An analysis of complaints against oral health professionals charged with misconduct at the HPCSA: 2004-2009.

AIM: This study investigates the nature, frequency, and outcome of complaints relating to misconduct laid against oral healthcare professionals (OHPs), charged with misconduct in South Africa. METHODS: Records of the Health Professions Council of South Africa (2004-2009) were analysed and classified using the ethical rules as a reference. "Clinically-related complaints" and "fraud" were added as extra categories. The nature and outcome of the complaints and the penalties were quantified, and the detailed nature of the complaints was qualitatively reported. RESULTS: Two percent of the registered dentists and 5.5% of the registered dental therapists were charged with misconduct. Clinically related complaints (59%) and fraud (29%) were most prevalent amongst the accused dentists. Fraud (46%), clinically related complaints (19%), advertising (15%), infection control (8%), and creating expectations that could not be met (8%) were the most common complaints against dental therapists. CONCLUSIONS: Substandard dental treatment and fraud were the main reasons for patient dissatisfaction that led to OHPs being charged with misconduct. Both these undesirable practices may be financially motivated. OHPs should take cognisance of these statistics and should adjust their professional approach accordingly in order to reflect acceptable ethical behaviour.

Trends in dental caries prevalence, severity and unmet treatment need levels in South Africa between 1983 and 2002.

OBJECTIVES: To determine trends in dental caries prevalence, severity and unmet treatment need levels amongst South African children. METHODOLOGY: Data obtained from three National Oral Health surveys (1982, 1988/89, 1999/2002) was used. RESULTS: Prevalence of caries amongst 12-year-old children decreased from 64.4% (1982) through 54.9% (1988/89) to 41.7% (1999/2002) and the DMFT decreased significantly (p < 0.05) from 2.54 (1982) through 1.73 (1988/89) to 1.17 (1999/2002). Unmet treatment need increased from 70.5% (1982), 72.3% (1988/89) to 75.2% (1999/2002). Significant decreases (p < 0.05) were recorded in the DMFT (1982-2002) in White, 75.3%; Asian, 64.1%; Black, 49.8%; and Coloured groups, 44.8%. High levels of untreated caries (D) and very low levels of treatment (M and F) were also observed. The highest mean dmft/DMFT for 6- and 12-year-olds respectively were recorded in the coastal areas of Metro Cape (5.1/1.86); followed by Port Elizabeth (3.86/1.37) and Durban (3.42/1.33); and the lowest in the interior--Bloemfontein (2.47/0.73). CONCLUSIONS: Caries reduced significantly during the past 20 years; is more prevalent and severe amongst Coloured and Black population groups and in coastal regions compared to the interior region. Unmet treatment need in 12- and 15-year-old children increased and more than 70% of caries in 6-, 12- and 15-year-old children go untreated.

Musculoskeletal disorders amongst practising South African oral hygienists.

OBJECTIVES: The study sought to determine the level of musculoskeletal disorders among working oral hygienists in South Africa and potential determinants that are associated with these disorders. METHODS: Oral hygienists registered with the HPCSA were requested to complete an anonymous questionnaire. Apart from demographic information they were asked to report on any musculoskeletal symptoms experienced in the hands, neck, shoulders and lower back as well as details of workload, types of scaling procedures, size of instruments, the mobility of the operator's chair and the adjustability of patient chairs. RESULTS: Of the 362 respondents, 61.3%, 66.5%, 56.6% and 59.6%, experienced hand, neck, shoulder and lower back symptoms respectively. Twenty-eight percent of the respondents performed hand-scaling for more than four hours per day. Twenty-six percent reported immobile operator chairs, while 12.6% reported patient chairs that were difficult to adjust. Employing multivariate analysis, excessive hand scaling was associated with hand and shoulder symptoms, while immobile operator's chairs and poorly adjustable patient chairs were respectively associated with neck and lower back problems. CONCLUSIONS: The prevalence of work-related musculoskeletal disorders in practising oral hygienists in South Africa appears to be similar to that in developed countries. Significant determinants of musculoskeletal disorders may be immobile operator stools, poorly adjustable patient chairs and excessive hand-scaling daily.

Empirical support for a fissure sealant placement timeframe protocol for black South Africans.

OBJECTIVES: It is recommended that fissure sealants should be placed within four years after eruption. Due to considerable variations in the eruption times of molar teeth, this recommendation is of limited value from a public health perspective. This study, therefore, sought to provide empirical support for a public health fissure sealant placement timeframe protocol. METHODS: The first and second molar eruption patterns of black South African children aged five to seven and 11 to 16 years were analysed in relation to caries experience using the 1999/2002 National Children's Oral Health Survey. RESULTS: By seven years of age, 90% of first molars had erupted with a caries experience of 3%. By 14 years of age the erupted first molars caries experience was 20%. The 13- and 14-year-olds presented with 86% and 98% erupted second molars with a caries experience of 11% and 20%, respectively. CONCLUSIONS: The study findings suggest that during school-based fissure sealant programmes involving black South African children, first molars should be targeted at age seven (Grade 1), or as soon as possible thereafter. However, caries protection may still be achieved until thirteen years of age (Grade 7). Furthermore, second molars should be sealed between the age of 11 and 13 years (grades 5-7).

Differences in the clinical appearances of white versus black patients with facial cleft deformities: a retrospective study of a South African clinic.

OBJECTIVE: The purpose of this study was to determine the difference in prevalence of the different categories of facial cleft deformities between the white and black patients in a database of 2806 cleft cases at the University of Pretoria. No variation of clefts between these two groups has ever been compared previously. For this purpose, the clefts were classified according to the system described by Bütow in 1985. MATERIAL AND METHODS: Records of 2806 patients attending the university's cleft lip and palate clinic, between August 1983 and February 2006, were reviewed. The study group included cleft patients with syndromic and nonsyndromic CL, CLA, CLAP, hP, hPsP, sP, COMBI clefts with or without oblique or transverse facial (or Tessier) clefts. Very few of the cases presented with speech problems only, but with no clefts. The cleft categories of cleft lip, cleft palate and cleft lip and palate, as well as their subdivisions, were analysed. RESULTS: Of these cleft patients, 2003 were white patients and 665 were black patients; the rest were Indian, Coloured and East-Asian patients. In the black and the white population groups (n = 2668), there were more males with cleft in the white group (58.2%), but more females with clefts in the black group (54.9%). The most common cleft type generally was the cleft lip, alveolus and palate cleft (CLAP) with a 434% prevalence of white patients and 296% of black patients. The most common cleft in the black patients was the cleft palate at 435%, which was only recorded in 35.0% of the white patients. The frequency of the other orofacial clefts in decreasing order was: sP 19.4% for white and 21.2% for black; hPsP 15.2% for white and 21.2% for black; CLA 9.7% for white and 19.8% for black; CL 5.9% for white and 4.5% for black and combinations of different orofacial clefts (COMBI), 6.0% for white and 2.6% for black. The isolated hard palate cleft (hP) occurred very rarely (0.4% for white and 1.1% for black). The left side of the face was more often afflicted (left to right 51.6% to 28.5% for white; and 35.0% to 37.9% for black). In 0.5% (white) and 3.9% (black) median clefts were observed. CONCLUSION: A retrospective study was done of 2806 facial black patients (2668 cases). There was a considerable variation between the groups of orofacial clefts occurring in the two groups.

Mandibular fractures: an epidemiological survey at the Oral and Dental Hospital, Pretoria.

OBJECTIVE: The objective of this retrospective analysis was to study the etiology, distribution, treatment modalities and complications of mandibular fractures of patients who attended the Maxillo-Facial and Oral Surgery (MFOS) unit at the School of Dentistry, University of Pretoria. METHOD: The records of a representative sample of patients who presented at the MFOS unit with mandibular fractures between January 1999 and December 2003 were captured on a data form specifically designed for this purpose. The data were then analysed using the Statistix 8 programme. RESULTS: Of the 501 patients who were included in the survey, 67.6% were in the age group 21 to 40 years. The majority of the patients (83.2%) were male. Assault (72.5%) was the most common cause of injury followed by road traffic accidents (14.2 %) and falls (8.8%). Of the 501 cases, 41.3% were bilateral, 32.7% on the left side and 26% on the right side. With regard to the location of the fractures, the majority occurred in the body of the mandible (411%), followed by those in the area of the symphysis/ parasymphysis (23.1%). In the majority of cases (51.7%) the treatment modality used was a closed reduction with intermaxillary fixation. Complications were reported in 14.6% of the 501 cases of which malunion (32%) was the most prevalent. CONCLUSIONS: Mandibular fractures are more common in males in the age range 21 to 40 years. Interpersonal violence is the main cause of these fractures. The majority of mandibular fractures occur in the body region while malunion is the most common complication.

Socio-economic inequities in dental caries experience of 12-year-old South Africans: policy implications for prevention.

OBJECTIVES: To examine the socioeconomic inequities in dental caries experience of 12-year-olds, in order to inform policy actions for caries prevention in South Africa. METHODS: Secondary analysis of the 1999-2002 national survey data of 12-year-olds (N=5411), available from 37 regions in 7 of the 9 provinces, was carried out. Logistic regression was used to determine risks for caries experience among 12-year-olds in each province, using parental occupation and racial group as independent variables. Regression curve-estimation was used to examine the spatial relationship between mean DMFT and caries prevalence. RESULTS: The mean DMFT (+/-SD) for the study population was 1.19 (+/-2.13), significant caries index was 3.35 and caries prevalence was 40.1%. The highest mean DMFT was among the Coloured population (2.14+/-2.50). Compared to children in the highest occupational class, the risk for children of the unemployed to experience caries was lower in the North West province (Odds ratio [OR]=0.47; p<0.01), but significantly higher in the coastal provinces-- KwaZulu-Natal and Northern Cape, with OR of 1.32 and 1.52 respectively. The regression curve derived demonstrated that a unit increase in caries experience in low-level caries populations would generate more cases than similar increase in high-level caries populations. CONCLUSIONS: DMFT alone provided an incomplete picture of the impact of caries in South Africa, thus the need to monitor inequities as part of policy impact. The distribution of caries suggests that 'high-risk' approach to prevention in the presence of existing social gaps may inadvertently reinforce inequities in caries-burden and supports the concurrent implementation of population-approach, such as water fluoridation.

Orthodontic status and treatment need of 12-year-old children in South Africa using the Dental Aesthetic Index.

OBJECTIVE: The aim of this study was to determine the prevalence and severity of malocclusion and orthodontic treatment needs in a sample of 12-year-old South African school children using the Dental Aesthetic Index (DAI), and to assess the relationship between malocclusion and certain socio-demographic variables. METHODOLOGY: The sample comprised 6142, 12-year-old children attending school in seven of the nine provinces of South Africa. For each subject the standard demographic information such as gender, population group, location type and employment status of the parents was collected, after which an intra-oral examination for occlusal status using the DAI was performed. Before the survey, the examiners were calibrated and trained and only examiners with an agreement score greater or equal to 80 per cent were included in the final study. RESULTS: The results showed that 47.7 per cent of the children in the sample presented with good occlusion or minor malocclusion, just over 52.3 per cent presented with identifiable malocclusion, a DAI score larger than 26. Of these, 21.2 per cent had definite malocclusion, 14.1 per cent had severe malocclusion and 16.9 per cent had very severe or handicapping malocclusion. Malocclusion as defined in this study was found to be significantly associated with the different population groups in South Africa, with gender and with dentition stage, but not with the location type or the employment status of parents. CONCLUSIONS: The results of this study show a high prevalence of malocclusion in 12-year-old South African children. The findings provide reliable base-line data regarding the prevalence, distribution and severity of malocclusion as well as useful epidemiological data on the orthodontic treatment needs of 12-year-old children in South Africa.

Caries status and treatment needs in South Africa: report of the 1999-2002 National Children's Oral Health Survey.

A third national children's oral health survey was conducted in South Africa between July 1999 and June 2002. OBJECTIVE AND METHODOLOGY: One of the objectives of the survey was to determine the prevalence and severity of dental caries and the treatment needs for dental caries in 4- to 5-, 6-, 12- and 15-year-old South African school children. The sample comprised 30876 children from the nine provinces of South Africa. RESULTS: The results of the survey show that 39.7 per cent of the 6-year-old group were caries free. This figure, 39.7 per cent, is below the goal of 50 per cent set by the Department of Health for 6-year-old children in South Africa for the year 2000. The DMFT of 1.1 for the 12-year-old group on the other hand was below the goal of 1.5 set for South Africa for the year 2000. The highest DMFT/dmft scores were recorded in the Western Cape Province and the lowest in the Limpopo Province. More than 80 per cent of caries in children go untreated while the greatest need for treatment in South African school children was for preventive services, restorations and extractions. The results for the 12-year-old-group show a reduction in dental caries severity in the permanent dentition in that the DMFT decreased from 2.5 in 1982 to 1.1 for the current survey. CONCLUSIONS: Although dental caries severity in South Africa is classified as low by WHO standards, the high levels of untreated caries in all age groups in South Africa is a cause for concern.

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.

A profile of South African orthodontists: NOHS 1988/89.

The response by orthodontists to a 1988/89 National Oral Health Survey questionnaire is reported. The 54 predominantly white male respondents reflected a balanced age distribution. The majority were in solo private practice. Almost half employed oral hygienists, 96 per cent worked between 40 and 49 weeks per year and 61 per cent worked between 35 and 44 hours per week. Half were satisfied with their busyness and the remainder were evenly divided between being too busy or not busy enough. The majority of patients were white. It is recommended that imbalances in race and gender amongst orthodontists be redressed.

Geographical distribution of dental operators in South Africa over the period 1972-1992.

Using data available on dentists for 1972, 1982 and 1992 and on dental therapists for 1992 the geographical distribution of dental operators (dentists/dental therapists) in South Africa was determined and the dental operator to population ratios were calculated. Over a period of 20 years the number of dentists in South Africa has increased by 135,6 per cent while the total population of the area has increased by 59,8 per cent. The lowest operator to population ratio was 1:4517 found in the PWV region, and the highest ratio was 1:48730, recorded in the Northern Transvaal. The greatest decrease in dental operator to population ratios occurred in Natal and Transvaal. The study shows that there is an imbalance in the geographic distribution of dental operators favouring large urban areas.

[Semi-microanalytical method of fluoride determination in enamel biopsies]. / Semi-mikro-analitiese metode vir fluoriedbepaling in glasuurbiopsies.

When making use of potentiometric micro-analytical methods in fluoride determination, only a portion of the lantanium fluoride (LaF) crystal of the fluoride electrode is employed. Although there is no difference in sensitivity when using either the total surface or a part of the surface of the LaF crystal, there are advantages in using the total surface of the crystal. For the purpose of utilizing these advantages to a maximum, a semi-micro-analytical method of fluoride determination was developed. A perspex electrode container with a specimen capacity of 50 microliters was designed and constructed in order to bring the total surface of the LaF crystal into contact with the testing solution. Due to the inexpensive and simple design of the containers there are practically no restrictions on the number that could be employed. The solution obtained from a single enamel biopsy could be used for at least two or three analyses. The results obtained by employing the technique described, showed that the method is precise and accurate. The semi-microanalytical method offers an alternative to the micro-analytical method of fluoride determination in enamel biopsies.