Dental INTERACTIVE

Editorial - Women and dentistry: professionals and patients in South Africa

SADJ August 2010, Vol 65 No 7 p286 - p288
L Doyal: BA (Soc), MSc (Econ) Emeritus Professor of Health and Social Care School for Policy Studies, University of Bristol
S Naidoo: BDS(Lon), LDS.RCS (Eng), MDPH (Lon), DDPH.RCS (Eng), MChD (Comm Dent), PhD (US) Professor and Principal Specialist, Department of Community Oral Health, University of the Western Cape, Tygerberg
Corresponding author
Prof S Naidoo: Department of Community Dentistry, Faculty of Dentistry, University of the Western Cape, Private Bag X1, Tygerberg, 7505. Tel: 021 937 3148, Fax: 021 931 2287. E-mail: suenaidoo@uwc.ac.za The last few years has seen the gradual emergence of an interest in �women and dentistry�. However the existing literature has serious limitations. Most importantly there is often confusion between two separate issues - women in the dental profession and the oral health needs of female patients. Clearly these are both important, but need to be explored independently. From the South African perspective, the literature is also limited by the fact that most research has been produced in developed countries with a focus on the United States in particular. This paper will clarify what is known about women in the dental profession on the one hand and women�s experiences as service users on the other. It will highlight the implications of each for the South African context.

Letters

Dear Editor,
As former Heads of the Department of Restorative Dentistry at the University of Pretoria, tasked with the education and training of Registrars in Prosthodontics, we cannot but comment on the letter by Dr Marais in the June issue of the SADJ.
It is surprising that Dr Marais uses an article, in which the author discusses inadequate communication about fees, to launch an attack on specialists in Prosthodontics and Maxillo-Facial-and Oral Surgery. As an aside, the concern expressed in the article seems justified. Comparing the opportunity to convey the costs for treating an abscess on a tooth in an emergency to that where emergency cardiovascular surgery is indicated, is really not realistic.
Our main concern relates to a statement in the third paragraph of his letter in which he states that �prosthodontists have this peculiar notion that they think they can do root canal treatments because they did a few of these during their training and delivered one paper about the subject.�
We do not know where Dr Marais obtained this warped view of the training of Prosthodontists. At the University of Pretoria, and we believe at all South African Universities, registrars are required to do an in depth study of endodontics. This entails, apart from the clinical exposure, journal discussions and seminars on the subject, one afternoon a week for one year. Since endodontics does not only entail root canal therapy, this study covers the full scope of the discipline including, inter alia, applied anatomy, physiology and pathology, including of course the therapeutic aspects, and including the management of the medically compromised patient. During our time at this institution this took place under the tuition of colleagues like the late Dr Stan Lewis, Prof Barry van Os and after they had passed on, Dr Henry Brummer. These colleagues were satisfied with the levels of competence attained by these registrars and we, in turn, accepted their judgement since they were and are respected professionals with vast experience, competence and knowledge and above all a sense of responsibility about the role they were performing. There is no way that we will refer to them as �call us what you wants�
It is regrettable that Dr Marais has elected to make these derogatory statements about the training of Prosthodontists without familiarizing himself with the requirements for the course in Prosthodontics, specifically those pertaining to endodontics. These requirements are available in the Study Guide for the MChD course at the University of Pretoria.
One cannot but come to the conclusion that he is of the opinion that only the self- selected few are entitled to do root canal therapy for patients, since, if he feels that prosthodontists, even with some further training, are not qualified to do these procedures, then the same should apply to general dental practitioners. He also neglects to specify which qualification, based on formal training and external assessment, is required before one may become entitled to perform root canal therapy. What is truly amazing is that he admits that even he has failures, but if a prosthodontist has a failure it represents a major deficiency in prosthodontic training and practice.
We do not intend dealing with all the controversial aspects in his letter, for example his peculiar reasoning regarding referrals, neither will we react on his views about apisectomy and our surgical colleagues, except to state that surgical endodontics still seems to be an integral component of the discipline, practised by many eminent colleagues.
We hope that this response will assist in generating an objective perspective on the issues he has raised.
With kind regards from two silly professors
Prof Len Becker
Prof Hannes Nel

Consequences of tooth loss (part 2): Dentist considerations - restorative proble

SADJ August 2010, Vol 65 No 7 p292 - p296
H L Craddock: PhD, MDent Sci, BDS, FDS(Rest Dent), MRD(Pros), MFDS RCS(Edin), MGDS RCS(Eng), DGDP(UK), Senior Lecturer, Honorary Consultant, Leeds Dental Institute, Leeds, UK.
This article is re-printed with permission from Dental Update 2010; 37: 28�32 Abstract
Partial tooth loss is much less well tolerated by patients than was previously the case and, on occasions, when extraction is inevitable, they may seek prosthetic replacement. This paper explores some of the consequences of tooth loss that may cause difficulties in tooth replacement, particularly if replacement is delayed for some time.
Clinical Relevance
An awareness of potential difficulties, particularly with posterior tooth replacement, will allow clinicians to make treatment decisions in the light of current evidence.
As discussed previously, patients expect to keep their teeth and have them remain aesthetically pleasing for their entire lives. On occasion, this may not be possible and some teeth may be lost as a result of caries, periodontal disease or trauma. Most anterior teeth are likely to be replaced soon after their loss and prostheses are usually well tolerated, if only for aesthetic reasons. We therefore rarely see changes to the position of adjacent teeth following anterior tooth loss. The exception to this is when a missing anterior tooth in a child is replaced with a removable prosthesis which is not worn by the patient.
Patients are not always aware of the options for tooth replacement at the time of extraction, may not feel that it is necessary to replace the tooth, or be unable to afford replacement at that time. It is therefore not uncommon to encounter sites for restoration where teeth are not in positions conducive to straightforward tooth replacement.

Clinical: The initial management of dento-alveolar trauma in general dental prac

SADJ August 2010, Vol 65 No 7 p298 - p302
DNT Auld: BDS, MFDS RCPS, Specialist Registrar in Paediatric Dentistry, Leeds Dental Institute, Leeds, UK.
GB Wright: BDS, MFDS, RCPSG, MPaed Dent, RCS(Ed), Specialist in Paediatric Dentistry, Glasgow Dental Hospital and School.
This article is re-printed with permission from Dental Update 2010; 37: 286�294 Abstract
Dento-alveolar trauma presents commonly in general dental practice, but may prove difficult to manage for those unfamiliar with it. Timely and well-informed intervention can significantly improve the clinical outcome for the patient. This article aims to inform the clinician on best current practice for the assessment and initial management of dental traumatic injuries, incorporating current international guidelines and practical arrangements for follow-up care.
Clinical Relevance
The dental trauma patient often presents to the general dental practitioner and the appropriate emergency management plays a vital role in relieving pain, protecting the dentino-pulpal complex, reducing displaced teeth and improving prognosis.

Scientific: Smoking practices of dental and oral health students at the universi

Scientific: Smoking practices of dental and oral health students at the university of the western cape SADJ August 2010, Vol 65 No 7 p304-308
NA Gordon: Department of Oral Hygiene, Faculty of Dentistry, Universtiy of Western Cape.
CA Rayner: Department of Oral Hygiene, Faculty of Dentistry, Universtiy of Western Cape.
Corresponding author
NA Gordon: Department of Oral Hygiene, Faculty of Dentistry, Universtiy of Western Cape. Tel: 021 370 4409. Fax: 021 392 3250. E-mail: ngordon@uwc.ac.za Summary
Introduction: The World Health Organisation code of practice on tobacco control urges health care professionals to lead by example by reducing smoking among them, act as role models for their patients and introduce tobacco control in the public health agenda of their country.
Aims: Describe dental and oral health student smoking practices, risk perception and the association between smoking status and providing smoking related advice to patients.
Method: A descriptive, cross sectional study of dental and oral health students using a self-administered questionnaire.
Results: The response rate was 62% (N= 375). Smoking status indicated that 15% were past smokers and 23% were current smokers (33.8% Male vs 17.6% Female: p Conclusion: The increasing prevalence of smoking among females observed globally is also evident in this population. Student smoking status does not influence practices in providing smoking related advice to their patients.
Key words: prevalence, tobacco, cigarettes, smoking, dentistry students, oral health students, socialisation, smoking cessation

Scientific: Trends in dental caries prevalence, severity and unmet treatment nee

Scientific: Trends in dental caries prevalence, severity and unmet treatment need levels in South Africa between 1983 and 2002SADJ August 2010, Vol 65 No 7 p310 - p314
C van Wyk: DIP(OH), HDip(OH), Dip(Odont), MSc (Odont) Department of Community Dentistry, School of Dentistry, University of Pretoria
PJ van Wyk: Department of Community Dentistry, School of Dentistry, University of Pretoria
Corresponding author
C van Wyk: Department of Community Dentistry, School Of Dentistry, University Of Pretoria, PO Box 1266, Pretoria, 0001. Tel: 012 319 2416. Fax : 012 323 7616. E-mail: candice.vanwyk@up.ac.za
ABSTRACT
Objectives: To determine trends in dental caries prevalence, severity and unmet treatment need levels amongst South African children.
Methodology: Data obtained from three National Oral Health surveys (1982, 1988/89, 1999/2002) was used.
Results: Prevalence of caries amongst 12-year-old children decreased from 64.4% (1982) through 54.9% (1988/89) to 41.7% (1999/2002) and the DMFT decreased significantly (p Conclusions: Caries reduced significantly during the past 20 years; is more prevalent and severe amongst Coloured and Black population groups and in coastal regions compared to the interior region. Unmet treatment need in 12- and 15-year-old children increased and more than 70% of caries in 6-, 12- and 15-year-old children go untreated.
Key words: dental caries, prevalence, severity, oral health surveys, unmet treatment need levels

Review: Primary prevention of atherosclerotic vascular disease

SADJ August 2010, Vol 65 No 7 p316 - p319
LJ Burgess: TREAD Research / Cardiology Unit, University of Stellenbosch and Tygerberg Hospital
NU Sulzer: TREAD Research / Cardiology Unit, University of Stellenbosch and Tygerberg Hospital.
Corresponding author
LJ Burgess: E-mail: lesley@treadresearch.com
Atherosclerosis is one of the most common causes of death and disability throughout the world.1,2 Cardiovascular diseases are expected to be the main cause of death globally within the next 15 years owing to a rapidly increasing prevalence in developing countries and Eastern Europe and the rising incidence of obesity and diabetes in the Western world.1-4 Coronary artery atherosclerosis has been a major focus for clinical investigation and considerable strides have been made in the development of programmes to prevent and treat the clinical manifestations of this disease.1 However atherosclerosis is a systemic disease with important sequelae in many other regional circulations - including those supplying the brain, kidneys, mesentery and limbs.1

General Practitioner: Duplication of dentures; myth, magic or bulldust

SADJ August 2010, Vol 65 No 7 p320 - p321
C Jooste: MChD, PhD Stell. E-mail: flymcginty@mweb.co.za Many years ago after 21 years in private practice I became a clinical assistant in prosthodontics and for the first time I was exposed to the concept of duplication of dentures as a treatment modality. I was intrigued and ascribed some of my earlier treatment failures due to a lack of this knowledge. I immediately obtained what I thought was a suitable patient and meticulously followed the instructions as described in the students� notes. Alas this required such clinical skill and judgement with unstable materials that I immediately discarded it - although we had to teach it to the long- suffering students. There are however much simpler methods of obtaining the desired result, but first let us discuss the principle of habituation and duplication of dentures.
Habituation is the ability that humankind has to adapt to artificial appliances such as spectacles, hearing aids and dentures. The strongest motive as far as dentures are concerned is no doubt aesthetics and patients will wear atrocious ones as long as it satisfies their ego. However this ability to habituate varies from person to person and diminishes with age and poor physical health. (Figures 1 and 2)

Communication: A short account of cancer - specifically in relation to squamous

SADJ August 2010, Vol 65 no 7 p322 - p324
L Feller: DMD, MDent(OMP). Department of Periodontology and Oral Medicine, School of Oral Health Sciences, University of Limpopo, Medunsa Campus, South Africa.
M Bouckaert: BChD, MDent(MFOS), FFDRCS(Ireland). Department of Maxillofacial and Oral Surgery, School of Oral Health Sciences, University of Limpopo, Medunsa Campus, South Africa.
UME Chikte: BChD, DHSM, MDent(ComDent), MSc, PhD. Department of Interdisciplinary Health Sciences, Faculty of Health Sciences, University of Stellenbosch, South Africa.
NH Wood: BChD, DipOdont(MFP), MDent(PeOM). Department of Periodontology and Oral Medicine, School of Oral Health Sciences, University of Limpopo, Medunsa Campus, South Africa.
RAG Khammissa: BChD, PDD, MSc(Dent). Department of Periodontology and Oral Medicine, School of Oral Health Sciences, University of Limpopo, Medunsa Campus, South Africa.
R Meyerov: BSc, BDS, MDent (OMP). Department of Periodontology and Oral Medicine, School of Oral Health Sciences, University of Limpopo, Medunsa Campus, South Africa.
J Lemmer: BDS, HDipDent, FCD(SA)OMP, FCMSAae, Hon.FCMSA. Department of Periodontology and Oral Medicine, School of Oral Health Sciences, University of Limpopo, Medunsa Campus, South Africa. Professor Emeritus of Oral Medicine and Periodontology, University of the Witwatersrand, South Africa.
Corresponding author:
L Feller: HOD: Department of Periodontology & Oral Medicine, University of Limpopo, Medunsa Campus, PO Box D26 School of Oral Health Sciences, Medunsa Campus, 0204, South Africa, Tel: 012 521 4834, Fax: 012 521 4835. E-mail: lfeller@ul.ac.za Abstract
Cancer is the outcome of a complex multifactorial process of cytogenetic and epigenetic changes that affect cell cycle progression, apoptosis, DNA repair mechanisms and cell differentiation. Cancer cells have the capacity to evade the immune system, to invade tissues and to metastasize.
Cancer is treated by surgery, chemotherapy and radiotherapy, each as single treatment modalities or more often in combination. Failure of treatment to cure a patient of cancer may be owing to the fact that radiotherapy and chemotherapy can eradicate transit-amplifying cells which are characterized by uncontrolled proliferation and prolonged survival; but cannot eradicate all cancer stem cells that divide slowly, have a relatively unlimited self-renewal capacity and express anti-apoptotic genes; and also owing to the fact that surgery cannot always eliminate occult fields of pre-cancerization.
Key Words: cancer stem cells, anticancer treatment, cancerization

General practitioner`s radiology case 85

SADJ August 2010, Vol 65 No 7 p325
Prof CJ Nortjé: BChD, PhD, ABOMR, DSc, Faculty of Dentistry, University of the Western Cape. E-mail: cnortje@uwc.ac.za This six-year-old female presented at the faculty with a history of repeated fractures since birth. Clinical examination revealed blue sclera and deformed legs due to multiple fracture episodes. A pantomogram and a lateral skull picture were taken. What are the important radiological features discernible?