Predictive value of group I oral lesions in detecting HIV infection amongst patients attending PHC facilities in Gauteng

Abstract The utilization of oral lesions as a screening tool for HIV is not well documented. Attendees at two primary health care facilities (Khutsong and Heidelberg) were assessed to determine the predictive value of group I oral lesions for HIV infection. The objectives were to investigate the: 1) HIV prevalence amongst attendees at PHC facilities, 2) Prevalence of HIV-related oral lesions and 3) Correlation between the oral lesions and the HIV status using the Likelihood Ratio test. Methods: All patients over 12 months of age presenting at the two facilities for a curative care consultation over a one-week period (in April 2005) were included. Consent was obtained by trained counselors who also conducted a brief interview and offered pre-test counseling to patients wishing to know their HIV status. Two calibrated dentists conducted a head, neck and oral examination and administered a rapid saliva HIV test (OraQuick HIV-1/2-Rapid HIV-1/2 Antibody Test). Results: A total of 654 attendees were surveyed in the 2 facilities. There was a 100% response. The mean age of the participants was 34 years (range: 1-94), and the majority (73%) were female. HIV prevalence rates were 34% at Khutsong and 36% at Heidelberg. The HIV prevalence peaked at 46% in the 16-45 age groups. Of the 228 who tested positive for HIV, 121 (53%) patients were diagnosed with 1 or more Group I oral lesion. Oral candidiasis (46%) and oral hairy leukoplakia (19%) were the two most common oral lesions diagnosed in the HIV positive cohort. The positive predictive values and specificity values for multiple lesions ranged between 96% and 100%. Most of the likelihood ratios for multiple lesions were greater than 10 which implied that the patients who presented with these lesions were extremely likely to test positive for HIV. The sensitivity values (1% to 37%) and negative predictive values (66% to 70%) remained relatively low. Conclusion: The HIV prevalence of patients attending PHC facilities was high (34%). Oral lesions are useful markers of HIV-infection and should alert clinicians to the presence of HIV infection. Multiple group I lesions were more predictive of HIV infection compared to single lesions

Attitudes of oral hygiene and dental therapy students regarding the introduction of community service.

Student Number : 9001367H - MPh research report - School of Public Health and Oral Health Sciences - Faculty of Health SciencesIntroduction: Compulsory Community Service (CS) for health professionals has been introduced in South Africa since 1997. Some of the aims for its introduction were to: 1) address the maldistribution of health service providers, 2) prevent qualified health professionals from emigrating and 3) improve clinical skills and knowledge of newly qualified medical graduates. The Oral Hygiene (OH) and Dental Therapy (DT) professions have as yet not been included in the performance of CS. However the Department of Health (DOH) is planning to introduce CS for these groups of health professionals in the near future. The role of the oral hygienist and dental therapist in South Africa (SA) cannot be over emphasized. Given the high caries levels, low oral hygiene education levels, large unmet oral health needs and the preventative approach of the DOH at all levels, the oral hygienist and dental therapist can provide invaluable human and technical resources that are currently required to address these concerns. Aims: To assess the attitudes of OH and DT students registered during 2004 at the five dental schools in South Africa regarding the introduction of CS. Objectives: 1) To obtain the demographic data of the OH and DT students, 2) to determine whether their current training programme prepares these students for CS, 3) to identify the provinces in which the OH and DT students would prefer to be placed for CS and 5) to identify the different types of professional activities that the OH and DT students would like to perform whilst completing CS. Methods: A self administered questionnaire was jointly developed between the Kwa- Zulu Natal Department of Health and the Division of Public Oral Health at the University of Witwatersrand, Johannesburg. The questionnaire was sent to all OH and DT students who were registered at each of the five dental schools in SA during 2004. Results: There were a total of 163 students (68%) who responded to the questionnaire. Of the respondents, 109 (70%) were OH students and 54 (64%) were DT students. There were 132 (81%) females and 31 (19%) males. The average age of the student’s was 21 years (17-37; mode 19; median 20 and SD 3.2). There were 59 (36%) Whites, 53 (33%) Black, 31(19%) Asian and 18 (11%) Coloured students. The majority of OH students (63%) were against the introduction of CS. There was a significant number (p<0.05) of White students who were registered for the OH degree that did not want to perform CS. A significant number of respondents (p<0.05) felt that they were adequately trained to perform all the necessary duties that may be required of them during their CS. Most of the respondents chose Kwa-Zulu Natal (26%), Western Cape (26%) and Gauteng (22%) provinces respectively as their first choice province for carrying out their CS. The majority of students (p<0.05) chose their resident province as their first choice province in which they would prefer to perform their CS. Students indicated a preference to perform oral health promotional activities (56%), health educational activities (21%) and clinical work (18%) in their CS programme. Conclusion: The majority of DT students supported the concept of CS. This was in contrast to the OH students where less than half of them supported its introduction. Overall, most of the students chose the more urban provinces (Kwa-Zulu Natal, Western Cape and Gauteng) to complete their CS

Oral health knowledge, attitudes and practices among school teachers in Tshwane district, South Africa

Teachers are perceived as role models and studies have shown that they can enhance the oral health behaviour of young children. To assess the oral health (OH) knowledge, attitudes and practices of public school teachers in a district in Pretoria, South Africa. This was a cross sectional analytical study. The sample comprised of six schools that were randomly selected within the Tshwane West sub district. A total of 160 teachers were included. A modified, self-administered, validated questionnaire was used to obtain the data. Of the 160 teachers included, 97 (61%) completed the questionnaire. The majority (80%) were female and the mean age was 38.23 years (±12.85; 22-66). More than 80% had an adequate level of OH knowledge, 94% reported it was important to visit a dental practitioner (DP) regularly and 94% believed that OH education should form part of the teaching curriculum. The most common reason for visiting a DP was toothache (32%) while fear (35%) was the most common barrier. Those with a higher mean age were more likely to brush frequently (p&lt;0.01), utilise dental aids (p=0.01) and visit a DP regularly (p=0.02). The majority of teachers had adequate OH knowledge. The respondents with a higher mean age were more likely to brush frequently, use dental aids and visit a DP regularly. Workshops for teachers are required to improve current levels of knowledge and address any queries regarding prevention and diagnosing of dental diseases

Learning experiences of undergraduate first-year dental and oral hygiene students at a South African dental university

Students in higher education institutions endure many difficulties which may adversely affect their career choices, learning experience and academic success. Aims and objectivesThe aim of this study was to identify factors contributing to learning experiences of undergraduate dental and oral hygiene students during their first year of study at a South African dental university. DesignCross-sectional design that included quantitative and qualitative data.MethodsAn online questionnaire was used to capture the students’ perceptions towards learning experiences and factors contributing to academic success. The sample consists of 84 first-year dental and oral hygiene students registered in the 2021 academic year. ResultsA total of 59 students responded (70%) and most of them reported to have problems with academic learning, time management, heavy workload and a negative attitude towards online lectures. Problems related to social learning included inability to make friends and lack of participation in university social activities, finances and accommodation. In terms of coping mechanisms, students utilised tutoring classes, sought advice from senior students, watched educational YouTube videos and applied for a study loan or bursary. Students reported to obtain emotional support from friends and family members and adopted a positive attitude resulting in committed self-motivation. ConclusionMost students had challenges with academic and social factors. Students requested they be assisted in time management skills and study skills, in coping mechanisms to deal with a demanding workload and having access to an educational psychologist

A review of the 2030 Human Resources for Health Strategy: Implications for dentistry in South Africa

The South African National Department of Health (NDoH) released a report in March 2020: “2030 Human Resources for Health (HRH) Strategy: Investing in the Health Workforce for Universal Health Coverage”. This report, has implications for the training of dental personnel and the planning of dental services in South Africa(SA). The aim was to summarise and critique the HRH strategic document with reference to dentistry. This was an independent review of the report and included recommendations and implications for the training of dental personnel in SA. The report employed two models to predict the number of dental personnel that will be required; one on achieving provincial equity and the other on improving access to Primary Heath Care (PHC) facilities. The calculations were based on dental personnel employed in the public sector and the number of uninsured people in SA. The first model predicted a shortfall of 486 dentists, 60 specialists, 13 Dental Technicians (Dent Tech), 162 Dental Therapists (DTs) and 104 Oral Hygienists (OHs). The second model, based on PHC utilization, predicted a surplus of 341 dentists and a shortage of 1128 OHs and 1164 DTs. In order to meet these shortages, NDoH would have to allocate R840 million or 2.3 Billion rands respectively, depending on which model is chosen. Irrespective of the model utilised, the NDoH needs to create and fill more dental posts, especially in provinces with low dental practitioner to population ratios. Dental training institutions need to align the training of dental graduates to meet the demands as set out in the report

A Randomized Controlled Trail Comparing the Efficacy of 0.5% Centbucridine to 2% Lignocaine as Local Anesthetics in Dental Extractions

The development of local anesthesia in dentistry has marked the beginning of a new era in terms of pain control. Lignocaine is the most commonly used local anesthetic (LA) agent even though it has a vasodilative effect and needs to be combined with adrenaline. Centbucridine is a non-ester, non amide group LA and has not been comprehensively studied in the dental setting and the objective was to compare it to Lignocaine. This was a randomized study comparing the onset time, duration, depth and cardiovascular parameters between Centbucridine (0.5%) and Lignocaine (2%). The study was conducted in the dental outpatient department at the Government Dental College in India on patients attending for the extraction of lower molars. A total of 198 patients were included and there were no significant differences between the LAs except those who received Centbucridine reported a significantly longer duration of anesthesia compared to those who received Lignocaine. None of the patients reported any side effects. Centbucridine was well tolerated and its substantial duration of anesthesia could be attributed to its chemical compound. Centbucridine can be used for dental procedures and can confidently be used in patients who cannot tolerate Lignocaine or where adrenaline is contraindicated

A review of the 2030 Human Resources for Health Strategy and Vision: Goals and their implications for dentistry

The South African National Department of Health(NDoH) released a report in March 2020: “2030 Human Resources for Health (HRH) Strategy: Investing in the Health Workforce for Universal Health Coverage”. The aim was to analyse the five National Health Goals for 2030 with reference to the impact they could have on dentistry in South Africa. This was an independent review of the HRH strategic document with inputs from three specialists in Community Dentistry. The views are that of the authors and not necessarily from the report itself. The strategic document comprised of five goals and each goal’s objectives implication to dentistry was analysed based on the SMART criteria. Some of the goals are being attained but to meet the remaining goals, government has to increase its commitment to improving oral health. More posts in the public sector needs to be created, managerial posts need to be filled by community dentistry specialists, current managers need to be upskilled, the number of mid-level workers (MWs) posts (oral hygienists and dental therapists) need to be increased and the MWs financial package needs to be improved. The tertiary institutions need to train oral health workers who are aligned with the oral disease burden, introduce careerpathways for MWs and assist in supporting oral health research and training of oral health managers. In terms of oral health, there is an urgent need to determine and align the disease burden and these goals. There should be an increase in the number of MWs, existing managers need to be upskilled, and adverts for managerial posts need to have clear criteria for the required skills.&nbsp

The self-perceived sources of stress among dental students at a South African dental school and their methods of coping

INTRODUCTION : Dental students have reported that, as a result of the nature of the dental curriculum, they are under severe stress while studying. AIM : to determine how students perceived the sources of stress and to identify the coping mechanisms used. METHODS : This was a cross-sectional analytical study using a standardized self-administered questionnaire. All dental students registered in 2015 were invited to participate. All data was secured as confidential and anonymous. RESULTS : Responses were received from 224 students (74%, of whom 26% were male). One third of responding males and 45% of responding females reported severe levels of stress. Clinical students reported a significantly higher (p=0.002) prevalence of severe stress over non-clinical students. The most common causes of severe stress were fear of failure (47%) and high workload (38%). The coping mechanisms included sleeping (64%) and watching television (55%). More than a quarter contemplated changing from Dentistry as a result of their perceived stress. Those who reported having severe stress were 1.8 and 2.1 times more likely to quit Dentistry or to commit suicide. CONCLUSION: Females and clinical students reported higher levels of severe stress. Those with severe stress were significantly more likely to contemplate quitting Dentistry or suicide.http://www.sada.co.zahj2017Community Dentistr

Periodontal disease - risk factors and treatment options

Periodontal disease (PD) encompasses both gingivitis and periodontitis. Both are initiated by plaque and are influenced by the immune and inflammatory responses of each individual. In addition, PD is modified by several risk factors including smoking, medications, alcohol, age, gender and systemic diseases. Gingivitis affects 50–90% of adults worldwide and is reversible by simple, effective oral hygiene and lifestyle changes. Between 10–15% of the global adult population suffer from progressive periodontitis, which if left un- attended, results in halitosis, pain and loss of teeth. As dental plaque is the principal etiological factor in the pathogenesis of PD, effective oral hygiene and plaque removal is the most important strategy in the pre- vention of this disease. There is also evidence that PD has several modifiable risk factors in common with cer- tain non-communicable chronic diseases like diabetes. Therefore, to prevent PD, the approach of controlling the common risk factors could be an effective strategy. Potential risk-factor entry points are reduction of tobacco use, reduction in consumption of harmful levels of alcohol, a healthy diet and good nutrition and improvement of personal hygiene. Whilst PD is not contagious it can become extremely common and debilitating, given the ideal environment. This paper discusses the risk factors and identifies options by which PD can be prevented and reduced.https://www.sada.co.za/the-sadjam2019Community Dentistr

Types of dental emergency services provided to dentally fit soldiers in Area Military Health Unit Gauteng, South Africa

BACKGROUND : The prevention and treatment of dental diseas-es are important in maintaining a combat-ready military force. AIM : To determine the type of dental emergency treat-ments provided over 12 months to soldiers who had been classified as dentally fit. METHODS : A retrospective analysis was carried out of the dental records of members of the South African National Defence Force in Gauteng who had been screened and certified to be dentally fit in 2009. The records of the par-ticipants were followed up for a year thereafter to determine the profile of dental emergency treatments rendered. Data analysis included frequencies and correlations using chi-square tests. The level of significance was set at p<0.05. RESULTS : Of the 6352 soldiers deemed to be dentally fit, 1947 (30.7%) returned for treatment within 12 months. Most required dental restorations (59%) followed by ex-tractions (13%) and crown/bridge repairs (12%). In general, males, soldiers between 41 and 50 years, non-commis-sioned officers, Whites and Oral Health Fitness II (OHF) received more dental emergency services compared with their counterparts. CONCLUSIONS: A large number of soldiers previously deter-mined as dentally fit required restorations and extractions within a year. The treatment procedure profile was influ-enced by OHF classification, race, age and military rank.http://www.sada.co.zahj2017Community Dentistr