density, taper and iatrogenic errors. Two independent investigators were first calibrated, and thereafter assessed 299 endodontic cases that were performed by 3rd, 4th and 5th year students between 2013-2015 at the Wits Oral Health Centre. Results: 68.9%, 73.6% and 70.9% were found for adequate length, acceptable density and acceptable taper of root filling respectively. The most acceptable length, density and taper results was by the 5th year students, while the lowest results were in the 4th year students. The iatrogenic errors were identified as 37.1% with ledge formation and canal transportation the most common. Conclusion: The result of this study shows that the quality of root canal treatment performed by undergraduate students is similar to other studies conducted at various dental schools around the world. The change in the curriculum has been justified, although the study does point out some areas of concern. There was a notable increase in quality from 4th year to 5th year students, possibly due to using of rotary system and dental operating microscope.Item The prevalence of recurrent ameloblastoma at the Wits oral health centre(2018) Chokoe, Nare HemeltonAbstract Background Ameloblastoma is a slow growing, locally invasive, benign tumour of odontogenic origin. Ameloblastoma is the most common odontogenic tumour with varying recurrence rates, depending on the adequacy of the tumour removal. A number of factors including inadequate removal of tumour have been associated with recurrence Aim The aim of the study was to determine the prevalence of recurrent ameloblastoma in patients treated at the Wits Oral Health Centre. Methods This study was a retrospective analysis of 246 records of patients diagnosed with ameloblastoma over a 24 year period (January 1992 to December 2015) in order to determine factors associated with recurrence. Descriptive statistics of mean, standard deviation, frequencies, percentages and proportions were used to summarize the data. Chi- squared and multivariate logistic regression was used to determine the association between the variables and recurrence associated with AMB. Results Males (49.6%) and females (50.4%) were equally affected with a mean age of 31 years (range 7-82 years). AMB affected the mandible (96%) more than the maxilla (4%). Multicystic AMB represented the majority (76.8%) of cases. Most AMB’s (92.7%) presented with bone perforation. Nineteen cases (7.7%) recurred, mostly in soft tissues, fifteen of which were treated radically and four conservatively. Fifteen (78.95%) recurrent AMB’s presented within 10 years of surgical treatment with the remainder (2, 1 and 1) presenting 13, 17 and 21 years post-treatment, respectively. AMB’s larger than 4cm in greatest diameter were associated with 84.21% of the recurrences. Multicystic AMB accounted for 84.21% of the recurrences. Conclusions This study is in agreement with most studies with regard to demographic data and clinicopathological features of AMB. Large multicystic AMB with soft tissue encroachment have a high propensity to recur even when treated by radical resection. Recurrence is a significant associated with histological margins and the surgical method of treatment.Item Evaluating the effectiveness of behaviour guidance intervention on tolerance for dental treatment in autistic children from a Johannesburg school(2017) Crous, StephanusIntroduction: The prevalence of Autism Spectrum Disorder is increasing exponentially with most affected individuals coming from middle and low-income countries. Managing this condition throughout a lifetime is costly and therefore the World Health Organization (WHO) has called for cost-effective behavior management solutions that can be used by non-professionals in lower resource settings. Dental care is the highest unmet health care need in individuals with special health care needs, autism being the most prominent. The objective of this study was to investigate the effectiveness of two behaviour guidance techniques, a visual schedule and social story, in facilitating successful dental treatment and to describe the relationship between oral health status and level of functioning. Materials and Methods: A cluster randomised controlled trial (CRCT) was implemented to evaluate the effectiveness of a specific combination of behavioural interventions: a social story and visual schedule on oral health examination and treatment outcomes. Twenty-five classes were randomized from the low, middle and high support levels to the control or intervention arms. The primary outcomes of interest were: sitting in the dental chair, cooperative behavior as rated by the Frankl scale and the number of fissure sealants placed. In addition, the oral health status was measured for the high, middle and low support groups. The intervention was administered by classroom teachers daily for two weeks prior to the dental visit. Intention-to- treat analysis was conducted. Data were analyzed using t-tests, ANOVA and chi-squared tests to compare the intervention and control groups. Multivariate models were built to test the hypothesis that the oral health status differed by level of support while controlling for age. Results: One-hundred and sixty-five children from the 25 classes obtained parental consent to participate in the study. There were no differences between the study arms for the outcome of sitting in the dental chair (p=0.6) or the number of fissure sealants placed (‘Fisher’s exact’ p = 0.24). However, the evidence suggests that the intervention group performed marginally better and more dental treatment was possible over a longer period of time, (‘Fisher’s Exact’ p = 0.057). There was a significant difference between the treatment and control arms in behavior as measured by the Frankl scale where the control groups displayed more cooperative behavior (‘Fisher’s exact’; p=0.014). When analyzing these outcomes against the level of support, significant differences was found showing that as the level of support needed to function increases, children became increasingly more uncooperative during sitting in the dental chair, behavior was more uncooperative (p<0.001) and fewer fissure sealants could be placed (p<0.001). Logistic regression analysis showed that level of support was the strongest predictor for sitting, behavior and fissure sealant placement while controlling for socio-demographic characteristics and treatment arm. More caries was observed in the primary teeth with caries prevalence of 42.7% and mean decayed, missing, filled teeth (dmft) of 2.01 (Std Dev.=3.07; 95% CI: 1.34; 2.69) compared to the secondary teeth 28% of children had caries and the mean DMFT was 0.9 (Std Dev = 1.91; 95% CI: 0.54; 1.25). Higher mean DMFT score were associated with increased level of support (p=0.001) and children with a DMFT score of 3 and more, required the highest level of support (level 3) and experienced the highest burden of decay while controlling for age. (aOR = 4.6; p<0.006) Conclusion: Level of support required by children with ASD was the strongest predictor of ability to sit in the dental chair, behave in a cooperative way and placement of fissure sealants and none of the primary outcomes were associated with the intervention. The severity of caries observed in the permanent dentition was positively associated with higher levels of support required to function. The social story was ineffective in improving the primary outcomes in the less structured environment of the classroom and administered by non-professionals.Item Caregiver's perceptions of oral health related quality of life among children with special needs in Johannesburg(2015) Nqcobo, Cathrine BatesbaThis study aims to assess Oral Health-Related Quality of Life among children with special needs, from the caregiver’s perspective. The objectives of the study were: (i) To describe the demographic profile of the caregivers in terms of age, gender and socio-economic status,(ii) To assess the dental caries status of children with special needs,(iii) To establish the caregivers’ perceived Oral Health-Related Quality of Life of the children with special needs using the short-form Parent-Caregiver Perception Questionnaire, (iv) To assess the impact of the dental caries status on the families of children with special needs using the Family Impact Scale questionnaire. Results: The study consisted of 150 caregiver child pairs, the mean age of the caregivers was 39.52 years (SD 9.26) and mean age of children was 8.72 years (SD 6.07). There was a high prevalence of untreated caries regardless of the type of disability. The highest caries prevalence in both the primary and permanent dentition was found in the Epilepsy and the Autism groups (75%-83%) while the lowest was found among Down syndrome and Cerebral palsy groups (30%-47%).All the caregivers expressed impact on the Oral Health-Related Quality of Life.The mean Parent-Caregiver Perception Questionnaire score was 12.88 (SD 12.14) while the mean Family Impact score was 6.05 (SD 6.77). The highest Parent-Caregiver Perception score of 20.5 (SD 11.07) was found in the complex disability group followed by the Down syndrome group 15.87 (SD 13.87). The highest scores were found in the oral symptoms, functional limitation and emotional wellbeing domains which contributed more to the parent perception score. Conclusion: Caregivers of children with special needs in the current study experienced a negative impact on Oral Health-Related Quality of Life. Caries experience of the children with special needs was slightly lower than in the general population irrespective of disabilities and had no impact on the FIS and overall global rating-well-being.Item A comparison of the oral health status of children and adults living in low, optimal, and high fluoride areas(2014-06-10) Molefe, Meshack ItumelengDental caries prevalence in many developing countries is low but an increased prevalence has recently been reported from some of these countries. This is in contrast to the data from the industrialised countries which show a consistent decrease in caries prevalence, particularly in urban populations. The phenomenon of a low caries experience in areas having an optimal fluoride concentration in water is well documented. On the other hand, many reports show that higher than optimal levels of fluoride in drinking water are associated with varying degrees of fluorosis (Murry et. al, 1991). In developing countries, a high prevalence of periodontal disease has been reported in both teenagers and adults. The present study compared the caries profile, periodontal disease and fluorosis among children and adults residing in low, "optimal" and high fluoride areas in four villages in the Mankwe region, North-West Province of South Africa. The population of the Mankwe region was approximately 63 000 in 1993 and fifty percent of whom were children (Development Bank of South Africa, 1994). The climateis hot and dry, and until recently, people depended on underground and rain water. Access to tap water was costly. Oral health facilities were limited and there were inadequate oral health personnel. The method of sampling, examination techniques, instruments used and the statistical analysis were carried out under supervision of experienced epidemiologist and in consultation with expert statisticians. The indices used included the Decayed, Missing and Filled Teeth (DMFT, drnft), Community Periodontal Index of Treatment Needs (CPITN) (WHO 1987; Ainamo et al, 1982), Dean's Index (Dean et al. 1942) and the Tooth Surface Index of Fluorosis (TSIF) (Horowitz et at,1984). A total of 360 subjects aged 6-7,12-13 and 30-55 years were examined. More than 90 percent of the 6-7 year old children were caries-free in the permanent dentition at all four study villages. Both ttmft and DMFT scores were very low. DMFT values for the 12-13 year old group was also well within the WHO goals in all the villages but increased in the adult group. The D-component was dominant in all groups with the occlusal surfaces most affected. There was a high percentage of periodontal disease but with low severity. Less than 30 percent of the adults aged 30-55 years demonstrated bleeding on probing at all the four villages. In the 30-55 year age groups, calculus was predominantly found at Lerome and less than 32 percent and 20 percent had shallow and deep pockets respectively at all the four villages. All those in the 12-13 and 30-55 year age groups were assessed as needing oral hygiene instructions and less than 20 percent of the adults needed advanced periodontal care. When using Dean's index in the 12-13 year age group, the highest percentage with fluorosis was found at Ruighoek which had an excessive amount of fluoride in drinking water, but fluorosis was also pronounced at Lerome. The central incisors were more affected than the lateral incisors when using the TSIF. Also, mandibular first molars were more affected than maxillary first molars. In the 30-55 year olds, there was a decrease in the severity of fluorosis with age at the high fluoride villages, but all of the adults examined had brown discolouration at Ruighoek. Based on the finding of this study it is suggested that greater efforts be made to introduce proven preventive treatment programmes in these communities. More human resources particularly in the form of auxiliaries should also be employed in order to promote oral health education and provide basic periodontal intervention. The fluorosis problem could be addressed by introducing potable water and the unsightly brown discolouration in adolescents could be eliminated by either bleaching, composite veneers or crowns, However, the latter solution is expensive and Is dependent on sophisticated equipment and highly trained dental personnel.