Dentistry in South Africa and the need for management and leadership training

Dental professionals face many challenges due to a rapidly changing environment, and are acknowledging the need for essential leadership skills to perform optimally. We assessed key stakeholders’ views about the need for management and leadership training in dentistry in South Africa . The aim of this study, was to assess the need for leadership and management training in Dentistry in South Africa from an industry perspective. A qualitative study. Purposive sampling of 14 Senior Managers in the dental environment and 11 recently qualified dentists in South Africa. We conducted one-on-one and telephonic interviews guided by a semi-structured questionnaire with open-ended questions. Interviews were recorded, transcribed and data was thematically analysed. Participants expressed concerns about dentistry in South Africa. All participants mentioned financial constraints, including the high cost of setting up a practice, high cost of imported consumables and dwindling support from medical schemes. Participants stated that strong leadership and managerial skills were important for dealing with these challenges. Inculcating these skills will make a remarkable difference in enhancing services and providing purposive direction within the profession.

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.

Effect of flask closure method on occlusal vertical dimension of complete upper and lower dentures

The movement of teeth during processing of complete dentures disturbs the harmonious occlusal scheme established at the final wax try-in stage. Aims and objectives: to investigate the effect of RS flask closure on occlusal vertical dimensions of complete dentures. The mean occlusal vertical dimension of complete maxillary and mandibular dentures fabricated by the conventional flask closure were measured and compared with that of dentures fabricated by RS flask closure. Design: A pre-test post-test control group experimental design. Methods: Thirty sets of complete maxillary and mandibular wax trial dentures were randomly assigned to experimental groups. Fifteen sets were assigned to conventional flask closure and the remainder to RS flask closure. Compression molding with a long curing cycle was performed for the processing of the dentures. Pre-processing and post-processing occlusal vertical dimensions were determined. Results: The mean occlusal vertical dimensions of wax trial dentures assigned to either group were similar. The data produced substantial evidence to reject the null hypothesis that the post-processing mean occlusal vertical dimensions of both groups were equal. Conclusion: The occlusal vertical dimensions produced by dentures clamped by the RS flask closure were significantly less than those produced by dentures clamped by the conventional flask closure.

Should dental amalgams be used in dental training? The perspectives of dental academics at a university in South Africa

Dental amalgam has been used in dentistry for the last 150 years to restore posterior teeth. Concerns regarding the safety issues with amalgam due to its mercury content have lead to the introduction of composite dental material to restore posterior teeth. This has transformed the teaching and training trends of direct restorative materials for posterior teeth. This descriptive study aimed to gain insight into academic staff and clinical supervisors’ perceptions regarding the use of dental amalgams in the teaching of restorative dentistry. This study used a qualitative method of data collection. Two focus group discussions were conducted between March and May 2020. Seventeen participants were invited to participate. Fourteen responded and participated, yielding an 82% response rate. The data identified two major themes, viz. the challenges experienced with the teaching of dental amalgam and curriculum development recommendations. Clinical quota requirements, disposal of waste products, and occupational and environmental risks regarding mercury exposure were sub-themes. Some of the curriculum recommendations included the skills gained during cavity preparations, the training and quota requirements of dental materials, and teaching trends locally, nationally and internationally.This study revealed that dental amalgam is still an integral part of the restorative dentistry curriculum at the university. However, the teaching of resin composite now occupies more than fifty percent of the restorative dentistry curriculum. Academics and clinical supervisors show a greater affinity for the placement of composite restorations.

Maxillofacial Radiology 194

CBCT imaging and analysis was performed. Observe unilateral expansion by the distending soft tissue outline illustrated through 3D rendering (Figure 2). Sagittal oblique (Figure 3) and axial (Figure 4) slices depict a round heterogenous predominantly high-density lesion with an encompassing thin uniform less dense peripheral band. Irregular root resorption, displacement of the inferior alveolar nerve canal, buccal-lingual cortical expansion, thinning, and interruption was apparent. Irregular thickening at the inferior border and surrounding osteosclerosis were noted. A macroscopic view (Figure 5), photomicrograph (Figure 6), and conventional radiograph (Figure 7) of vertically sectioned surgical specimens of similar lesions. Note the intimate relationship with the tooth roots.

What’s new for the clinician – summaries of recently published papers

To date, very few treatments have been demonstrated to reduce the burden of morbidity and mortality from COVID-19. Although corticosteroids have been proven to reduce mortality in severe disease, there has been little convincing evidence on interventions that may prevent disease, reduce hospitalizations, and reduce the numbers of people progressing to critical disease and death. Ivermectin is a well-known medicine that is approved as an antiparasitic by the World Health Organization and the US Food and Drug Administration. It is widely used in lowand middle-income countries to treat worm infections. Also used for the treatment of scabies and lice, it is one of the World Health Organization’s Essential Medicines.1 With total doses of ivermectin distributed apparently equalling one-third of the present world population,1 ivermectin at the usual doses (0.2–0.4 mg/kg) is considered extremely safe for use in humans.1 In addition to its antiparasiticactivity, it has been noted to have antiviral and anti-inflammatory properties, leading to an increasing list of therapeutic indications. South African authorities approved the use of a drug used to control parasites in humans and livestock to treat coronavirus patients. Additionally, in January 2021, the South African Health Products Regulatory Authority (SAHPRA) announced that ivermectin, would be allowedfor use on compassionate grounds in a controlled-access program. Ivermectin locally has been used for the prevention and/or management of Covid-19 infection. This has resulted in a huge black market trade of ivermectin in South Africa as many health professionals and others have taken to social media and other platforms to profile this drug as an effective treatment for the covid-19 viral infection. Roman and colleagues (2021)1 conducted a systematic review and meta-analysis to evaluate treatment effects of Ivermectin (IVM) on clinical outcomes and adverse events (AEs) in people with COVID-19.

Resolution of a large periapical lesion in an immature maxillary lateral incisor with the aid of triple antibiotic paste

Apexification procedures are frequently performed on immature permanent teeth with incomplete root formation, open apices and necrotic pulp status with or without periapical lesions in order to induce a calcific barrier prior to root canal therapy. The elimination and control of infection in the root canal space is critical to the success of these procedures. A healthy 21-year old male presented with pulpal necrosis, a large periapical lesion, incomplete root formation and an open apex on a maxillary right lateral incisor. Triple antibiotic paste was used to achieve antimicrobial control after traditional calcium hydroxide paste medicament failed to resolve the symptoms. Obturation was achieved using MTA and the conventional apexification technique. Excellent healing of the large periapical lesion was achieved without surgical intervention and the 4-year follow-up CBCT demonstrated complete bone fill of the lesion. Clinicians should be aware that alternative antimicrobial medicaments, such as triple antibiotic paste, may be beneficial in situations where conventional medicaments prove unsuccessful. The use of triple antibiotic paste may result in sufficient healing of the periapical lesion to justify placement of an MTA apical barrier without the need for surgical intervention

Is “Failure to treat” a Treatment failure?

Over-servicing in dentistry has been widely reported on and censured due to the potential physical, social and financial harms it can cause a patient. In contrast, under-treatment is less often noticed or raised as a concern as it seldom presents with overt signs of carelessness or disregard. In addition, it is usually not accompanied by any time or financial burdens, thus patients rarely complain about it. While some practitioners may argue that failure to treat is a form of negligence, this paper will explore if, and when it could be justified. While practitioners may never reach a consensus agreement, the ultimate message is that all treatment should be patient centred and should only commence following their educated, considered, autonomous, and voluntary consent.

Survival of Patients with Floor of Mouth Squamous Cell Carcinoma Treated with Surgical Resection and Reconstruction

To identify predictors of survival in patients with floor of mouth Squamous Cell Carcinoma (FOMSCC) in order to improve patient selection for resource intensive resection and reconstruction procedures. A retrospective record review of patients who underwent resection and reconstruction for FOMSCC at Charlotte Maxeke Johannesburg Academic Hospital. Patient data were collected and analyzed with respect to age, sex, race, tobacco usage, alcohol usage, tumour stage and post-operative chemo-radiation. One- and five-year recurrence and survival rates were also evaluated. Within the study period, 20 patients were identified that were treated with resection and reconstruction for FOMSCC. The mean age at diagnosis was 56.85 years, with 70 percent of the sample being male and fifty percent being black. Amongst the sample, 90 percent of patients used tobacco and 60 percent were frequent alcohol users. The most common stage at diagnosis was stage IVA which was found in 40 percent of the sample. There were no significant factors associated with recurrence at 1 year. At 5 years, alcohol usage was a significant predictor of recurrence (P=0.044).There were no significant factors associated with death at 1 year however tumour stage at 5 years was a significant predictor (P=0.035). Out of 20 patients, five patients had recurrence. Total person-time was 72.9 person-years, with a mean follow-up time of 3.65 (SD 2.04) years per person. Out of 20 patients, nine patients died within 5 years (45%). Alcohol was the only statistically significant factor associated with increased mortality. Our findings suggest earlier diagnosis, and active treatment of early stage disease may be the best means of improving 5-year survival rates. Efforts to improve quality of care and manage limited resources should concentrate on choosing the appropriate disease stage for surgical management, improve cancer surveillance and strengthen referral system so as to improve early detection of disease and provide, social support and counselling for adjunctive habits such alcohol and tobacco use cessation which will improve patient outcomes.

Deep neck space infections in Adolescents

Adolescent deep neck space infection is an important pathology that often requires hospitalization for antimicrobial therapy. The aim of the study was to identify the inciting organisms and their resistance profiles in the adolescent population of patients with deep neck space infection. We performed a single-center cross-sectional retrospective analysis of patients between 10 and 16 years of age, with deep neck space infections. From the 319 cases of deep neck space infections that presented over the study period, nine patients met the criteria to be included in the study. The mean age being 11.8 years. The microbiology of the specimens revealed mainly Staphylococcus and Streptococcus species and in some patients microscopy and culture showed no predominant bacteria. There was an overall 86% resistance of organisms to penicillin and ampicillin but most organisms were sensitive to amoxicillin-clavulanic acid Deep neck space infections in adolescents can initially be managed with amoxicillin-clavulanic acid, source control and surgical drainage if required. Culture directed therapy can be initiated after microbiology results. The spaces involved are similar to adults with 44% of patients having deep neck abscess secondary odontogenic infection. The microbiology however is similar to that of children with Streptococcus and staphylococcus species being the most predominant.