Dental status of rural school children in a sub-optimal fluoride area.

Past investigations by us have shown high levels of caries experience in rural coloured school children of the Western Cape. These studies were all undertaken in fluoride poor areas. In contrast studies of children in areas with optimal and higher concentrations of fluoride in their drinking water have shown lower DMFT scores. On a previous visit to the town of Fraserburg in the North Western Cape we observed fluorosis in children, although the fluoride content of the municipal drinking water was sub-optimal (0.68-0.78 ppm F-). The purpose of this study was therefore to measure the dental status of 6, 12 and 15 year old school children using the dmft, DMFT and Dean's Fluorosis Index according to the 1987 WHO guidelines. The examinations were done by two calibrated examiners using portable equipment. Results showed low mean dmft values of 3.31 +/- 3.90 and 0.22 +/- 0.86 for the 6 and 12 year olds respectively. The corresponding DMFT scores including that for 15 year olds were 0.08 +/- 0.35; 1.45 +/- 1.81 and 1.00 +/- 1.60 respectively and no significant statistical gender differences were observed (p>0.05). The mean fluorosis scores for 6, 12 and 15 year olds were 1.68 +/- 1.05; 2.78 +/- 1.34 and 2.90 +/- 1.58 respectively. For both the 12 and 15 year olds the severity of fluorosis ranged from no fluorosis to severe mottling and corrosion. It can be concluded that the results even at a sub-optimal fluoride level show a high similarity to the dental status of children in rural fluoride rich areas. Defluoridation of the Fraserburg municipal drinking water therefore becomes imperative and a concentration of 0.4 ppm F- is suggested. Furthermore the children have no access to dental services and this has led to accumulated needs which demand urgent addressing.

Effectiveness of two school-based caries preventive programmes.

Although the efficacy of school-based preventive programmes is well established, their effectiveness under conditions prevailing in the community require further exploration. A longitudinal study was conducted to assess the community effectiveness of two school-based caries preventive programmes. A group of 150 primary school pupils, 10-15 years old were randomly selected from each of three primary schools (Dagbreek, Vergesig, De Villiers) in the Boland town of Robertson. The sample comprised 75 10-12 year-olds and 25 in each of the 13, 14 and 15 year age groups. The 75 (10-12 year-olds) constituted the experimental cohort, which was to be followed up over a period of 3 years and compared to the 13-15 year-olds, the control or baseline cohort. The experimental cohort in Vergesig was exposed to a daily toothbrushing programme with a fluoride dentifrice, the Dagbreek children were exposed to the same regimen plus a weekly 0.2 per cent fluoride rinse and the De Villiers cohort acted as a control group for contamination and co-intervention. The DMFT index (WHO, 1987) was used as a caries measure. Dagbreek showed a reduction of 0.96 DMFT (14.2 per cent) and Vergesig of 1.85 DMFT (24.5 per cent). The difference is attributed to a higher baseline DMFT at Vergesig. The weekly fluoride rinse did not confer any additional benefit. Although the caries reduction was lower than that generally found in clinical trials, the two intervention programmes were cost-effective.

Dental and oral hygiene student's knowledge of HIV infection and AIDS.

A survey was conducted to assess the knowledge of 30 oral hygiene (OH I & II) and 79 dental students (BCHD III & VI) on HIV infection and AIDS. A questionnaire consisting of twenty-nine questions based on the 'agree-disagree' format was prepared for this study. Clinical slides were projected to assess students' ability to identify oral manifestations of HIV infection. Most students agreed that HIV-sero-positive people were entitled to the same dignity and respect as those who were suffering from other illnesses. Students were concerned about treating sero-positive patients. They would preferably receive training in the management of these patients in a controlled environment. They had a poor perception of the risk of infection following needle-stick injury and whether HIV could be transmitted through contact with saliva. Most students felt that they had insufficient lectures on HIV/AIDS and had practically no clinical exposure to HIV-sero-positive patients.

The relationship between plaque index scores, fluoride content of plaque, plaque pH, dental caries experience and fluoride concentration in drinking water in a group of primary school children.

The aim of this study was to determine the relationship between fluoride in drinking water, plaque and dental caries experience in a sample of primary school children from a fruit farming (mainly grapes) area. The children who qualified for the study (n = 177) were placed into three groups according to the concentration of fluoride in their drinking water namely, less than 0.4 ppm (group A), between 0.4 and 1.6 ppm (group B) and more than 1.6 ppm (group C). Most children (78.5%) did not have a toothbrush. Plaque scores were significantly lower in groups B and C. A statistically significant inverse correlation was observed between plaque scores and fluoride content of plaque (p < 0.05). Plaque pH did not differ significantly between the groups. The concentration of fluoride in plaque was high and increased with increasing concentration of fluoride in the drinking water. Dental caries experience was relatively low in primary (dmft = 2.15; 2.07; 1.79) (p > 0.05) and permanent teeth (DMFT = 1.22; 1.43; 1.38) (p > 0.05). Paradoxically, there was also no significant inverse correlation between dental caries experience and fluoride concentration in drinking water. However, the significant inverse correlation between fluoride content of plaque and caries experience supports the contention that fluoride can be accumulated in plaque and act as a reservoir which provides prolonged elevated levels of fluoride to produce a cariostatic effect. It is postulated that the high fluoride levels in the plaque reservoir is responsible for the relatively low caries experience, the significant differences in caries experience between the groups and the poor correlation between dental caries experience and fluoride concentration in drinking water.

Root caries in a sample of elderly persons.

With the anticipated increase in the aged adult population and the associated gingival recession, the prevalence of root caries is expected to increase. The purpose of this study was to determine the experience and distribution of root caries in a group of aged adults living in Kayelitsha. All non-institutionalized elderly black adults participating in a community geriatric programme were examined. Root caries was recorded using visual and tactile criteria and expressed as the root caries index (RCI) rate. The mean age of the subjects was 65.2 years, the mean number of teeth present was 17.3 and the mean RCI rate was 2.2 per cent. All subjects had gingival recession while only 23.8 per cent had root caries. No surfaces with restored root caries lesions were found. In the maxilla the highest RCI rate was observed on the interproximal surfaces of the posterior teeth (4.4 per cent) but in the mandible the buccal surfaces of the posterior teeth had the highest RCI rate (4.2 per cent). In both the maxilla and the mandible the lingual surfaces of the anterior teeth showed no root caries. Maxillary teeth did not have a significantly higher root caries attack rate than mandibular teeth. Root caries does not appear to be a public health problem in the sampled population.

A survey of dental practice and equipment characteristics.

The aim of this study was to determine what would be regarded as essential equipment required for setting up a dental practice and the cost thereof. This information could be useful for the newly qualified dentist. Seventy five completed questionnaires returned from a randomly selected group of practising dentists were analysed to obtain this information. Equipment costs were obtained from a dental supply house and are tabulated. Guidelines recommended for setting up a practice include determining the type of service to be rendered, selecting the equipment required for this purpose, seeking expert financial advice and commencing the practice on a conservative basis with only the essential items of equipment.

Oral health status and treatment needs of black college students at Khayelitsha.

Descriptive information on the oral health status and treatment needs of black students at a teacher training college in Khayelitsha was collected to facilitate the planning of appropriate preventive and therapeutic programmes. A random sample of 96 subjects was drawn from the college population. The average age of the group was 27.3 years; 83.3 per cent were females and 90.6 per cent had experienced caries. The mean DMFT was high (11.14), the mean score for males was almost half that for females (p = 0.0247). 54.2 per cent needed treatment for caries such as fillings (47.9 per cent) and extractions (25.0 per cent). No students had shallow pocketing and deep pockets were recorded in only 3.4 per cent. However more than 4 segments on average showed signs of bleeding or higher scores for periodontal disease. A significant difference existed between the sexes for the presence of calculus (p less than 0.005). Oral hygiene instruction and prophylaxis were needed by the majority of students namely 92.1 per cent and 70.8 per cent respectively. The high number of students with bleeding and calculus indicates that an intensive program of oral health education is required by this group.

A caries preventive programme for Robertson school children--baseline data.

This study describes the baseline caries experience of a cohort school children in the Robertson area who were selected to take part in a longterm school-based preventive programme. On the whole baseline DMFT values for the various age groups did not differ significantly except for the 13-year-olds at Vergesig who had significantly higher values than those obtained at the other two schools. The D-component predominated with a moderate M-component and no filled teeth. The teeth at risk for the respective age groups did not differ significantly between the schools. The frequency of caries experience decreased from the molars to the central incisors except for the canines which were least vulnerable. The DMFT values were high and warrant the search for the most suitable preventive measures to facilitate reduction towards the WHO goal of 3 for 12-year-olds by the year 2000.

Denture requirements of indigents in the Western Cape region.

This study was undertaken to determine the denture requirements of indigents who make application to the Department of National Health and Population Development for prostheses. An analysis of 4573 denture application forms for the period 1 January 1983 to 31 December 1984 was undertaken in the Western Cape region in order to obtain the relevant information. The general profile of applicants was that of a middle-aged coloured female who was unemployed with a monthly income of R144.51. Almost 60 per cent of applicants had been edentulous for a period of 1-10 years and the greatest demand was for full upper and lower dentures. The mean period of wearning dentures ranged between 15.9 and 21.7 years. A disturbing finding was that a high percentage of applicants (48.6%) had no motivational reasons for wanting dentures.

[Demographic and economic trends in medical schemes--a time series analysis]. / Demografiese en ekonomiese tendense vir mediese skemas--'n tydreeksanalise.

A time series analysis was performed on medical scheme statistics with the aim of determining current and future demographic and economic trends. This would enable one to reach a better perspective on the current and future financial dilemma presently experienced by medical schemes. Data for the period 1978-1986 was analysed on a computer, using the Statgraphics program. The linear trend projection method, based on the regression analysis technique was used. Real values were determined by deflating nominal values against the consumer price index with 1980 as base year. There are at present 253 medical schemes in operation. Approximately 16 per cent of the economically active population are members of medical schemes. White members increased by only 3.8 per cent during the period 1978-1986, in comparison to the 87.1 per cent by black members. The beneficiaries represent 19 per cent of the total population; black beneficiaries increased by 422.1 per cent, while Whites increased only fractionally by 0.73 per cent. Membership fees increased by an average of R8.08/member/month or R1.72/member/month in real terms. Ninety five per cent of the income of medical schemes was derived from membership fees. The average real growth rate of income was 8.4 per cent, while net assets increased by only 3 per cent. An average deficit of R11.02 million/year is estimated for the recommended reserve funds in real terms. The greatest proportion of benefits paid was for professional services (47.4 per cent) followed by medicine (26.3 per cent) and hospital services (19.8 per cent). The real growth rate for benefits paid was 8.6 per cent per year.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of information systems in public health services.

The purpose of this review is to establish a conceptual framework on the role of information systems in public health care. Information is indispensable for effective management and development of health services and therefore considered as an important operational asset or resource. A Health Information System is mainly required to support management and operations at four levels: namely transactional and functional; operational control; management planning and control; and strategic planning. To provide the necessary information needs of users at these levels of management in the health care system, a structured information system coupled with appropriate information technology is required. Adequate and relevant information is needed regarding population characteristics, resources available and expended, output and outcome of health care activities. Additionally information needs to be reliable, accurate, timely, easily accessible and presented in a compact and meaningful form. With a well-planned health information system health authorities would be in a position to provide a quality, cost-effective and efficient health service for as many people as need it, optimal utilisation of resources and to maintain and improve the community's health status.

[Water fluoridation as a public health measure. A sociopolitical perspective]. / Waterfluoridasie as openbare gesondheidsmaatreël. 'n Sosiopolitiese perspektief.

This review provides a perspective on water fluoridation as a public health measure and the sociopolitical disputes preventing its implementation. Notwithstanding its world-wide recognition as a safe, efficient and cost-effective public health measure, water fluoridation has increasingly found itself in the sociopolitical arena. Factors responsible for preventing the implementation of water fluoridation include public sensitivity, anti-fluoridation campaigns, negative reporting by the media, public debates and lack of professional involvement. Successful implementation of water fluoridation can only be achieved by a purposeful national strategy, active communication and involvement by all concerned.

[Personal and professional characteristics of women dentists in RSA]. / Persoonlike en professionele eienskappe van dame tandartse in die RSA.

Dentistry is a relatively new occupation for females in the RSA. Female dentists have particularly increased since 1975. Currently, approximately 11.4 per cent of the dental labour market consists of female dentists. Present student intakes indicate that the number of female dentists will increase to approximately 20.9 per cent within the next five years. Personal and professional characteristics of female dentists were determined by means of a survey of 55 female dentists on the Register of the South African Medical and Dental Council. Replies were received from 36 of the women, representing a response rate of 65 per cent. Female dentists are relatively young, married, their spouse mainly also in a professional occupation, and have at least two children. Factors which may have an special impact on professional activities include marital conflict due to interpersonal relationships, interaction of the mother and wife role on occupation, and lapse in service due to pregnancy. The results of this study indicate that female dentists are in general professionally and intellectually active in service. Female dentists are more inclined to private practice. Unmarried females are, as expected, professionally more active on a full-time basis in comparison to married females which are proportionally more active on a part-time basis. The respondents are mostly of the opinion that the dental profession provides sufficient occupational satisfaction to justify a professional identity for female dentists.

CPITN: a tool in the planning of dental services.

The need for a systems approach in the planning of dental public services has been emphasised. A random sample of 1,400 farm labourers and their dependants was assessed using the CPITN index. This data was used to estimate manpower and time requirement based on treatment strategies. Results indicate that virtually everybody aged 7 years and older (94 per cent) require oral hygiene education, 79 per cent need a scaling, while 5 per cent need complex treatment. The need for scaling increased from 61 per cent among 7 to 19-year-olds to 98 per cent in the over-20-year-olds. A small proportion (22 per cent) of sextants amongst 7 to 19-year-olds need scaling, compared with 82 per cent in the over-20 group. While no sextants in the 7 to 19-year-olds require complex treatment, a negligible proportion (0.43 per cent) among over-20-year-olds need such treatment. The findings are extrapolated to the sample population and the times for each procedure used to calculate resources for treating the sample population. It is estimated that approximately 7.3 working years would be required to provide the necessary treatment. In terms of manpower it is estimated that seven full-time oral hygienists and one part-time dentist will be needed to fulfil the total treatment needs. The CPITN appears to be an appropriate tool in the planning of dental health services. Planners should, however, relate estimates to available resources and establish priorities accordingly.

[Oral health and treatment needs of 12-13 year-old epileptic schoolchildren in two special schools in the West Cape]. / Die mondgesondheidstatus en behandelingsbehoeftes van 12-13 jarige epileptiese skoolkinders in twee spesiale skole in die Wes-Kaap.

The aim of this study was to determine the oral health status and treatment needs of 12-13 year old epileptic children at the Jan Kriel and Bet-El schools for neurologically handicapped children. This information will be used as a guideline to aid the planning and evaluation of oral health programs at both institutions. A total of 25 White and 25 Coloured epileptic schoolchildren were respectively examined at Jan Kriel and Bet-El. The variables examined were the status and treatment needs for both caries and periodontal lesions, phenytoin-induced gingival hyperplasia and fractures of anterior teeth. The measurement of the variables were based on the criteria of the World Health Organization. The mean DMFT at Bet-El was 4,8 in comparison with 2,0 at Jan Kriel. No children at Bet-El were caries free, whilst 32 per cent of the children at Jan Kriel were caries free. Sixty four per cent of the children at Jan Kriel needed no treatment for caries in comparison with the 8 per cent at Bet-El. Caries treatment needs consisted mainly of 1- and 2-surface restorations at both institutions. Only 8 per cent of the children examined at Bet-El were periodontally sound in comparison to the 32 per cent of the children at Jan Kriel. A high prevalence of gingival bleeding on probing was observed at both institutions. A need for oral hygiene instructions existed at both institutions. More than 50 per cent of the children at Bet-El needed scaling and polishing.(ABSTRACT TRUNCATED AT 250 WORDS)

The effectiveness of a school-based oral health education program--a pilot study.

The aim of this study was to determine the short term effectiveness of an oral health education (OHE) program on a group of coloured school children. The variables measured were the level of oral hygiene and the knowledge of oral health care. All Sub A, B and Std. 1 pupils at the Levana Primary School in Retreat took part in the pilot study. A representative sample, stratified by sex, was randomly drawn from each class. Oral hygiene levels were measured by means of the Debris Index-Simplified (Greene and Vermillion, 1964). Additionally, all pupils were exposed to a set of questions to determine their level of knowledge of oral health care. Assessments were carried out before intervention (baseline) and at 1 and 3 month intervals (post-course 1 and 2). The results of this study indicate that the OHE program is effective in meeting the basic requirements within the school framework. Recommendations are made to improve the current OHE program. The evaluation of the impact of the OHE program has provided a basis for further longterm investigation and systematic planning.