Maxillofacial injury: a retrospective analysis of time lapse between injury and treatment in a South African academic maxillofacial and oral surgery unit.

BACKGROUND: The study was undertaken in an academic maxillofacial and oral surgical unit in a large quaternary hospital attached to the Medical School of the University of the Witwatersrand, Johannesburg, between 2002 and 2006. OBJECTIVE: To investigate the number of days in seven patient management intervals from facial fracture occurrence to discharge from hospital, to gain insight into reasons for treatment delays. RESULTS: Facial fractures were treated a mean of 20.4 days from occurrence. There was a mean of 10.3 days from fracture to hospital presentation, and an identical period from hospital presentation to treatment. Statistical analysis showed that delay times decreased from 2002 to 2006. CONCLUSION: More rapid referral to the maxillofacial and oral surgical unit is the most practical way to reduce delays further.

A pilot study evaluating an intervention designed to raise awareness of clinical trials among potential participants in the developing world.

BACKGROUND: This pilot study evaluated the speaking book 'What it means to be part of a clinical trial'. The book aims at empowering populations with information on their rights and responsibilities when enrolled in clinical research. Wide publication of the book-at significant cost-is anticipated. It is important that the book is evaluated within the communities for whom it is intended, and the necessary changes (if any) are made, before translation and large-scale publication takes place. OBJECTIVE: The objective of the study was to measure the efficacy and ease of use of the book. METHODS: Participants were recruited from a catering company. Participants were questioned on their knowledge of clinical trials and were then given the book. Instructions for use of the book were given to one group ('experimental' group). The other group ('control' group) was not given any instructions. A week later, the investigators returned, repeated the knowledge questions and asked 'ease of use' questions. RESULTS: A two-way repeated measure of covariants showed a statistically significant positive increase in knowledge of clinical trials among the intervention group (p=0.02). Results for the control group displayed trends that were not statistically significant. Percentage analysis of 'ease of use' questions proved that the book is easy to use, although some changes would be beneficial. CONCLUSION: This study revealed that the speaking book is easy to use. It significantly increased knowledge of clinical trials among the study sample if instructions on use of the book were provided.

Dental caries in children in South Africa and Swaziland: a systematic review 1919-2007.

OBJECTIVE: To determine caries rate trends in children in South Africa and Swaziland since the first published epidemiological study in 1910. METHOD: Cochrane Collaboration methods were used to do a systematic review of reported caries rates from 1919 to 2007 in 5-6y, 11-13y and 14-17y children. RESULTS: There are variations in caries rates among racial groups and between rural and urban areas but secular trends show decreasing prevalence and dmft or DMFT over time. CONCLUSION: This systematic review shows decreasing caries rates in children in a developing region of Africa.

Commentary on "Measuring the Quality and Performance of Institutional Review Boards".

This commentary uses personal research ethics experience in South Africa to consider the position of Tsan who recommends a consortium to develop common metrics / performance indicators for determining quality of RECs / IRBs. Terms such as performance, quality and throughput need clarification in research metrics before effective metrics may be useful.

Dental caries trends in 5- to 6-year-old and 11- to 13-year-old children in three UNICEF designated regions--Sub Saharan Africa, Middle East and North Africa, Latin America and Caribbean: 1970-2004.

AIM: The aim of the study was to investigate trends in dental caries prevalence and severity in three developing regions of the world over 35 years. DESIGN: A systematic review of published information. METHODS: Online databases were used to find 130 caries epidemiological studies that used WHO caries diagnostic criteria, published between 1970 and 2004 among 5- to 6-year-old and 11- to 13-year-old children. Mean caries rates were calculated in seven 5-year periods followed by plotting, and analysis of co-variance (region, period). RESULTS: Trends in mean prevalence and mean dmft among 5- to 6-year-olds were confusing but among 11- to 13-year-olds were clearer. Both mean prevalence and mean DMFT were lowest in Sub-Saharan Africa and highest in Latin America and the Caribbean. Rates decreased with time in Latin America and the Caribbean and remained more or less static in the other two regions. Analysis of covariance showed a significant effect of region (P<0.01) for mean prevalence at 5- to 6-years. For mean prevalence at 11-to 13-years, as well as mean dmft and DMFT in both age groupings there were significant effects of region (P=0.01 to <0.0001) and period (P<0.05 to <0.0001). CONCLUSIONS: The common perception that dental caries rates are increasing in developing countries was not supported in this systematic review.

Technique for linear measurement on panoramic and periapical radiographs: a pilot study.

OBJECTIVE: This study was conducted to compare vertical and horizontal periodontal measurements of posterior teeth on standardized panoramic and intraoral radiographs. METHODS AND MATERIALS: Standardized panoramic and periapical radiographs were made of 16 human skulls using ball bearings placed on the maxillary first molars to allow adjustment for horizontal and vertical magnification. RESULTS: At 14 of 19 measurement sites there was no significant difference between measurements on the 2 radiographic film types. At 4 sites vertical measurements on panoramic radiographs were significantly larger than on periapical radiographs (0.80 to 1.37 mm). At one site horizontal measurements were significantly greater on periapical radiographs (0.88 mm). CONCLUSIONS: If there is adjustment of the raw data for magnification as suggested in this study, panoramic radiographs may be used for measurement studies in the posterior region once the patients are positioned appropriately within the focal trough of the machines and the magnification range for the posterior focal trough is used for adjustment of data.

Views of Medical Doctors Regarding the 2013 WHO Adult HIV Treatment Guidelines Indicate Variable Applicability for Routine Patient Monitoring, for Their Family Members and for Themselves, in South-Africa.

South African doctors (n = 211) experienced in antiretroviral therapy use were asked via an online questionnaire about the WHO 2013 adult antiretroviral integrated guidelines, as well as clinical and personal issues, in three hypothetical scenarios: directing the Minister of Health, advising a family member requiring therapy amidst unstable antiretroviral supplies, and where doctors themselves were HIV-positive. Doctors (54%) favoured the 500 cells/µl WHO initiation threshold if advising the Minister; a third recommended retaining the 350 cells/µl threshold used at the time of the survey. However, they favoured a higher initiation threshold for their family member. Doctors were 4.9 fold more likely to initiate modern treatment, irrespective of their CD4 cell count, for themselves than for public-sector patients (95%CI odds ratio = 3.33-7.33; P<0.001, although lower if limited to stavudine-containing regimens. Doctors were equally concerned about stavudine-induced lactic acidosis and lipoatrophy. The majority (84%) would use WHO-recommended first-line therapy, with concerns split between tenofovir-induced nephrotoxicity (55%), and efavirenz central nervous system effects (29%). A majority (61%), if HIV-positive, would pay for a pre-initiation resistance test, use influenza-prophylaxis (85%), but not INH-prophylaxis (61%), and treat their cholesterol and blood pressure concerns conventionally (63% and 60%). Over 60% wanted viral loads and creatinine measured six monthly. A third felt CD4 monitoring only necessary if clinically indicated or if virological failure occurred. They would use barrier prevention (83%), but not recommend pre-exposure prophylaxis, if their sexual partner was HIV-negative (68%). A minority would be completely open about their HIV status, but the majority would disclose to their sexual partners, close family and friends. Respondents were overwhelmingly in favour of continued antiretrovirals after breastfeeding. In conclusion, doctors largely supported adult WHO guidelines as public policy, although would initiate treatment at higher CD4 counts for their family and themselves. Resistance to INH-prophylaxis is unexpected and warrants investigation.

Dental clinic attendance in Soweto, South Africa, before and after the introduction of free primary dental health services.

OBJECTIVE: To compare patient attendance rates 1 year before and after the introduction of free primary dental health services in Soweto, South Africa. METHODS: Monthly clinic records for clinic attendance, both casual and booked, and number of dental operators were recorded 1 year either side of April 1996. RESULTS: Patient attendance fluctuated by day and season. There was a mean 46% increase in attendance after free primary dental health services were introduced, with more than a sixfold increase in casual attendees (pain, sepsis) than in booked patients (restorative treatment, dentures, orthodontics). CONCLUSIONS: There was a statistically significant increase in casual patient attendance in the year after free primary dental health care was introduced with an increased dental operator load.

Trends in dental caries in Latin American and Caribbean 5-6- and 11-13-year-old children: a systematic review.

OBJECTIVES: To determine trends in dental caries prevalence and severity in Latin America and Caribbean. METHODS: A systematic review was done of studies published between 1970 and 2000 among 5-6- and 11-13-year-old children that used WHO caries diagnostic criteria. RESULTS: Over the last 30 years, there has been a significant decrease in caries severity for children 5-6 years old and also a significant decrease in caries prevalence and severity for children 11-13 years old. The same broad trends were observed when caries prevalence and severity was analyzed for the last 20 and 10 years but these were not statistically significant. CONCLUSIONS: Evidence of a decrease in dental caries in Latin American and Caribbean children has been shown, although the decrease was less prominent in the past few years.

Caries and micronutrient intake among urban South African children: a cohort study.

OBJECTIVE: To report on associations between caries and micronutrient intake among a 'true cohort' group of 5-year-old urban black South African children. METHODS: The study sample was a true cohort that had nutrition as well as dental information for 1991 and 1995 (n = 259). Micronutrient intake and dental caries associations were examined with SAS using the linear logistic analysis and a critical level of statistical significance of P < 0.05. RESULTS: Of the 21 micronutrients investigated, vitamin B12, riboflavin, magnesium and biotin were individually significantly associated with caries incidence, but taken together only magnesium was significant. CONCLUSIONS: The association of micronutrient intake with caries was weak, isolated and not clinically relevant. Micronutrient intake was not an indicator of the presence or absence of caries among the children studied.

Mutans streptococci and lactobacilli in carious dentine before and after Atraumatic Restorative Treatment.

OBJECTIVES: This study was performed to examine the cultivable flora in dentine after manual excavation of caries lesions using the Atraumatic Restorative Treatment (ART) technique and to examine for associations between the microbiological results and cavity size, dentine colour and consistency. METHODS: Dentine samples from 40 caries lesions were collected before and after treatment and cultured for total viable counts (TVC), mutans streptococci (MS) and lactobacilli. RESULTS: The bacterial bioburden between the two samples showed a significant reduction in the frequency and proportions of TVC and MS but not lactobacilli. CONCLUSION: Cavity preparation produced a clinical change in dentine colour and consistency from dark shades and soft dentine at enamel dentine junction to light shades and hard dentine at the cavity floor. The results show that cavity size, dentine colour and consistency are not absolute indicators of the microbiological bioburden in an ART cavity.

A method for comparison of biomedical publication quality across ISI discipline categories.

The purpose of this paper is to offer a method to help to objectively compare quality of publication in biomedical journals in different disciplines with varying ISI Impact Factors (IF). Three methods--the number of journals per ISI Journal Citation Report discipline category/10, the IF/10, and the log (IF+1)/10--were used to calculate an article score. The distribution of article scores were compared across three defined ISI discipline categories: two clinical categories, dentistry (ISI category--dentistry, oral surgery, and medicine, forty-five journals) and medicine (ISI category--medicine, internal and general, 110 journals), and one basic science category, physiology (ISI category--physiology, seventy-four journals). The use of article scores per discipline category enables a reasonable, relative comparison of the quality of biomedical publications of individuals across disciplines for the purpose of promotion or awarding of research grants.

Position and orientation of the maxillary first permanent molar and localized attachment loss.

AIM: To investigate associations between the position and orientation of the maxillary first permanent molar and localized attachment loss (localized gingival recession or alveolar bone concavity) at the mesiopalatal aspect of this tooth. METHODS: The study samples were 30 orthodontic study casts of young patients treated without premolar extractions, 45 pretreatment adult periodontal patient study casts, and 56 adult skulls. Measurements made were the maxillary first permanent molar crown angulation, inclination, rotation, and arch position, as well as the presence or absence of localized gingival recession/alveolar bone concavity at the mesiopalatal aspect of the tooth. RESULTS: Localized attachment loss was most frequent in the periodontal study casts. The localized attachment loss was significantly associated with crown angulation, inclination, and type of sample but not with crown rotation and arch position. CONCLUSION: Orthodontists need to consider the final position of the maxillary first molar crown in terms of its angulation and inclination to reduce the likelihood of the localized attachment loss at the mesiopalatal aspect of the maxillary first molar.

A misadventure with an elastic band, 38 years later.

This case report is of maxillary central incisors still in place 38 years after periodontal surgery to correct the damage to supporting tooth structure caused by an orthodontic elastic band.

Gingival health in relation to clinical crown length: a case report.

INTRODUCTION: Gingival margin position in relation to synthetic crowns and crown length could be etiological factors in gingival health. CASE PRESENTATION: A 27-year-old male presented with necrotizing ulcerative gingivitis with short clinical crowns suggestive of altered passive eruption. Three years after the initial diagnosis, he presented with crowns on the maxillary incisors. There were short clinical crowns and marked gingival inflammation. CONCLUSION: Placement of the crown margin could be an etiological factor in gingival inflammation. Therefore, should the margin be subgingival, equigingival or supragingival?

Gingival health in relation to clinical crown length: a case report.

INTRODUCTION: Gingival margin position in relation to synthetic crowns and crown length could be etiological factors in gingival health. CASE PRESENTATION: A 27-year-old male presented with necrotizing ulcerative gingivitis with short clinical crowns suggestive of altered passive eruption. Three years after the initial diagnosis, he presented with crowns on the maxillary incisors. There were short clinical crowns and marked gingival inflammation. CONCLUSION: Placement of the crown margin could be an etiological factor in gingival inflammation. Therefore, should the margin be subgingival, equigingival or supragingival?

The effect of traditional African food mixtures on growth, pH and extracellular polysaccharide production by mutans streptococci in vitro.

Four, traditional African food mixtures (maize plus milk and sugar, maize plus gravy, samp plus beans, brown bread plus margarine and peanut butter) were evaluated for their ability to sustain the growth of mutans streptococci in batch culture. A synthetic complex medium, brain heart infusion with 3% sucrose was used as an experimental control. Six NCTC laboratory reference strains and five clinical isolates collected from the plaque of children were investigated. The doubling time of bacterial strains was prolonged in maize plus gravy (2.5-6.0 h) and samp plus beans (1.3-9.9h), and the number of cell divisions was low, compared with bread plus margarine plus peanut butter (0.7-5.1h). The least amount of acid was produced in maize plus milk plus sugar (3.92+/-8.15 mmole/mL), and the average pH during the fermentation of maize plus milk plus sugar, maize plus gravy and samp plus beans did not drop below the critical point for enamel demineralisation, pH 5.7. Bacterial growth in samp plus beans produced a small quantity of lactic acid (0.46+/-1.10 mmole/mL) compared to bread plus margarine and peanut butter (2.64+/-3.30 mmole/mL) and BHI plus 3% sucrose (12.23+/-10.72 mmole/mL). Extracellular polysaccharide (ECP) produced was lowest in maize plus milk and sugar (0.22+/-0.33 mg/mL), compared with the remaining food mixtures (0.47-1.75 mg/mL). Statistical analysis showed that the influence of the mixed-foods on doubling time (F=3.01, P=0.03), pH (F=14.41, P<0.0001) and ECP (F=135.32, P<0.0001) was greater than the significant variance found between mutans streptococci strains. Results suggest that the level of mutans streptococci activity in samp plus beans, maize plus milk and sugar and maize plus gravy contributes little towards the formation of dental caries, and that significant differences exist between mutans streptococci laboratory reference and clinical strains in response to traditional African food mixtures.