Oral hygiene habits and status of orthodontic patients attending the University of Pretoria, Oral and Dental Hospital

Most orthodontic patients struggle to maintain good oral hygiene during treatment. To determine oral hygiene habits and status of patients undergoing fixed orthodontic treatment at University of Pretoria, Oral and Dental Hospital. A cross-sectional descriptive study. A modified, validated, self-administered questionnaire was used, and clinical examinations were conducted using Orthodontic Plaque Index, Gingival index, and Bleeding index. The questionnaire sought to determine knowledge and practice patterns. Data analysis included frequencies and correlations using chi-square test, with a significance of p<0.05.Fifty patients participated with 34(68%) being female with ages from 10 to 28 and a mean of 18,5. Seventy percent avoided sticky foodstuff, 74% used mouthwash, 56% flossed daily and 84% brushed twice daily. However, 82% consumed sugar containing drinks. Clinical exam revealed an Orthodontic Plaque Index mean of 2.6, Gingival Index mean of 0.1 while the Bleeding Index was 13.3 and 90% had normal gingiva. There was a significant difference in Gingival Index score between patients at age category 10-19 and 18-24 (p< 0.05). This study revealed a satisfactory oral hygiene status among patients at the institution with the majority of patients maintaining good oral hygiene practices. However, 82% consumed sugar sweetened beverages

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<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

Self-reported substance use, in dental and oral hygiene students at a university in South Africa

A recent study amongst South African dental students found that a number of them had perceived moderate to severe stress and as a result, some have resorted to stimulant drugs. The aim of the study was to assess substance use by dental and oral hygiene students at a university in South Africa. A cross-sectional design was used and all dental and oral hygiene students registered in 2019 at a university in South Africa were asked to participate. Materials and Methods A pretested, validated self-administered questionnaire was used to achieve the aim. The objectives were to identify which substances were used, where they were obtained, frequency and reasons for use, as well as the self-perceived benefits and side effects experienced. Data was analysed using SPSS version 27. The data was confidential and anonymity was ensured. A total of 303 (88%) agreed to participate with ages from 17 to 36 years and a mean of 22.3 years. Over two thirds 206 (67.9%) used substances. Almost half of the group (44.6%) took one product, 16.5% took two, and 7% consumed between 3 and 5. The sources of substances ranged from peers, friends, acquaintances and pharmacies. Nearly twenty percent of the students used caffeine products, energy drinks, and methylphenidate. Almost 10% used anti-anxiety pills and anti-depressants whilst just above 11% used natural boosters and multivitamins. More than half of the students used the substances to stay awake and improve marks and 45(22%) of the users struggled to stop. Conclusions Over two thirds of students used substances, with almost half using one substance. There were multiple sources of substances. More than half of the students used them to stay awake and improve marks

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 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

Frozen sections in head and neck surgery and the impact of intraoperative analysis on final resection margins: An institutional study

Frozen section (FS) analysis is an indispensable tool for intraoperative patient management.To assess the utilisation of head and neck FS analysis, with a particular focus on the concordance rate between the intraoperative FS margin analysis and the final FFPE results. Additionally, to determine whether FS analysis had any impact on intraoperative patient management.Lastly, to determine the impact of the FS analysis on the final margin status of resection specimens. Histopathology reports from January 2015 to December 2018 were reviewed at Pretoria Oral and Dental Hospital to analyse all FS requests involving the head and neck region. Captured data was analysed to determine the concordance rate, discordance rate, and FS deferral rates, with correlations performed using the Chi-square test. Eighty-two frozen section cases were reviewed with a total of 312 FS tissue sections performed. The majority (73%) of the FS requests were from the Maxillofacial and Oral Surgery (MFOS) department for the assessment of surgical margins. The FS-FFPE concordance and discordance rates were at 97.5% and 2.4% respectively, with a deferral rate of 1.2%. Additional surgical margins were only received in 16 of the 26 cases with positive margins on intraoperative FS analysis. There was no statistically significant correlation between intraoperative FS positive margin status and advanced pathological T staging. The concordance rate between intraoperative FS margin analysis and final FFPE results were within an acceptable range. In a significant number of cases, the intraoperative FS margin analysis did not influence further surgical management

Buccal corridor changes in orthodontically treated extraction and non-extraction Class 1 patients

Patients seek orthodontic treatment mainly to improve their facial aesthetics and obtain an acceptable smile. It is purported that orthodontic extraction treatment may result in narrow buccal corridors which in turn may lead to unaesthetic smile. To determine if the dimensions of the buccal corridors are influenced by extraction or non-extraction treatment in Class 1 patients. Retrospective record-based study conducted between 2012 and 2017 at University of Pretoria Orthodontic department. Smile pictures of pre- and post-treatment Class 1 patients treated with or without premolar extractions were matched. Buccal corridors between the two groups were measured by measurement of visible maxillary dentition and oral aperture dimensions. Data analysis included frequencies and correlations using chi-square test, with a significance level set at p<0.05. Seventy-one patient records met the selection criteria with the majority being females (70%). The age range was between 10 and 37 with a mean of 17.5 years. Thirty-five patients were treated with extractions and thirty-six patients with non-extraction treatment. There was a significant difference in the visible maxillary dentition pre and post treatment with extraction patients showing a 6 to 6 and non-extraction showing 5 to 5 dentition post treatment (p<0.05). There were no differences in the ratios of the visible maxillary dentition and oral aperture in both groups pre and post treatment (p> 0.05). Orthodontic treatment of Class 1 cases with premolar extraction did not lead to deleterious changes in the buccal corridors

Improving the Census Legal and Policy Reforms for a More Accurate, Equitable, and Legitimate Count

The census is a cornerstone of American democracy. The results of this constitutionally required, once-a-decade count of every person living in the United States dictate how seats in the House of Representatives are divided among the states, how state and local governments draw electoral districts, and how more than $1.5 trillion annually in federal funds is distributed for essential services such as health care, food assistance, and education. At its best, the census offers an authentic picture of who we are as a diverse and growing nation.The 2020 census struggled. It faced a barrage of obstacles, from executive interference to chronic underfunding to the Covid-19 pandemic. In the face of these challenges, it ultimately failed to reach 18.8 million people — more than 5 percent of the country's population. What's more, the census once again disproportionately undercounted people of color, with the Latino undercount rate more than tripling from the prior decade. And multiple states were undercounted by significant margins. These inaccuracies compromise the census's ability to fairly distribute political power and federal funding both across states and across communities, undercutting the democratic promise of our political system. Meanwhile, overall census response rates remain stuck in a rut, costs are rising, and the bureau's reliance on labor-intensive door-to-door outreach is showing its limits. The census is too critical to continue in this precarious state.This paper sets forth a blueprint for reforming the law and policy of the decennial population count. Our goal is to make future censuses more accurate, equitable, and legitimate. An accurate census correctly captures the number and demographic characteristics of all people residing in the country. An equitable census is designed, funded, and run to count all groups precisely and to distribute political power and economic support commensurate with each community's fair share. A legitimate census — one that is scientifically rigorous and democratically accountable and boasts universal participation — warrants and inspires widespread trust. Legitimacy and accuracy require equity; an equitable census is free from the long-running tendency to undercount Black, Latino, and Native American communities in comparison with white ones, inspiring confidence in its fundamental fairness

A Review of the South African National Oral Health Policy

Advocacy for oral health promotion, prevention and treatment of oral diseases is founded on a comprehensive oral health policy that is integrated into the South African National Health Policy. The policy is intended to be a roadmap in the pursuit of achieving optimum oral health for the South African population. To review the National Oral Health Policy of SA (NOHPSA) in terms of context, strengths, weaknesses, implementation and monitoring regarding the oral health status of the SouthAfrican population.Results Promotive and preventive services lack detail on activities to achieve goals. The objectives, although very well defined, cannot be measured and there is no way of knowing whether they have been achieved. It was evident that the policy needs to be reviewed and updated in accordance to recent survey data, population growth and the profile (number and types) of health service providers. The prospect of updating the policy relies on the availability of current epidemiological surveys, which are not available, the most recent survey was conducted in 2002. The policy lacks a monitoring and evaluation plan. This is critical not only for the assessment of actualisation of aims and objectives, but for the sustainability of intended interventions

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London