Scielo RSS <![CDATA[South African Dental Journal ]]> http://www.scielo.org.za/rss.php?pid=0011-851620160010&lang=pt vol. 71 num. 10 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Celebrating the first year of Sefako Makgatho Health Sciences University</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Communique</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000002&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>The role of socio-economic position on satisfaction with oral health services among South African adults: a structural equation model</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000003&lng=pt&nrm=iso&tlng=pt OBJECTIVE: To investigate how differences in socio-economic position (SEP) influence satisfaction with dental services among South Africans. METHODS: Data collected from a nationally representative sample of the South African population ≥16 years old (n=3,112) included socio-demographics, health insurance enrolment, past-year dental visit and facility type (public or private), satisfaction and reason(s) for dissatisfaction with the dental services received. Using structural equation modelling, a pathway to satisfaction with dental services was tested using a number of model fit statistics. RESULT: Of the 15.1% (n=540) who had visited a dentist in the past-year, 54.1% (n=312) were satisfied with the services received. Reasons for dissatisfaction included long waiting time (33.1%), painful procedure (13%) and rude staff (10.4%). Being of higher SEP was associated with reporting using private facility. Those who visited public facilities were more likely to have encountered a long waiting time, which in turn was associated with being more likely to report treatment as having been painful and reporting dissatisfaction. Long waiting times had the greatest direct effect on dental service dissatisfaction (β = -0.31). CONCLUSION: Improving waiting time is likely to be the major factor to help reduce socio-economic disparities in the quality of dental services experienced by South Africans. <![CDATA[<b>The efficiency of the referral system at Medunsa Oral Health Centre</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000004&lng=pt&nrm=iso&tlng=pt INTRODUCTION: The functioning of various referral systems in health service delivery at district level have been described. AIMS AND OBJECTIVES: To examine the effectiveness of the elective treatment referral system that operates internally at Medunsa Oral Health Centre. The proportion of emergency and non-emergency patients who consulted at the diagnostic unit and were subsequently referred for elective treatment at clinical units during February 2013 was compared with those who had actually received treatment one year later. DESIGN: This was a retrospective, comparative cross-sectional study in which existing medical records were reviewed. METHODS: Treatment records of emergency and non-emergency patients who consulted at the diagnostic unit and were subsequently referred to clinical units for elective treatment during February 2013 were reviewed one year later. The service register of the diagnostic unit for the month of February 2013 was also reviewed. Data related to the referral preferences of attending clinicians, demographic characteristics and dates when treatment was actually received was extracted. RESULTS: Significantly fewer (14.6%) patients of either group were treated than were referred. The average waiting time for treatment was 81.2 days and ranged between 6 and 184.5 days. CONCLUSIONS: The internal referral system that operates at Medunsa Oral Health Centre was shown to be inefficient. <![CDATA[<b>Comparing repeat and first visit patients' satisfaction with service quality at Medunsa Oral Health Centre</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000005&lng=pt&nrm=iso&tlng=pt INTRODUCTION: The SERVQUAL model is commonly used in medical centres to assess patient satisfaction with service quality. AIMS AND OBJECTIVES: This study examines patient satisfaction with their experience at Medunsa Oral Health Centre. Satisfaction rates of first time and repeat patients were determined and compared using SERVQUAL dimensions. Factors associated with patient satisfaction were identified using a multiple variable logistic regression model. DESIGN: This was a comparative cross-sectional descriptive study. METHODS: A pretested routinely used standardised SERVQUAL questionnaire was used to collect data from study participants at Medunsa Oral Health Centre. It consisted of 16 questions which rated mainly positive statements of six dimensions of service quality using a five response categories Likert scale. The categories were strongly agree, agree, unsure, disagree and strongly disagree and the scale was anchored from -2 through to 2. The benchmark score for an overall satisfied patient was 16 out of a total possible score of 32. RESULTS: Two-thirds of both patient groups were satisfied overall. Differences in satisfaction rates for all service quality dimensions were not statistically significant. Access, empathy, reliability, and tangible exerted a significant influence. CONCLUSIONS: Patient satisfaction with service quality was high - no differences were found between study groups. <![CDATA[<b>Piloting the Community Service Attitudes Scale in a South African context with matching qualitative data</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000006&lng=pt&nrm=iso&tlng=pt INTRODUCTION: There is a need to measure the social accountability of dental students following service learning (SL) exposure. OBJECTIVES: To pilot the Community Service Attitudes Scale (CSAS) and to test its reliability in a South African context while matching CSAS findings with students' perceptions of their SL experience. METHODS: Final year dental students at Sefako Makgatho University anonymously completed a modified version of the CSAS and submitted written reflections before and after SL exposure. Students also participated in two focus group discussions after exposure. Before and after CSAS data were statistically compared using t-tests. Qualitative data from the focus groups and reflective essays were matched against the findings of the CSAS. RESULTS: Students (n=41, 76% CSAS response rate) generally displayed positive attitudes towards communities in need, both before and after exposure (no statistical difference). The CSAS internal consistency was excellent (α = 0.96). Qualitative findings suggested a need for stakeholders' involvement in the procurement of SL resources and in meeting community needs. There was tension between SL and quota-driven dental training. CONCLUSION: The CSAS showed good reliability and appears a useful tool to measure social accountability in South Africa. The qualitative findings need further investigation. <![CDATA[<b>Styloid process elongation according to age and gender: a radiological study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000007&lng=pt&nrm=iso&tlng=pt The aim of the study was to investigate the ossification patterns and types of elongated styloid process (ESP) in relation to age and gender in patients attending the Medunsa Oral Health Centre at Sefako Makgatho Health Sciences University. Out of the 102 panoramic images evaluated, 40.2% and 59.8% were male and female patients respectively. Type I ESP was the most frequent type (59.1%), followed by Type III (24.8%), Type II (9.4%) and Type IV (7.7%). The Type A calcified outline pattern of ossification was the most common (48.9%), followed by Type D (28.9%), Type C (14.1%) and Type B (8.1%). Panoramic images are vital in evaluating ESP seen as incidental findings and dental practitioners need to be aware of its variations. <![CDATA[<b>Bacteriology and management of orofacial infections in a Maxillofacial and Oral Surgery Clinic, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000008&lng=pt&nrm=iso&tlng=pt INTRODUCTION: The widespread use of antibiotics in clinical medicine has contributed to a significant decline in the morbidity and mortality attributable to orofacial infection. However, there are indications of global variations in the microbiology, sensitivity to antibiotics and clinical outcomes, which have not been studied locally. AIM OF THE STUDY: To investigate the bacteriology and antimicrobial sensitivity of microorganisms causing orofacial infections amongst patients attending a local Maxillofacial and Oral Surgery Clinic, in order to inform an appropriate antibiotic therapy regimen. METHODOLOGY: Study design and setting: A retrospective record-based survey conducted at the Medunsa Oral Health Centre, Sefako Makgatho Health Sciences University, South Africa. DATA COLLECTION: Demographic details, clinical information and laboratory data (identified microorganisms and antibiotic sensitivity), were acquired from files dating between March 2011 and June 2015. RESULTS: In total 122 pathogens had been successfully cultured from 127 patient specimens. The profile of microorganisms was predominately aerobic, with Streptococcus viridans, Coagulase negative staphylococcus and Staphylococcus aureus comprising the majority. All responded favourably to first line antibiotics. Penicillin, clindamycin and gentamycin were the most effective antimicrobials. CONCLUSION: Penicillin remains the drug of choice in treating orofacial infections. The current study discourages the indiscriminate use of metronidazole. <![CDATA[<b>Trends in the seasonal variation of dry socket at Medunsa Oral Health Centre</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000009&lng=pt&nrm=iso&tlng=pt INTRODUCTION: The multifactorial aetiology of dry socket is firmly established. A probable seasonal variation was recently explored - the results indicated a significantly lower risk in spring. AIMS AND OBJECTIVES: This study sought to further explore the hypothesis of seasonal variation by describing trends in the occurrence of dry socket over three years at Medunsa Oral Health Centre. DESIGN: This was a repeated cross sectional analytical study in which existing medical records were reviewed. METHODS: Treatment records of 13615 adult patients who underwent routine tooth/teeth extraction(s) between January 2010 and December 2012 were reviewed. Data related to demographic characteristics, date of extraction, and diagnosis of dry socket were acquired. Dry socket odds were calculated. A Chi-squared test for trend was performed. RESULTS: Females accounted for 66.4% of the dry socket cases. The mean age of the occurrence of dry socket was 36 years (SD 11years). The risk for dry socket was lowest during spring (September - November) throughout the years 2010 to 2012. Statistically significant seasonal variation was found in the years 2010 and 2011. Other significant risk factors included younger age and female gender. CONCLUSIONS: The findings suggest a seasonal variation in the risk of dry socket. <![CDATA[<b>Mandibular third molar and angle fractures: a meta-analysis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000010&lng=pt&nrm=iso&tlng=pt OBJECTIVE: To use a quantitative systematic review of available, credible literature to enable an estimation of the risk of mandibular angle fracture in the presence of mandibular third molars (M3s). METHODS: Data were obtained through a systematic search of PubMed, Embase, and a thorough hand search of eligible references. Papers were included with: (i) acceptable methodological rigor; (ii) complete and accurate data. Details were recorded on the presence of third molars among the reported cases with or without angle fractures. Two calibrated researchers used a specially designed data abstraction form to independently populate information from the selected studies. Comprehensive Meta-Analysis software ver. 3.3.070 was used to calculate relative risk (RR) as the estimate of risk in this study. RESULTS: Nineteen (19) retrospective cohort studies were analysed, comprising of 9888 patients with 3254 mandibular angle fractures. In the presence of mandibular third molars, the risk of mandibular angle fractures increases by 44% when compared with the risk in the absence of third molars. CONCLUSION: The presence of mandibular third molars increases the risk of mandibular angle fracture. Clinicians should be discerning in identifying patients at increased risk, or those likely to benefit from appropriate prophylactic removal of wisdom teeth. <![CDATA[<b>Clinical and radiological features of 90 odontomas diagnosed in the Oral Health Centre at Sefako Makgatho Health Sciences University</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000011&lng=pt&nrm=iso&tlng=pt This paper presents the variations in the clinical and radiological appearances of 90 odontomas diagnosed during routine radiographic examination in a population sample attending an African Dental Hospital. The majority occurred in males (1,4:1) and compound odontomas were more common than the complex type (3,2:1). The most frequent sites recorded were the anterior maxilla for the compound type and the posterior mandible for the complex type. The majority were associated with impacted permanent teeth (57.7%) followed by retention of deciduous teeth (16.6%), displacement of adjacent teeth (11.1%), expansion of the cortical plates (8.9%) and congenitally missing teeth (3.3%). More than 50% of the lesions presented with a radiolucent rim. Early removal is important in order to maintain the chronology of tooth development and to prevent extensive and costly intervention at a later stage. Odontomas are exclusive to the tooth bearing areas of the jaws and are the most common benign odontogenic tumours.¹ They develop from primordial odontogenic tissue. Due to their composition being a combination of odontogenic epithelium and odontogenic ectomesenchyme, odontomas are categorised in the mixed group in the 2005 World Health Organization classification of odontogenic tumours.² Two types are recognised. Complex odontomas are described as malformations in which the dental tissues are arranged more or less in a disorderly pattern with little or no resemblance to normal teeth on radiographs. The compound type presents with normal dental tissues arranged in an orderly pattern giving rise to multiple small tooth-like structures called odontoids or denticles.³ Histologically, enamel, dentin, cementum and sometimes pulp tissue are present and although the individual tissue types may appear normal, their micro anatomical arrangement is abnormal.4 Due to their limited growth potential, odontomas are not true neoplasms but rather are developmental dental malformations behaving similarly to hamartomas.¹ The aim of the present study was to analyse the clinical and radiographic features of odontomas diagnosed in an African population sample and to compare the findings with those of other studies. <![CDATA[<b>The use of temporary skeletal anchorage devices amongst South African orthodontists</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000012&lng=pt&nrm=iso&tlng=pt BACKGROUND: Temporary Skeletal Anchorage Devices (TSADs) are small titanium screws that are inserted through the gingival or palatal mucosa into supporting bone to form an independent rigid anchor unit or may be tied to adjacent teeth to enhance their anchorage capability. On completion of orthodontic treatment the orthodontist is easily able to unscrew and remove the screws. OBJECTIVE: To conduct a survey on the clinical use of TSADs amongst South African orthodontists. MATERIALS AND METHOD: The method consisted of a structured survey questionnaire which was sent to 110 South African orthodontists registered on the South African Society of Orthodontists database in 2013. RESULTS: Forty six orthodontists completed the survey, a response rate of 41.81%. Of these respondents, 63.04% used TSADs, and of those, 58.62% placed TSADs themselves while the remainder referred to maxillo-facial surgeons, and to a lesser extent, to periodontists, for placement. The majority (72.41%) loaded TSADs immediately. TSADs were used mostly to provide anchorage when teeth were moved mesially (52%) or distally along the arch. CONCLUSIONS: South African orthodontists have adopted a cautious approach to the use of TSADs. Training in the placement and the clinical application of TSADs should be incorporated in the curriculae of postgraduate orthodontics. <![CDATA[<b>Effect of denture cleansers on flexural strength of heat-polymerized and auto-polymerized acrylic resins</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000013&lng=pt&nrm=iso&tlng=pt AIM: To compare the flexural strengths of two types of acrylic resins after immersion in three different denture cleansers, for two different time periods. MATERIALS AND METHODS: 380 rectangular acrylic resin specimens (60mm x 20mm x 2mm) were fabricated and divided into three groups. Group 1 - baseline, ten of each type of acrylic resin; Group 2 - heat-polymerizing, 180 specimens, and Group 3 - auto-polymerizing, 180 specimens. Random samples of 30 specimens from Groups 2 and 3 were severally immersed in three different liquids: two denture cleansers i.e. alkaline peroxide- based (Corega) and sodium hypochloride- based (Jik), and tap water. Immersion time of six hours was taken to represent one day, hence, three and six months of continuous immersion represent one year and two years realtime, respectively. Flexural strengths were determined before, then after the three and six month periods. A two-way analysis of variance (SPSS version 23.0© (IBM USA) determined any statistical differences between the recorded flexural strengths. RESULTS: Sodium hypochloride decreased flexural strength for both polymethylmethacrylate resins. Water reduced flexural strength of the heat-polymerizing resin. The alkaline peroxide cleaner had no impact on flexural strength. CONCLUSION: Flexural strength of heat-polymerizing acrylic resin can be significantly reduced by exposure to denture cleansers. <![CDATA[<b>Refusal of potentially life-saving dental care: Antithetical conflict of ethical principles</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000014&lng=pt&nrm=iso&tlng=pt AIM: To compare the flexural strengths of two types of acrylic resins after immersion in three different denture cleansers, for two different time periods. MATERIALS AND METHODS: 380 rectangular acrylic resin specimens (60mm x 20mm x 2mm) were fabricated and divided into three groups. Group 1 - baseline, ten of each type of acrylic resin; Group 2 - heat-polymerizing, 180 specimens, and Group 3 - auto-polymerizing, 180 specimens. Random samples of 30 specimens from Groups 2 and 3 were severally immersed in three different liquids: two denture cleansers i.e. alkaline peroxide- based (Corega) and sodium hypochloride- based (Jik), and tap water. Immersion time of six hours was taken to represent one day, hence, three and six months of continuous immersion represent one year and two years realtime, respectively. Flexural strengths were determined before, then after the three and six month periods. A two-way analysis of variance (SPSS version 23.0© (IBM USA) determined any statistical differences between the recorded flexural strengths. RESULTS: Sodium hypochloride decreased flexural strength for both polymethylmethacrylate resins. Water reduced flexural strength of the heat-polymerizing resin. The alkaline peroxide cleaner had no impact on flexural strength. CONCLUSION: Flexural strength of heat-polymerizing acrylic resin can be significantly reduced by exposure to denture cleansers. <![CDATA[<b>Immune-mediated response of bone in osteomyelitis - fundamental concepts</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000015&lng=pt&nrm=iso&tlng=pt Advancement of knowledge on the role of the immune system in bone metabolism has uncovered a dynamic interdisciplinary research field labelled "osteoimmunology". The immune system provides stem cells for bone remodelling and elaborates cytokines under both physiological- and pathological circumstances which map the local response of bone cells and alter the phenotypic expression of bone. This manuscript provides an overview of the interaction between the immune system and bone in the different stages of osteomyelitis and correlates the inductive patterns with the radiologic appearances. <![CDATA[<b>Biological significance of palatine tonsillar epithelium: microstructure and disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000016&lng=pt&nrm=iso&tlng=pt The epithelial microstructural configuration of the paired palatine tonsils is adapted to optimize lympho-epithelial symbiosis at the first point of contact with an antigen introduced to the pharynx through breathing or swallowing. The loosely arranged reticulated nature of the epithelium of the tonsillar crypt and vesicular transcytosis of live bacteria and viruses across receptor cells contribute to the early pathogenesis of specific neoplastic- and infective diseases which are discussed in the manuscript. <![CDATA[<b>Oral mucosal ulceration - a clinician's guide to diagnosis and treatment</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000017&lng=pt&nrm=iso&tlng=pt Oral mucosal ulceration is a common clinical complaint. Ulceration is often debilitating and affects patients from a wide age group. The clinician confronted with such a patient often feels overwhelmed by the different diagnostic possibilities. Given the wide spectrum of conditions encountered, it is striking that the common use of antibiotics and antifungals to treat oral ulceration, is largely inappropriate. This overview provides general dental practitioners (GDP's) and other general healthcare workers with a broad classification of commonly encountered mucosal ulcerative lesions, a practical approach to reach a diagnosis and basic treatment strategies for each condition. <![CDATA[<b>Lower facial and cervical lymphadenopathy in the context of clinical dentistry</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000018&lng=pt&nrm=iso&tlng=pt The dental practitioner is in a good position to detect lower facial and cervical lymphadenopathy. A medical history and a physical examination of a patient with lower facial and cervical lymphadenopathy might provide important clues as to the underlying cause. Lower facial or cervical lymphadenopathy is usually a manifestation of reactive hyperplasia to local infections of mouth, teeth, jaws or oropharynx; less commonly of malignant metastases. Discrimination between benignly and malignantly enlarged lymph nodes is crucial for appropriate treatment. If the lymphadenopathy does not improve after treatment of a clinically apparent infective cause, then special investigations become necessary for definitive diagnosis and treatment planning. The purpose of this article is to provide the dental practitioner with some guidelines for evaluating patients with lower facial and cervical lymphadenopathy. <![CDATA[<b>Continuous education in sedation: Is the current sedation continuum still relevant?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000019&lng=pt&nrm=iso&tlng=pt The dental practitioner is in a good position to detect lower facial and cervical lymphadenopathy. A medical history and a physical examination of a patient with lower facial and cervical lymphadenopathy might provide important clues as to the underlying cause. Lower facial or cervical lymphadenopathy is usually a manifestation of reactive hyperplasia to local infections of mouth, teeth, jaws or oropharynx; less commonly of malignant metastases. Discrimination between benignly and malignantly enlarged lymph nodes is crucial for appropriate treatment. If the lymphadenopathy does not improve after treatment of a clinically apparent infective cause, then special investigations become necessary for definitive diagnosis and treatment planning. The purpose of this article is to provide the dental practitioner with some guidelines for evaluating patients with lower facial and cervical lymphadenopathy. <![CDATA[<b>Maxillo-facial radiology case 146</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000020&lng=pt&nrm=iso&tlng=pt The dental practitioner is in a good position to detect lower facial and cervical lymphadenopathy. A medical history and a physical examination of a patient with lower facial and cervical lymphadenopathy might provide important clues as to the underlying cause. Lower facial or cervical lymphadenopathy is usually a manifestation of reactive hyperplasia to local infections of mouth, teeth, jaws or oropharynx; less commonly of malignant metastases. Discrimination between benignly and malignantly enlarged lymph nodes is crucial for appropriate treatment. If the lymphadenopathy does not improve after treatment of a clinically apparent infective cause, then special investigations become necessary for definitive diagnosis and treatment planning. The purpose of this article is to provide the dental practitioner with some guidelines for evaluating patients with lower facial and cervical lymphadenopathy. <![CDATA[<b>Treatment versus Research: Part 5: Bridging the Boundaries</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162016001000021&lng=pt&nrm=iso&tlng=pt The dental practitioner is in a good position to detect lower facial and cervical lymphadenopathy. A medical history and a physical examination of a patient with lower facial and cervical lymphadenopathy might provide important clues as to the underlying cause. Lower facial or cervical lymphadenopathy is usually a manifestation of reactive hyperplasia to local infections of mouth, teeth, jaws or oropharynx; less commonly of malignant metastases. Discrimination between benignly and malignantly enlarged lymph nodes is crucial for appropriate treatment. If the lymphadenopathy does not improve after treatment of a clinically apparent infective cause, then special investigations become necessary for definitive diagnosis and treatment planning. The purpose of this article is to provide the dental practitioner with some guidelines for evaluating patients with lower facial and cervical lymphadenopathy.