The effect of overbooking on idle dental chair capacity in the Pretoria region of the Gauteng Oral Health Services.

An analysis of annual reports revealed that on average 20% of patient appointments with oral hygienists in the Department of Health in the Pretoria region were not utilised due to patient noncompliance (i.e. broken appointments). Many solutions have been considered to address the high rate of noncompliance and the resulting idle chair capacity. One solution selected to overcome some of the negative consequences of broken appointments was deliberate overbooking. The aim of our study was to determine the effect of overbooking on idle dental chair capacity by measuring the utilisation rate over a three month period (July to September) after 25% overbooking was introduced in the Pretoria region. A statistical analysis was conducted on our results to determine an overbooking rate that would ensure full utilisation of the available dental chair capacity. The available time units over the three month study period amounted to 1365, allocated to 1427 patients resulting in an overal overbooking rate of 4.54%. The overall utilisation rate was found to be 79.2%. The calculated regression line estimated that there would be full utilisation of dental chair capacity at an overbooking rate of 26.7%. Overbooking at the levels applied in this study had a minimal overall effect on idle dental chair capacity. Our results confirm the need for careful planning and management in addressing noncompliance. In a manner similar to the clinical situation, organisational development requires a correct diagnosis in order that an appropriate and effective intervention may be designed.

Fracture of the genial tubercles associated with a mandibular denture: a clinical report and review of the literature.

We report a case of fractured genial tubercles associated with a mandibular denture in an elderly female patient and review the literature reports of this condition over the past 50 years. The period without natural teeth and the amount of atrophy of the mandible appear to be associated with the condition, especially when atrophy has reached an extent where the genial tubercles become a direct part of the denture bearing area. The signs and symptoms generally associated with this condition include pain and swelling, haematoma of the floor of the mouth, painful and limited movement of the tongue, dysphagia and painful swallowing, and an obvious experience of discomfort while wearing the lower denture. The radiographic assessment of the mid-line region of the face on conventional radiograph views is often complicated by superimposition of the spine, and therefore computerised or cone-beam volumetric tomography will provide a better view of the fractured segment. The management of the condition is either by conservative care, or by surgical exposure and removal of the fractured tubercles. Irrespective of the chosen mode of treatment, the reports indicate that recovery can be expected to be uneventful in a relatively short period of time. Consensus suggests that the indications for surgical intervention in fractures of the genial tubercles are minimal, as the majority of patients do not require any active treatment and had resolution of their symptoms after conservative management.

A cost-efficiency analysis of a mobile dental clinic in the public services.

During 1997, the Gauteng Oral Health Services implemented a Mobile Oral Health Care System (MOHCS) in the province. For the first year (1997/98) one mobile dental clinic was utilised in the West Rand region of the province and services were provided by dentists, dental therapists and oral hygienists. The purpose of the MOHCS is to provide an accessible and affordable comprehensive oral health care service of high quality and standard. The aim of this study was to determine the cost-efficiency of the mobile dental clinic utilised in the West Rand region over the first year of implementation. After consultation with all stakeholders, an operational plan was finalised. The plan included a traveling schedule, clinicians available for service delivery, and a management information system (MIS). Statistics on dental materials, consumables, treatment provided, etc. were collected and analysed. During the study period 2072 patients received dental treatment at 38 different sites in the region. At an average cost of R56.50 (+/- US$11) per patient, services to the value of R92.45 (+/- US$18) per patient were delivered during 104 working days. Of the 1477 patients treated by a dentist or dental therapist, 53% were treated by extracting 1026 teeth, and 27% by restoring 570 teeth. For oral hygiene patients, 67% received an oral hygiene procedure and 13% received fissure sealants. With a net margin ratio of 0,39 and a breakeven point of 1173,46 patients and 58,90 days, an accessible and cost-efficient service was provided to health districts in the West Rand region.

Evaluation of Atraumatic Restorative Treatment restorations and sealants under field conditions.

Conventional restorative procedures require the use of dental materials, expensive equipment, instruments and electricity. This makes dental restorations costly and limits the availability and accessibility of the service to areas where these facilities are available. The new philosophy of restorative care requires minimal intervention and advocates early interception of the caries process through the use of glass-ionomers as sealants and as restorations. This new approach makes dental care accessible to all members of society in developing countries. The aim of this study was to evaluate the use of Atraumatic Restorative Treatment (ART) restorations and sealants under field conditions. Both were assessed for their retentive properties and the development of secondary caries adjacent to the procedures. A longitudinal study design was followed. ART restorations and sealants were assessed at intervals of 6 and 12 months. After 12 months 56.5% of ART restorations were still present in the primary dentition and 84% in the permanent dentition. Of these 85.1% had no defects in the primary and 78.6% no defects in the permanent teeth. 72.3% of primary and 92% of permanent teeth on which ART restorations were placed had no caries after 1 year. Even though most of the sealants were absent due to poor retention after 12 months (89.6%), 98.9% of the teeth where the sealant was initially placed had no caries. Only 6.3% of sealants present had marginal defects. The ART technique is strongly recommended for the management of small, occlusal carious lesions in primary and permanent teeth.

Cost evaluation for the implementation of water fluoridation in Gauteng.

Regulations to implement water fluoridation in South Africa were promulgated in September 2000. Water providers are now compelled to fluoridate public water sources. In terms of Regulation 5(c) of the regulations, certain information regarding the cost of water fluoridation must be submitted to the Director General of Health. The purpose of this survey was to evaluate the cost of water fluoridation in Gauteng and to provide a model for similar calculations in other provinces. The following criteria were used to evaluate the cost of water fluoridation in Gauteng--per capita cost per year, cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA). The calculated cost per capita per year was R0.73 while CEA showed that R3.95 will be spent to save 1 DMFT. The cost-benefit ratio based on the scale of benefits cost of a 2 surface plastic restoration was 0.04. Evaluation of cost for the implementation of water fluoridation in Gauteng was extremely favourable and a model to estimate the per capita figure is provided.

Reasons why South African qualified dentists are working in the UK.

Various reasons are provided why professional people are leaving or had left the country since 1990. A substantial number of these emigrants were dentists who went to practise their profession in the United Kingdom (UK). The purpose of this study was to determine, by way of a questionnaire, why some South African qualified dentists prefer to practise their profession in the UK. The results showed that the high level of crime and violence in South Africa is the most important reason why South African qualified dentists are leaving or have left the country. Economical considerations, either their own financial position or the general economy of the country also appear to be an important reason why South African qualified dentists are moving abroad.

From SA to UK: a profile of South African qualified dentists registered with the General Dental Council.

During the past five years, the media were inundated with reports of professional people leaving the country. A number of the emigrants were dentists who went to the United Kingdom to practise their profession. The purpose of this study was to gather data on South African qualified dentists registered with the General Dental Council (GDC) in the United Kingdom and to provide baseline information on this group of health professionals. The results of the study showed a steady increase in the number of South African qualified dentists registered with the GDC in the period 1990 to 1995. Attrition of South African qualified dentists is, however, not entirely due to emigration to the United Kingdom.

Medical scheme expenditure on dental care--a smaller slice of the pie.

Medical schemes play an important part in financing dental care in the private sector and provide many dental practitioners with a substantial source of income. Data on medical scheme expenditure indicates a steady decline in their proportional pay-out for dental care during the period 1985 to 1994. In 1985 more than 12 per cent of total medical scheme expenditure was spent on dental care. In 1994 this had reduced to 8.37 per cent. In the present study, the historical trend (1985-1994) of medical scheme expenditure on dental care is analysed. By using the least squares method, the annual medical scheme expenditure on dental care is computed for the next eleven years (1995-2005). If the secular trend continues, less than 4 per cent of medical scheme expenditure will be paid for dental care by the year 2005.

The fluoride concentration in the drinking water of towns in the Transvaal, Orange Free State and Natal.

In previous studies the water fluoride content of the larger cities in South Africa, and smaller towns in the Cape Province were recorded. This project was extended to include smaller towns (500 or more inhabitants) in the Transvaal, Orange Free State and Natal. Drinking water was collected in polypropylene containers and the fluoride content determined potentiometrically. The information obtained made it possible to compile a table setting out the fluoride content of the drinking water in these smaller towns. The study confirms a previous observation that water from boreholes has the highest (p < 0.05), and fountains the lowest fluoride content.