Syphilis in the context of HIV infection.

Both HIV infection and syphilis are sexually transmitted diseases, share the same risk factors for acquisition and often occur concurrently. Syphilis may promote HIV acquisition and transmission and HIV infection may alter the course and response of syphilis to treatment. Oral lesions may occur at any symptomatic stage during the course of a syphilitic infection, usually presenting as any one of a number of distinct clinical forms, but not infrequently with a variety of nonspecific clinical features, or clinical features mimicking other disease entities. In South Africa where HIV infection is epidemic, syphilis is prevalent. It is the purpose of this paper to review the interrelationship between syphilis and HIV infection, and the oral manifestations of syphilis.

HIV-associated Kaposi sarcoma in African children.

HIV-associated Kaposi sarcoma (HIV-KS) is common in African countries where HIV infection is pandemic and anti-retroviral medication is not readily available. Human herpesvirus-8 (HHV-8), which is the essential, but not the sole aetiological factor in KS, is endemic in sub-Saharan Africa and is substantially more prevalent in HIV-seropositive than in HIV-seronegative subjects. In children in sub-Saharan Africa, KS, whether it be HIV-KS or African endemic KS is much more prevalent than any other epidemiological forms of KS. In addition, in sub-Saharan children oral KS is common, and the life-expectancy of HIV-seropositive children with KS is short. Since generalized systemic KS is frequently associated with oral HIV-KS, it is advisable to introduce systemic cytotoxic chemotherapy early in the course of oral HIV-KS. Although the introduction of highly active antiretroviral therapy (HAART) brought about a decline in the incidence of HIV-KS worldwide, HIV-KS remains a significant problem in sub-Saharan Africa where the prevalence of HHV-8 infection is high and access to HAART is limited.

Teaching approaches in South African dental schools: direct restorative procedures.

INTRODUCTION: Worldwide the use of amalgam has declined and mercury-containing products are banned in several countries. National and international opinions on amalgam were recently discussed in journals. According to surveys, significant time is spent on the teaching of amalgam in American, Canadian, Irish and United Kingdom Dental Schools. AIMS AND OBJECTIVES: To i) investigate the teaching approaches on direct restorative techniques and materials in South African Dental Schools; ii) compare the teaching approaches of the dental schools in South Africa with each other as well as with the American, Canadian, Irish and United Kingdom schools; iii) use the information of this study as baseline data for future studies on teaching approaches. METHODS: A questionnaire regarding the teaching and training of direct restorations was e-mailed to the heads of Restorative Dentistry departments in four South African Dental Schools in 2007. RESULTS: Significant time is spent on teaching and training of amalgam as a restorative material. Teaching and training on direct restorations are very similar in all South African Dental Schools. CONCLUSION: Although there is a decline in the use of amalgam worldwide, significant time is spent on teaching of amalgam restorations in South African Dental Schools and this corresponds to the curriculums of American, Canadian, Ireland and United Kingdom Dental Schools.

Curriculum structure: principles and strategy.

This report provides general guidelines for the structure of a curriculum, followed by specific advice on the principles of learning and teaching, the process of restructuring and change leadership and management. It provides examples of several educational philosophies, including vertical and horizontal integration. It discusses the use of competence, learning outcomes, level of degree and assessment and provides a number of recommendations. It does not seek to be prescriptive of time allocation to disciplines within a curriculum. Although this report has been written primarily for those who will develop an undergraduate curriculum, the information may be sufficiently generic to apply to the recent development in graduate entry ('shortened dental' or 'accelerated') courses and to postgraduate degree planning and higher education certificate or diploma courses for other dental care professionals (auxiliaries). The report may have a European bias as progress is made to converge and enhance educational standards in 29 countries with different educational approaches - a microcosm of global collaboration.

Gender and race distribution of dental graduates (1985-2004) and first year dental students (2000-2005) in South Africa.

This paper, written at the close of a decade of democracy in South Africa, sets out to analyse the demographic profile of dental graduates from 1985-2004 at the five Faculties/Schools of Dentistry in South Africa. A comparison of the profiles for the pre-democracy (1985-1994) and post-apartheid (1995-2004) periods has been made. The demographic profile of first year dental students from 2000-2005 is also presented. From 1985-1994, most dental graduates were male (79%), but this changed substantially from 1995-2004, with females comprising 46% of those graduating. In the pre-democracy period, more than three-quarters of all graduates were White (78%), decreasing to 46% in the post-apartheid period under review. Black graduates increased from 6% to 24% across the two study periods. Amongst the first year dental student intake from 2000-2005, females comprised 57%. There was an almost equal distribution across the White, Black and Asian groups. Dental faculties/schools have made important strides in transforming the demographic profile of their students. The percentage of Black graduates, however, needs to be significantly increased if it is to reflect the national population. Faculties/schools must further ensure that able students from working class background are identified and considered for acceptance into the undergraduate dental programme, and should then be offered the necessary academic and mentoring support to enable success.

5.1 The demography of oral diseases, future challenges and the implications for dental education.

This Section considered the immense challenges presented by the changing demography of populations (in particular, cross-boundary flow), changing oral and dental disease trends. It also considered the difficulties of gathering data on such information. It then considered how these challenges may affect the education of the dental team in the future. The Section considered the concept of the 'global village' as a representation of the changing world demography. We were at pains to recognize that our role was in considering both emerging and established market economies. In fact, a major part of the Section's activities concentrated on the development of the professional ethic of social responsibility - represented at the local, regional, national and international levels. We considered a finite group of oral and dental diseases, namely dental caries, periodontal diseases, oral cancer and cranio-facial disorders. In addition, we chose to comment on systemic diseases influenced by oral diseases, oral diseases influenced by systemic diseases and iatrogenic diseases (including prion disorders and cross-infection control issues). The Section recognized the profound difference between needs and demands in the provision of oral and dental health care. We considered the concept of best practices within our working remit and named these as: * the gathering of valid data on health trends; * uniformity in the measurement of disease and diagnostic parameters; * the identification of a core curriculum which best addresses an increased awareness of changing demography; and * a multidisciplinary approach to education and research in the context of global collaboration. The Section recognized the enormous potential for global networking with the explosion of information and communication technology. We investigated the requirements in converging towards higher global standards, while accepting and appreciating important regional and continental differences. To this end, the Section has put forward a number of important recommendations and realistic goals.

Estimation of dental caries treatment needs--a review of the literature.

If we wish to achieve a better understanding of the treatment needs in the delivery of primary dental services, we need to know why differences in dental caries recorded in the general practice and survey settings occur and the reasons for these differences. We also need to know how this factor influences the volume and type of treatment planned, both for the individual skilled benchmark epidemiologist and practitioner, and for mean world extremes on the other hand. This paper reviews estimates of dental caries treatment needs from the perspective of translation of dental caries status to estimates by need, estimation of need for dental care at the time of examination, differences in caries diagnosis between the epidemiologist and clinician and the consequences thereof, and changes in the presentation of dental caries that have occurred over the years. It is evident from this review of dental caries treatment needs that although the past record of dental epidemiology and clinical diagnosis can be defended, we cannot afford to do what has been done in the past, which was appropriate for lesions seen in the 1960s and 1970s, to the disease as it occurs in the 1990s.

The influence of socio-economic variables on the prevalence of periodontal disease in South Africa.

The purpose of this study was to assess the influence of race, level of education and income on the frequency distribution of periodontal disease in an adult South African population. A retrospective data analysis of the National Oral Health Survey (NOHS, 1988/89) was done on 3,763 adults with an age range of 20-64 years. From the results obtained it would appear that socio-economic variables have an influence on the prevalence of periodontal disease in South Africa.

Regional urban-rural distribution of dental caries experience in Swaziland.

Understanding the regional and countrywide urban-rural distribution of dental caries in Swaziland was considered important for the formulation of a National Oral Health Policy based on the Primary Health Care Approach. A National Oral Health survey was undertaken in Swaziland at the request of the ministry of health. Part of the objective of this study was to establish the regional urban-rural distribution of dental caries in Swaziland. For the 6-18 year olds a cluster sampling technique by schools was used to get a representative sample. For the 35-44 year age group a simple random sampling technique was used in areas of employment influenced by regional and urban-rural distribution. All examinations were carried out using the WHO 1987 criteria. More than 90 per cent of the mean dmft of 6 and 12 year olds was comprised of the decayed component of the dmft/DMFT. The level of restorative care (ft/dmft, FT/DMFT) was low for all age groups. For the 6 and 12 year olds in the Lubombo region there was a significant difference (p < 0.05) in the urban-rural caries experience. When regional data for 6 and 12 year olds were pooled, the difference in urban-rural caries experience is also significant (p < 0.05). For the older age groups there was no significant difference (p > 0.05) in the regional urban-rural caries experience. This study indicates that the oral health care system in Swaziland with its limited resources, should focus its attention on the younger age groups especially in urban areas as far as dental caries treatment needs and preventive programmes are concerned.

Efficacy of an experimental dentifrice formulation on primary school children in Ga-Rankuwa, Pretoria.

The purpose of this study was to assess the efficacy of a dentifrice containing 1 per cent chlorhexidine gluconate at reducing plaque formation and gingival inflammation over a 12 week period. The effects of the test toothpaste were compared with control and conventional dentifrices in a randomised double-blind clinical trial of parallel design. Following baseline examination at which gingival and plaque indices (GI and PI) were measured, 156 primary school children were assigned to one of three groups that were matched for age, gender, GI and PI. After plaque control instruction the pupils were requested to use the dentifrice twice daily. After 6 and 12 week intervals the PI and GI were reassessed. There was no significant difference in GI between groups. The PI was significantly lower (p < 0.002) after use of the chlorhexidine containing dentifrice compared with the other two products.

Project Swaziland (Part 1): development of oral health services--study methodology and summary of results.

A collaboration in oral health services research between the Kingdom of Swaziland and the Republic of South Africa is reported. The aim and methodology of the project is described and a summary of the results of the descriptive study is given. The latter included the status of dental caries, periodontal disease and malocclusion of 12 year old school children, an evaluation of a community preventive programme, an assessment of the knowledge, attitudes and behaviour of school teachers towards oral health and an analysis of the output of public oral health services. Five major strategies were recommended for the further development of oral health services in Swaziland and it is recommended that these be undertaken within the contextual realities of Southern Africa.

Project Swaziland (Part 3): periodontal health status of 12 year old school children.

An investigation on the periodontal disease profile and its treatment implications was conducted on a sample of 12-year-old Swazi schoolchildren of the Kingdom of Swaziland using the CPITN index. Only 1.9 per cent of the pupils in the sample were free of periodontal disease and 64.5 per cent had calculus. There was a significant difference (p < 0.05) in the frequency of calculus accumulation between rural and urban pupils. The mean number of sextants with bleeding and calculus was 4.9 and 2.0 respectively while 98.1 per cent of the pupils required TN1 and 65.4 per cent TN2. It would appear that calculus accumulation occurs at a relatively early age amongst children in Swaziland. Moderately trained dental auxiliaries should constitute the backbone of the primary oral health care service in Swaziland.

Dental caries experience and periodontal status of handicapped institutionalised black high school pupils in Soshanguve, Pretoria.

This study compares the oral health status, as reflected by caries experience and periodontal status, of 3 cohorts of institutionalised handicapped pupils. The 3 groups of impairments studied were physical, visual and aural disability. 267 institutionalised handicapped high school pupils were examined. 163 (61 per cent) were physically, 84 (31.5 per cent) visually, and 20 (7.5 per cent) aurally handicapped. 34 per cent of the study population was caries-free with a mean DMFT of 2.63. There was no statistically significant difference (p greater than 0.05) between the caries experience of the three handicapped groups. Similarly no significant difference (p greater than 0.05) was observed between males and females. More than half of the calculus accumulation occurred among the physically disabled. At the 90 per cent confidence interval there was no significant difference in bleeding and shallow pocketing among the three groups. However, there was a significant difference for the presence of calculus. The physically disabled pupils consistently indicated the highest proportion of bleeding, calculus accumulation and shallow pocketing.

Dental caries prevalence and CPITN of 12-year-old rural schoolchildren in Transkei.

The study investigated the prevalence and pattern of caries with particular reference to tooth and surface type and the CPITN of 12-y-old rural schoolchildren in Engcobo, Transkei. 349 schoolchildren, with a 4:6 male:female ratio were examined. The fluoride content of the water varied from 0-0.5 p.p.m. The results indicate that caries levels are low--47 per cent of the sample was caries-free. Both the median DMFT and DMFS was 1.0 (with a mean 1.7 and 2.8). The D component comprised 89 per cent, the M-10 and F-1 per cent of the total DMFT. Amongst boys, caries was distributed almost equally between the maxillary (112) and mandibular (114) arches whereas for girls more teeth were affected in the mandibular arch. Molar teeth in boys and girls accounted for 90 per cent of all teeth affected with the first molars accounting for 50 per cent and the second molars 40 per cent. In the maxillary and mandibular arch for the total group, a greater number of first molars were affected than the second molars. For girls in both the maxilla and mandible, the second molars were affected more frequently than the first molars. Overall the occlusal surfaces were affected most frequently followed by the buccal, distal, lingual and mesial. Gingival bleeding and calculus were prevalent in most sextants. Less than 6 per cent of the total subjects had no periodontal disease. Calculus was found in over 70 per cent of the children. The vast majority of the sample (94 per cent) needed oral hygiene instruction.