Upholding parameters of care in a service-provision constrained time period

Advances in technology necessitate constant changes in all aspects of medical education and patient care. This requires educators and clinicians to merge traditional practices with new innovations, materials and techniques. We are also aware that rapid and dramatic changes are taking place in the world with respect to urbanisation and migration, science and technology and the future of the earth

Isolate in unison, wear your mask in unity

In keeping with the cover theme of masks, it seems that the dreaded Corona virus (SARS-CoV-2) has made manypeople weary and even rebellious towards wearing protective facemasks. This brought back memories of a patient who had been treated at one of the government hospitals many years before airborne epidemics made mask-wearing in public an observable occurrence. His story will be related in the hopes that its childlike innocence will be a reminder to us all that if we unselfishly unite in our struggles against this, and any of life’s adversities, we WILL all winin the end

International Earth Day - 22 April

In the 1969 UNESCO Conference in San Francisco, peace activist John McConnell proposed a day to honour the Earth and the concept of peace. The first such event was celebrated on March 21, 1970 to coincide with the first day of spring in the northern hemisphere. A month later the United States Senator Gaylord Nelson proposed the idea to hold a nationwide environmental teach-in on April 22, 1970

Professor Johannes Frederick van Reenen ...a doyen of the profession (20/04/1926 to 8/9/2007)

Frikkie Van Reenen qualified BDS (Rand) in 1949, and then spent his first year as a dentist in London before returning to South Africa and opening a private practice in Pretoria. It was there that he began his foray into acade-mia when he was appointed to a post as an honorary lecturer at the Faculty of Dentistry, University of Pretoria

Special-IST versus Special inter-IST

Dentists who wish to specialize in a specific discipline have to undergo and complete a rigorous, structured and extensive postgraduate academic and practical training programme, and pass all the requisite exams. Only then can they be registered with a regulating professional body and be recognized as such in that field. Thereafter their scope of practice becomes limited to that specialty alone. This differs from general dentists, who are not restricted in their scope of practice, but may have limitations to the extent of their capabilities. They may choose to upskill themselves through attendance at short courses, hands-on training workshops, informal study groups, dental company workshops or even YouTube videos. Unlike the trainee in a formal institution, this is unstructured and outcomes are unspecified, yet some of these practitioners then market themselves as specialists in these fields. While the Health Professions Council of South Africa (HPCSA) has set out a list of core ethical values and standards for good practice, there are no regulations enforcing the need for these practitioners to undergo and pass HPCSA recognized examinations to assess their capabilities, knowledge and skill in these modalities. This opens the profession up to risks of practitioners contravening a number of core values and standards expected of trusted professionals and can mislead and put the general public at risk. This paper aims to explore if regulation of this type of practice is required, who should be allowed to offer additional training to dentists, and who should be regulating the trainers

Probing Status Quo Bias in Dentistry

The status quo bias in dentistry refers to a practitioner's preference for certain treatment modalities and resistance to contemplating the need for a change. Lack of updating skills and amending their work routine accordingly can result in them providing treatment that is dated or even totally obsolete. It could even be detrimental to their patient's oral health and open them up to the risk of litigation. The concept of Continuing Professional Development (CPD) was introduced to try enforce clinicians to improve their knowledge and skills, and keep abreast of current best practice recommendations. However, it should not be seen as a mere points collecting exercise that has little effect on bringing about changes in their work. Dentists need to continually review their work, and make adjustments when necessary in order to do better and be better. Only then canthey claim to be acting in their patients’ best interest and fulfilling their duty of beneficence

Fraudulent records – Grave forensic consequences

Natural disasters, fatal accidents, and violent criminal offences are part of everyday life. All of these may result in fatalities that shatter the lives of the victim’s families and friends. Their trauma is compounded by the fact that all unnatural deaths have to be investigated, and the bodies of the deceased positively identified before they can be released to the families for burial. Bodies of victims of violent crimes, fires, drowning, motor vehicle or aviation accidents, work place fatalities or situations where some time has elapsed since death may be so disfigured that “identification by a family member is neither possible or desirable”. Often the nature or degree of the injury may be so extensive that fingerprinting is also not a viable option. DNA analysis may be considered, however it takes time and is a costly procedure. There are also concerns with maintaining strict control over the chain of evidence during all additional procedures and tests. Thus, in these situations the forensic odontologist may be called in as part of the investigative team

Refusing to treat – is it legal? Is it justifiable? Is it ethical?

Historically, when clinicians wanted to know if certain conduct was ethical, they would consult the guidelines set out in the Hippocratic oath. While adherence to the oath may “represent an expression of the professions’ ethical obligations”, and be useful in promoting their commitment to “abide by these norms”, this assumption is open to question.1 Different practitioners may see and interpret the codes in different ways, depending on their personal ethos as well as the specific time and situation under consideration. At the same time, ethical material can and should reform, and when needed, be re written under optimal cool, calm conditions. Changes should be based on “contributions from those with a variety of perspectives who have access to as much available knowledge as possible” and not implemented as a result of immediate pressures where there may be distorting circumstances.1 Perhaps the best way to judge their value is to debate how well the code addresses the issue at hand in terms of its “comprehensiveness, clarity and consistency”.1 This paper uses an actual patient scenario as a basis on which to pose some clinically and ethically related queries and postulate possible solutions

Looking beyond the physical management of patients with head and neck cancer

Cancers of the head and neck region often leave patients with conspicuous defects, as well as limitations in physical and psycho-social functions. Rehabilitation is challenging and can never fully restore the anatomical, physiological, or functional characteristics that have been lost. Ideally newly diagnosed cancer patients should be managed by a multidisciplinary team of specialists from various allied fields who will be able to educate them and help them decide on the most appropriate and suitable treatment options. Patients must understand the processes, be of possible side effects and comprehend the limitations aware of rehabilitation. At the same time, clinicians may need to consider issues of distributive justice when deciding which patients will receive which resources, especially in financially limited institutions and countries. The biggest challenge to us as clinicians as well as community members is to try and treat all patients holistically and to address both their physical and psychosocial needs. This requires a fervent commitment to action, and that we all stand together and help each other through difficult times

Deciding on prosthodontic treatment in children with inherited dental abnormalities : should psychological or dental well-being take precedence?

Children with inherited dental anomalies have many complex problems that may interfere with their physical, mental and psychological well-being.1,2 The anomalies generally present early in life as isolated conditions, or associated with other defects, and may require immediate as well as prolonged multidisciplinary management.2 The spectrum of defects is diverse, as is the range of deformities that can manifest in the head and neck region.1 Common to all is their potential to have “profound negative consequences for the individual and their families, ranging from aesthetic concerns that impact on their self-esteem, to masticatory difficulties, tooth sensitivity, financial burdens, and protracted dental treatment.”http://www.sada.co.zaam2019Prosthodontic