Endodontic treatment-related antibiotic prescribing patterns of South African oral health professionals.

AIM: To assess the antibiotic prescribing patterns of South African dentists for patients undergoing endodontic treatment. METHODOLOGY: This study used data from 2013 health insurance claims submitted by South African oral health professionals to determine the antibiotic prescribing patterns related to endodontic treatment. A logistic regression model was used to test the fully adjusted statistical significance of the association between the exploratory variables (gender, age group, event type, abscess treatment, chronic health) and the dependent variable (antibiotic prescription). Odds ratios with 95% confidence intervals (CI) are reported, and a 95% CI excluding 1 was considered statistically significant. RESULTS: Almost 10% of endodontic treatments were prescribed an antibiotic. There were no significant differences in prescribing patterns by gender, age and chronic health status. Prescriptions were more common at the preparatory stage (9.4%) of root canal treatment compared to the therapy (4.7%) and canal filling (2%) stages. Patients who received apical surgery (OR = 2.28; 95% CI 1.38-3.76) and treatment of an abscess (OR = 2.57; 95% 1.82-3.63) had a significantly increased odds of being prescribed an antibiotic. Almost three-quarters of prescriptions were for narrow spectrum antibiotics. CONCLUSION: The frequency of antibiotic prescribing by South African dental practitioners for patients undergoing endodontic treatment is relatively low and predominantly involved narrow spectrum antibiotics. It, however, remains important that antibiotics are only prescribed when clinically essential, such as when there are obvious systemic effects. These include fever above 37 degrees, malaise, lymphadenopathy, trismus, increase swelling, cellulitis, osteomyelitis and persistent infection. The wider dissemination and adherence to clear evidence-based prescribing guidelines for antibiotics in this clinical area are important.

South African healthcare reforms towards universal healthcare - where to next?

The National Assembly approval of the National Health Insurance (NHI) Bill represents an important milestone, but there are many uncertainties concerning its implementation and timeline. The challenges faced by the South African healthcare system are huge, and we cannot afford to wait for NHI to address them all. It is critical that the process of strengthening the health system to advance universal healthcare (UHC) begins now, and there are several viable initiatives that can be implemented without delay. This article examines potential scenarios after the Bill is passed and ways in which UHC could be advanced. It begins with an overview of the trajectory of health system reform since 1994, then examines the scenarios that may emerge once the Bill is passed by Parliament and makes a case for finding ways in which UHC could be advanced within the country, regardless of any legal or financial barriers that may delay or limit NHI implementation.

Thematic analysis of the challenges and options for the Portfolio Committee on Health in reviewing the National Health Insurance Bill.

The Portfolio Committee on Health (PCH) obtained public input on the National Health Insurance Bill from a wide array of individuals and organisations between May and September 2021. The record of these submissions collated by the Parliamentary Monitoring Group provided the source material for this article. The concerns, suggestions and other issues raised by respondents were analysed to determine what challenges and options the PCH needs to take seriously as they prepare the Bill for Parliament. Prominent issues raised included concerns about the proposed governance structure, flaws in the funding model, the risk of corruption, the constitutional and human rights at risk, limited access to care for several groups, and the unresolved nature of the medical benefits to be provided under the Bill. Future legal contestation of the Bill on several of these issues has the potential to stop or delay its implementation for a long time. The PCH has some hard decisions to make: whether to address these concerns with quite radical revisions of the bill, to omit problematic elements, or to leave it unchanged, and accept the contestation this will bring.

Professionally applied topical fluoride and fissure sealants: matching insurance claims with evidence.

OBJECTIVE: The purpose of this study was to assess the extent to which medical aid schemes are funding evidence-based dental care, specifically assessing claims patterns for professionally applied topical fluoride and fissure sealant treatments to the beneficiaries of a large South African medical aid scheme. The rising costs of dental care provide the impetus to review spending patterns to assess whether resources are being utilised optimally. The emergence of evidence-based dentistry offers an important tool in this regard. METHODOLOGY: The 2005 membership and claims data of a large South African medical scheme were analysed for the period 1 January 2005 to 31 December 2005. The claim patterns for two dental caries preventive interventions with different levels of evidence were assessed and compared for two age groups: under 20 years of age and 20 and above. RESULTS: About 30% received a topical fluoride application, equally provided to both age categories. Less than 3% of all who visited the dentists received at least one sealant. Of those under 20 years of age, only 10% received this proven preventive intervention. CONCLUSIONS: This study highlights the need to substantially increase the provision of fissure sealants to children with erupting first (5-7 year olds) and second (11-13 year olds) permanent molar teeth and decrease the provision of professionally applied fluoride applications to those outside of specifically identified caries-risk groups. This study further illustrates the potential of applying evidence-based dentistry research findings to assessing the appropriateness of claim patterns as well as the funding thereof.

Scientific. Risk of intraoral cancer associated with tobacco and alcohol--a case-control study.

OBJECTIVES: The study examined the role of tobacco, alcohol consumption and their synergistic effect on the aetiology of intraoral cancer. DESIGN: A hospital-based, analytical case-control study. SUBJECTS: Information was collected from 67 intraoral cancer patients attending a cancer unit (cases) and 67 controls attending other clinics in the same hospital. Cases and controls were individually matched for age, gender and ethnicity. METHODS: A structured interview was used to collect the data on items related to smoking status and alcohol consumption. RESULTS: The odds of developing intraoral cancer were 41 times (OR = 4.63; 95% CI: 1.74-12.30) higher for current smokers compared to non-smokers. The odds of developing intraoral cancer were eight times higher for past drinkers (OR = 8.59; 95% CI: 2.96-24.92) and current drinkers (OR = 8.54; 95% CI: 3.55-20.50) compared to non-drinkers. Consumers of both tobacco and alcohol were ten times more likely to develop intraoral cancer compared to those who do neither. CONCLUSIONS: The risk of intraoral cancer arising from use of alcohol and tobacco, icant. The findings of the study strongly endorse the rationale behind efforts by the South African government to implement strict tobacco legislation and campaign for responsible drinking.

Dental caries, socio-economic development and national oral health policies.

A relationship between a population's level of socio-economic development and dental caries has often been assumed. Proxy measures such as sugar consumption have been used to reflect this. This study tests the hypothesis that there is a relationship between dental caries and the level of socio-economic development, using recent international data. It goes on to explore the implications of this relationship for the development of national oral health policies. Dental caries data was obtained from the WHO, Global Oral Epidemiology Data Bank for the period 1981-1996. Socio-economic data was obtained from the United Nations Development Programme (UNDP). Countries were ranked according to the Human Development Index (HDI) and their GNP. The study confirms the existence of a relationship between dental caries and development. Caries is a good proxy measure for socio-economic development. Countries in the throes of socio-economic transition have the highest DMFT scores.

Setting global goals for oral health for the year 2010.

OBJECTIVE: To discuss the determinants for the possible setting of global goals for oral health for the year 2010. RESULTS AND CONCLUSIONS: If the application of oral health goals is to measure the outcome of oral health strategies and plans, they need to be substantially redesigned to reflect disparities in oral health and access to oral health care. It is no longer acceptable to focus only upon one or two arbitrarily selected disease entities and say these reflect the oral well-being of communities and the success (or failure) of oral health programmes. The use of validated socio-dental indicators to assess prevalence of socio-dental impacts seems essential, as does the avoidance of goals for conditions that are strongly influenced by culture, class, ethnicity and other widely variable local influences.

Oral diseases and socio-economic status (SES).

OBJECTIVE: To determine the association between social, economic and behavioural risk factors and national prevalences of: oral cancer, dental caries (12-year-olds) and destructive periodontal disease (35-44-year-olds). DATA SOURCES: Sources for the social and economic parameters were the UN Development Program; the behavioural risk factors' source was the World Health Organization, the UN Food and Agricultural Organization and the World Atlas of History. Oral diseases data came from UICC Globocan and the World Health Organization databases. DATA EXTRACTION: Data were extracted by hand from official publications. DATA SYNTHESIS: Data were synthesized and analyzed in sequence using SPSS, Pearson's correlation coefficient and multiple regression analyses. CONCLUSIONS: There is a discernable association between the three oral diseases and the variables selected, which varies in strength, being strongest for chronic destructive periodontitis and weakest for oral cancer. Dental caries lies in between. The degree to which variables account for differences in the three oral diseases between the countries studied is striking, being insignificant for oral cancer incidence, modest for oral cancer mortality, stronger for dental caries and strongest for destructive periodontal disease. Removing variables with strong co-linearity with the Human Development Index has little effect on the regression coefficients.

Evidence to support a food-based dietary guideline on sugar consumption in South Africa.

Since 1997, South Africa has been developing and implementing food-based dietary guidelines for people aged >6 years. The complexity of the population, which contains different ethnic groups, as well as the rapid urbanization that is taking place, means that food-based dietary guidelines need to consider both overnutrition and undernutrition. The initial guidelines did not include guidance on sugar, and the Department of Health was not prepared to approve them until appropriate guidance on sugar was included. This paper summarizes the evidence available for such a guideline and the nature of that evidence. Other low- and middle-income countries, particularly those in Africa, may face a similar dilemma and might learn from our experience.

African countries propose a regional oral health strategy: The Dakar Report from 1998.

It is clear that the African region faces a number of serious oral diseases, either because of their high prevalence or because of the severe tissue damage or death that can occur. Previous approaches to oral health in Africa have failed to recognise the epidemiological priorities of the region or to identify reliable and appropriate strategies to assess them. Efforts have consisted of an unplanned, ad hoc and spasmodic evolution of curative oral health services. This document focuses on the most severe oral problems that people have to live with like noma, oral cancer and the oral consequences of HIV/AIDS infection. It proposes a strategy for assisting member states and partners to identify priorities and interventions at various levels of the health system, particularly at the district level. The strategy aims at strengthening the capacity of countries to improve community oral health by effectively using proven interventions to address specific oral health needs. The strategy identifies five main 'programmatic areas', including (i) the development of national oral health strategies and implementation plans, (ii) integration of oral health in other programmes, (iii) delivery of effective and safe oral health services, (iv) regional approach to education and training for oral health, and (v) development of effective oral health management information systems. Many of the programmatic areas share similar characteristics described as a 'strategic orientation'. These strategic orientations give effect to the concepts of advocacy, equity, quality, partnership, operational research, communication and capacity building. The WHO Regional Committee for Africa (RC) is invited to review the proposed oral health strategy for the African region for the period 1999-2008 and provide an orientation for the improvement of oral health in member states in the region.

Access to health care in South Africa--the influence of race and class.

OBJECTIVES: The first democratic government elected in South Africa in 1994 inherited huge inequities in health status and health provision across all sections of the population. This study set out to assess the impact of the new government's commitment to address these inequities and implement policies to improve population health in general and address inequalities in health care in particular. DESIGN: A 1998 household survey assessed many aspects of health delivery, including their own perceived and actual access to health care among different segments of South African society. RESULTS: Race was the main predictor of perceived changes in access to health care, with black, coloured-and Indian respondents significantly more likely to feel that access had improved since 1994, compared with white respondents. Socio-economic status (SES) was the main predictor of actual access to health care, with low and middle SES classes significantly less likely to access care when ill. CONCLUSIONS: One-third of respondents perceived health care access to have improved between 1994 and 1998, and this response was partially determined along racial lines. About one-quarter reported an inability to access health care when they required it, and this response was partially determined along socio-economic lines. This set of contrasting responses suggests that at a political level perceptions are largely influenced by race, but at the operational level actual access is influenced by SES.

Oral disease in Africa: a challenge to change oral health priorities.

Colonial and other unsustainable oral health strategies exported to Africa have failed to improve oral health in the region. An alternative way of interpreting and responding to the problems of oral health in Africa is presented. It begins with a systematic interpretation of the health information available, using the application of the basic epidemiological principle of defining a specific health problem by describing its prevalence, severity (morbidity, mortality) and age adjusted distribution in the population. African oral disease priorities determined in this way are shown to be fundamentally different from those perceived previously. It is recommended that this new approach be used in customising a viable set of oral health policies and intervention strategies for each individual African community.