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
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.
Retrospective analysis of pan-facial fractures at Wits Oral Health Centre
(University of the Witwatersrand, Johannesburg, 2023) Gumede, Ntokozo Bhekisisa; Rikhotso, Ephraim
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.
Analysis of the thickness of the cortices along the course of the inferior alveolar nerve
(University of the Witwatersrand, Johannesburg, 2023) Seleke, Kgothatso Morake; Mabongo, Mzubanzi; Kotsane, Daisy Fidelis
Introduction Surgical procedures performed around the course of the inferior alveolar nerve (IAN) accounts for 63% of neuropathy reported2 . These surgical procedures include dental implant placement, surgical extractions around the lower molar area, internal fixation, mandibular ramus graft and bilateral sagittal split osteotomy. Failure to pay attention to detail while performing these surgical procedures may result in inferior alveolar nerve injuries, developing in neurological deficit which are characterized by either paraesthesia or anaesthesia. Aim -The aim of this study was to analyse the buccal and lingual cortical bone thickness along the course of the inferior alveolar nerve. Objectives To analyse the thickness of the buccal-lingual cortical bone along the inferior alveolar canal (IAC). To determine whether there is association between position of the IAC and thickness of the cortices. To determine the factors (age and gender) associated with buccal-lingual position of the nerve. Materials and Methods This was a retrospective study based on analysing radiographic records of patients who took CBCT at Wits Oral Health Centre (W.O.H.C) from January 2015 up to December 2018. The estimated sample size was 132 quadrants of CBCT images which was determined with 95% confidence level, 5% margin of error, 50% population proportion and 200 population size. CBCT images were taken using SIDEXIS next Generation software. The IAN was identified and highlighted along its course to the mental foramen. Results- The male and female buccal-lingual cortical measurements at all points were approximately the same. The lingual right cortical thickness increased with an increase in age, and the buccal right cortical thickness decreased with an increase in age. There was no association between gender and IAC position. The width of the buccal cortex was greater on the left than the right side and the lingual cortical thickness was also greater than the right. In the present study it was found that the males had a thicker buccal cortex posteriorly and a thinner cortex anteriorly compared to females. Females had thicker buccal cortex on the right side at point posteriorly whereas anteriorly it was thicker on the left. The left and right buccal cortices show the median increase in all age groups. The IAC was close to the lingual cortex at the molar region and buccal cortex at the premolar region. The position of the IAC whether buccal, lingual or inferior can be attributed to the type of the IAC as; straight projection, catenary-like projection and progressive descent. It was also determined by the type and depth of impaction, position of the roots of the third molar and the width or thickness of the buccal-lingual cortices. Conclusion- CBCT play an integral role in diagnostic imaging due to details of the images. The position of the IAC that houses IAN is influenced by various factors including but not limited to gender and age as well as the surrounding anatomy. By understanding the surrounding anatomical influences on the position of the IAN, any surgery to the area would minimize complications associated with the IAN especially with the use of detailed imaging such as CBCT.
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, Vinayagie
Introduction: 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.
The patterns and distribution of maxillofacial fractures at Pelonomi hospital
(University of the Witwatersrand, Johannesburg, 2023-10) Mvala, Boyisile Stephen; Rikhotso, Risimati Ephraim
Background: 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.
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.
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, Cathrine
Background: 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.
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 underutilised
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.
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.
Antibiotic prescribing patterns among dentists in the Durban metro region, South Africa
(University of the Witwatersrand, Johannesburg, 2024) Rampersad, Yuvti; Premviyasa, Vinayagie
Antibiotic 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%)
Risk factors for caries and periodontal diseases: a comparative4 study among HIV-positive and HIV-negative adults in nyarugenge5 district, Rwanda
(University of the Witwatersrand, Johannesburg, 2024) Murererehe, Julienne
Dental caries and periodontal diseases are among HIV-positive persons' most frequent oral conditions. These common oral diseases contribute to the impairment of general health and well- being. Dental and periodontal problems among HIV-positive individuals are more severe and difficult to manage than dental and periodontal problems among HIV-negative people. Thus, risk factors for caries and periodontal diseases must be controlled for comprehensive oral health and the general well-being of HIV-positive patients. The burden of oral diseases is reported to be high in Rwanda. Nearly 65% of the oral health survey participants had experienced dental caries and above 54% had untreated cavities. In addition, dental calculus was found among 60% of participants. More than 34% had oral debris. Surprisingly, more than 70% of this population has never visited dentists or dental facilities. This evidence gives impetus to undertake more focused investigations on oral diseases in Rwanda, particularly among HIV-positive people. Therefore, this study sought to assess the risk factors for caries and periodontal diseases among HIV-positive and negative adults in Nyarugenge District, Rwanda Methods This research used a mixed-method approach (qualitative embedded design). For the quantitative part, a comparative cross-sectional study was conducted among 200 HIV-positive and 200 HIV- negative adults aged ≥18 years. Consecutive and purposive sampling method was used to select participants for quantitative and qualitative parts of the study respectively. Caries was assessed using the Decayed (D), Missing (M), and Filled Teeth (F) index (DMFT). Periodontal disease was assessed using the Plaque Index (PI), Community Periodontal Index of Treatment Need (CPITN), and Clinical Attachment Loss (CAL). Oral health Related Quality of Life (OHRQoL) was assessed using the oral health impact profile short version (OHIP-14). Descriptive statistics, Chi-square test, t-test, Cronbach alpha, and multiple logistic regression were applied to analyse quantitative data using Stata version 15. For the qualitative data collection, in-depth interviews (IDIs) were conducted among 10 HIV-positive and 11 HIV-negative adults with caries and periodontal diseases using a semi-structured interview guide. Thematic content analysis using an inductive approach was applied for data analysis of IDIs. NVivo software version 11 was used to code and organize the data. Results A higher proportion (50.5%) of HIV-positive adults had experienced caries (DMFT>0) compared to HIV-negative counterparts (40.5%) and the difference was statisticaly significant (p=0.045). The prevalence of D was higher (23.5%) among HIV-positive compared to HIV-negative adults (13.6%) (p=0.011). The Mean (SD) DMFT score among HIV-positive and HIV-negative participants were 2.28 (3.68) and 1.29 (2.21) respectively (p=0.001). The predictors of caries in HIV-positive persons were being female (OR= 2.33; 95%CI= 1.14-4.75), frequent dental visits (OR= 4.50; 95% CI=1.46-13.86) and detectable RNA viral load (OR= 4.50; 95% CI=1.46-13.86). Among HIV-negative participants, the middle age range (36-45 years) [OR= 6.61; 95%CI=2.14- 20.37], and frequent dental visits were significantly associated with caries (OR=3.42; 95%CI: 1.337-8.760). For periodontal status, having dental calculus was the most prevalent item of the CPITN found among HIV-positive 168 (84%) and 182 (92%) HIV-negative individuals. The mean (SD) score for CAL was higher in HIV-positive persons 1.23 (0.95) compared to HIV-negative counterparties 0.99 (0.75). The difference was statistically significant (p=0.003). Being a male was a predictor of having dental plaque and a need for periodontal treatment for both HIV-positive (PI OR: 2.90 (95%CI=1.26-6.66)); (CPITN OR: 3.33 (95%CI=1.14-9.70)) and HIV-negative respondents (PI OR:3.28 (95%CI=1.48-7.28)); (CPITN: OR: 7.78 (95%CI=1.04-58.07)). A higher percentage of HIV-positive individuals had poorer OHRQL than HIV-negative counterparties in all items of OHIP-14 except for OHIP3 (found it uncomfortable to eat any foods because of problems with teeth or mouth) and OHIP-14 items (being totally unable to function because of problems with teeth or mouth). The findings revealed significant results regarding OHIP1 “trouble pronouncing any word” with a prevalence of 11(2.5%) and 9(2.25%) in HIV-positive and HIV-negative participants, respectively. Also, HIV-positive persons had higher percentage 11(2.75%) for the OHIP 13 item “life not satisfying due to teeth and mouth problems” than HIV-negative counterparties 8(2%) and the difference was statistically significant p≤0.05. Moreover, dental caries was significantly associated with poor OHRQoL among HIV-positive and HIV-negative participants for all 14 items of OHIP-14 tool. There was no association between periodontal disease and OHRQoL in both HIV-positive and HIV-negative adults. Two broad domains and five themes emerged from the interviews. The first broad domain was “perceptions on causes of oral diseases” with 2 themes (individuals and external themes). The second broad domain was “perceptions on oral diseases effect” with 3 themes (physical or functional effect, psychological effect and social effect themes). Conclusion and recommendations This research showed a higher prevalence of caries and CAL among HIV-positive adults than HIV- negative counterparts. Also, the mean (SD) PI value was significantly higher in HIV-positive adults compared to the mean PI value in HIV-negative individuals. The reported higher prevalence of caries in HIV-positive persons was associated with being female, detectable viral load, and frequent dental visits. Periodontal disease was associated with older age, being male in HIV-positive and HIV-negative participants. Moreover, HIV-positive adults reported poorer OHRQoL than HIV-negative counterparties. Furthermore, qualitative results revealed individual and external levels factors of oral disease and emphasized the physical/ functional, psychological and social effects of oral diseases on quality of life. Therefore, there is a need for effective oral health interventions specific to HIV-positive persons in Rwanda. The interventions should also raise awareness of the risk of common oral diseases (such as dental caries, and periodontal disease) and provide preventive oral health services among the Rwandan population, especially HIV-positive individuals. There is a need for a collaborative effort to establish programmes for regular and timely screening and management of periodontal disease and dental caries among the general population and specifically, HIV-positive individuals in Rwanda. To ensure timely oral health care among HIV- positive Rwandans, this study provides baseline data to aid policymakers and stakeholders to integrate oral health care services within HIV treatment programmes in R
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.
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, E
The 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 indicated
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.
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.
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.