Perceptions regarding the shortened dental arch among dental practitioners in the Western Cape Province, South Africa.

AIM AND OBJECTIVES: This survey was conducted to determine the knowledge of and opinions related to the shortened dental arch (SDA), among dentists in the Western Cape Province, South Africa. METHODS: The study sample included two consecutive groups, drawn by a process of randomisation from the registered dentist population that included general dentists, specialists, those who had emigrated and retired dentists. A self-administered questionnaire was mailed, e-mailed and/ or faxed to those selected. Reminders were either e-mailed or made by telephone over a period of six months. RESULTS: A final sample of 84 respondents with a mean age of 43 years (SD = 11.9) was obtained. This represented a response rate of 23% (n = 84) from the final working sample (n = 368), derived from the target group (n = 618) originally contacted. All participants completed an informed consent form in which confidentiality was assured. Several respondents (40%) said they had heard about the SDA while at university, which would be in line with the age range of respondents in relation to introduction of the concept into dental curricula. As many as 62% had never read any research articles related to the concept which could partly account for the low response rate. The majority (86%) felt that patients can function with a SDA and that they would recommend acceptance to their patients. CONCLUSION: Respondents know of the potential benefit that the SDA may have for their patients and see it as a viable alternative treatment option for the partially dentate patient, even though their level of current knowledge of the subject must be considered questionable.

Bisphosphonate-related osteonecrosis of the jaw.

Bisphosphonates are agents commonly used in the treatment of osteoporosis, and in the management of metastatic bone disease, and of hypercalcaemia of malignancy. Any oral surgical procedure or traumatic event exposing bone to bacterial infection may precipitate osteonecrosis of the jaw in subjects who have been treated with bisphosphonates which suppress bone turnover and inhibit the angiogenesis associated with healing. New guidelines for the treatment of bisphosphonate-related osteonecrosis of the jaw are emerging, but hitherto treatment has been empirically conservative.

A meta analysis of the prevalence of spinal pain among dentists.

INTRODUCTION: Physical exertion among dentists seems to put them at increased risk for the occurrence of spinal pain. OBJECTIVE: To assess the prevalence of spinal pain among dentists by performing a systematic review and meta-analysis. METHODS: A systematic-literature search was conducted on prevalence of spinal pain among dentists. The databases searched were CINAHL, MEDLINE, Science Direct, CENTRAL (The Cochrane Library), ProQuest: Science Journals, and PsyclNFO. A standardised data extraction form was used to extract data. Prevalence proportions were pooled by meta-analysis. RESULTS: The search yielded 936 studies. Eight articles met the inclusion criteria. The meta-analysis yielded a combined prevalence of 53.90% (95% Cl: 41.96 to 65.84%) for thoracic-lumbar pain, 41.23% (95% CI: 27.52 to 54.93%) for lower back pain and 41.39% (95% CI: 27.81 to 54.98%) for neck pain. There was, however, a considerable heterogeneity between studies. CONCLUSION: Ergonomic interventions including exercise and therapeutically based preventative measures may have an impact on reducing high prevalence of spinal pain.

Lupus erythematosus: a short account.

Lupus erythematosus is a chronic autoimmune inflammatory disease with diverse clinical manifestations including arthritis, skin disorders and kidney disease. Pathologically it is characterised by complex interactions between multiple genetic, epigenetic and extraneous factors; and serologically by the presence of a variety of antibodies which are reactive to intracellular molecular constituents. Impaired clearance of apoptotic cells and of immune complexes, loss of immune tolerance to self-antigens and dysregulation of the cytokine network act synergistically with extraneous factors such as ultraviolet radiation, viruses and certain drugs to induce and sustain lupus erythematosus.

A case study of a dental receptionist diagnosed with Legionnaires' disease.

AIM: This article describes the search for the source of infection after a female dental receptionist was diagnosed with Legionnaires' disease. METHODOLOGY: An environmental investigation was carried out to locate the source of the infection. Samples were taken from different sources at sites where the dental receptionist resided and worked, and tested for Legionella pneumophila. Thermal measures were employed to eliminate the favourable conditions for the growth of Legionellae. RESULTS: The initial sampling of 13 sites indicated that there were four sample points which showed the presence of Legionella. Heat shock treatment of the hot water system was introduced as an intervention measure. A subsequent sampling of 14 sites indicated that two sample points showed the presence of Legionella. Water supply temperatures were found to be within the Legionella spp. ideal growth range. Faults were identified and measures were taken to regulate thermal temperatures outside the range which permits Legionellae growth. CONCLUSION: There is scientific evidence that water used as a coolant and irrigant during dental procedures can be heavily contaminated with micro-organisms. Thermal control of water and measures to correct faulty water systems can assist in prevention of Legionnaires' disease.

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.

Chemotherapy- and radiotherapy-induced oral mucositis: pathobiology, epidemiology and management.

Oral mucositis is a debilitating complication of anticancer treatment, characterised by erythematous, atrophic, erosive or ulcerative lesions. Oral mucositis is almost always painful, affects eating, sleeping, and speech and affects the physiological and social well-being of the patient. The pathophysiology of the condition is not well understood. Guidelines to the treatment of oral mucositis are often contradictory so that there is no evidence based standard treatment protocol. Therefore the treatment is empiric. This paper offers a brief review of current knowledge of the pathophysiology and treatment of oral mucositis.

A short account of cancer--specifically in relation to squamous cell carcinoma.

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.

Oral cancer-associated paraneoplastic syndromes.

Paraneoplastic syndromes are cancer-associated endocrinological, haematological, dermatological or neurological disorders, which are directly related neither to the physical effects of the tumour mass, nor to invasion by the primary tumour, nor to metastasis of the tumour; nor are they associated either with the side-effects of anticancer treatment or with any of the complications of cancer. These syndromes are brought about by the ectopic production of biological mediators by the malignant tumour cells, or by immunological responses to the malignancy. Certain cancers are typically associated with specific paraneoplastic disorders. Though uncommonly, oral carcinomata have reportedly been associated with paraneoplastic pemphigus, humoral hypercalcaemia of malignancy, syndrome of inappropriate antidiuretic hormone, and paraneoplastic leukocytosis syndrome.

HPV modulation of host immune responses.

Host immune responses to HPV are generally low-level because the virus, being confined to basal epithelial cells is shielded from the circulating immune cells during initial stages of infection. In this location there is only a limited expression of viral proteins. Other factors contributing to the low level of host immunity are that HPV infection is non-lytic (does not cause death of the infected cell); that a functionally active immune response is generated only at later stages of HPV infection, in post-mitotic suprabasal keratinocytes where all viral genes are expressed; and that only in suprabasal keratinocytes has the HPV DNA been sufficiently amplified to be detected by the host immune-surveillance cells. In addition to the natural low-level immune responses towards HPV, HPV also employs several mechanisms to down-regulate innate and cell-mediated immunity, thus facilitating host immune evasion and persistent infection. The environment, lifestyle, the genetic make-up of the host, and the viral genomic characteristics can also influence the persistence of HPV infection, and consequential diseases. Persistent infection with high-risk HPV is associated with increased risk of developing HPV-mediated premalignancy and malignancy. It is not clear if the natural humoral immune response as opposed to vaccination is effective in eliminating primary HPV infection or in preventing progression of infection; but after initial infection, the host develops HPV-specific T cell immune responses that appear to be capable of clearing established infection, of protecting against progression of early HPV-associated intraepithelial neoplastic lesions to squamous cell carcinoma, and of preventing reinfection.

Salt fluoridation: a meta-analysis of its efficacy for caries prevention.

UNLABELLED: The aim of this meta-analysis was to assess the caries preventive effect of Salt fluoridation (SF) in the permanent dentition in children. THE OBJECTIVES WERE TO COMPARE: (1) the caries preventive effects of SF versus no exposure in different age cohorts (6-8; 9-12; and 13-15 years old); (2) SF versus other community based interventions (milk or water fluoridation [WF]). METHODS: 9 English and 2 non-English databases were searched for papers that reported on the caries preventive effect of groups (with controls) that were exposed to SF in the form of mean DMFT scores with standard deviations. Differences in exposed and nonexposed groups were computed on the basis of weighted mean differences (WMDs) with 95% confidence intervals (CIs). RESULTS: For 6-8 year olds, the pooled reduction in DMFT scores was -0.98 [95% CI: -1.68 to -0.29]; for 9-12 year olds, it was -2.13 [95% CI: -2.55 to -1.70] and for the 13-15 year old groups, -4.22 [95% CI: -6.84 to -1.55]. All the analyses favoured the SF groups (p <0.001). For SF versus WF, there was no difference (-0.11 reduction [95% CI: -0.29 to +0.07]). CONCLUSION: Within limitations, the pooled estimates of the WMDs for the different age cohorts favoured SF versus no exposure.

The pathobiology and mechanisms of infection of HPV.

There are more than 120 types of low-risk and high-risk human papillomaviruses, all of which are epitheliotropic. HPV infection may be latent, or active in a subclinical form or a symptomatic form, the latter manifesting as benign or malignant neoplasms. In basal cells with non-productive HPV infection some early HPV proteins are expressed independently of cell maturation: the productive cycle of HPV replication depends upon specific cellular factors of the maturation of the infected keratinocytes. In HPV-mediated oncogenesis, the combined pathobiological effects of E6 and E7 oncoproteins of high-risk HPV culminate in cellular genomic instability and transformation of persistently infected cells, that progress to the development of a malignant phenotype. In this article we provide insights into the stages of HPV infection, and into the viral genomic organization and replicative cycle.

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.

Tuberculosis part 3: HIV-tuberculosis co-infection.

Tuberculosis is the most common opportunistic infection in HIV-seropositive persons. Tuberculosis may occur at any stage of HIV disease but the prevalence of TB increases with the progressive diminution of CD4+ T cell numbers. There is a synergistic relationship between tuberculosis and HIV infection as each accelerates the progression of the other.

The relationships between two different drinking water fluoride levels, dental fluorosis and bone mineral density of children.

This field study included the whole population of children aged 10-15 years (77 from a 0.19 mg/L F area; 89 from a 3.00 mg/L F area), with similar nutritional, dietary habits and similar ethnic and socioeconomic status. The fluoride concentration in the drinking water, the bone mineral content, the bone density and the degree of dental fluorosis were determined. The left radius was measured for bone width, bone mineral content, and bone mineral density. The mean fluorosis score was 1.3 in the low fluoride area and 3,6 in the high fluoride area. More than half the children in the low fluoride area had no fluorosis (scores 0 and 1) while only 5% in the high fluoride area had none. Severe fluorosis (30%) was only observed in the high fluoride area. The Wilcoxon Rank Sum Test indicated that fluorosis levels differed significantly (p < 0.05) between the two areas. No relationships were found between dental fluorosis and bone width or between fluorosis and bone mineral density in the two areas (Spearment Rank correlations). A significant increase in bone width was found with age but no differences amongst and boys and girls. A significant positive correlation was found in the high fluoride area between bone mineral density over age. In the 12-13 and 13-14 year age groups in the high fluoride area, girls had higher bone mineral densities. However, a significant negative correlation (p<0.02) was found for the low fluoride area (0.19 mg/L F) over age.

Tuberculosis part 4: Control of Mycobacterium tuberculosis transmission in dental care facilities.

The risk of transmission of Mycobacterium tuberculosis (Mtb) in oral healthcare facilities is probably low, but the consequences if it occurs, are grave. The greatest risk of exposure to Mtb transmission is associated with treating dental patients from communities with a high prevalence of tuberculosis (TB) and HIV disease because these patients may have active TB but be unaware of their status. The risk of Mtb transmission in the dental surgery is heightened by dental treatment with ultrasonic and air operated high speed instruments that generate aerosols. This article offers recommendations for the necessary components of an effective Mtb infection control programme.