In vitro human dental enamel erosion by three different wine samples

The aim of this study was to investigate the erosive effect of different wine samples on the enamel of human permanent teeth. Twenty-one extracted, sound, permanent human incisor teeth were imbedded in epoxy resin and seven immersed in each of the three different wine samples for 0, 2, 5, 15, 30, 45 and 60 minute periods. The Knoop hardness for each tooth at each of the immersed periods was determined as a measure of the degree of enamel erosion (demineralisation). The main finding was that all three wines eroded enamel (softer enamel) which should mainly be due to their very low pH values (3.2, 3.7, 3.8) and high total acid content. From the Wilcoxon non-parametric tests it was clear that wine 2 had the severest influence on the hardness of the teeth, and the wines differed significantly (p < 1%) from 30 minutes onwards. These tests showed that wine 1 differed significantly from wine 2 from 30 minutes onwards and so did wine 3, but wines 1 and 3 did not differ at all (p > 5%). It is concluded that all three wine samples were erosive to enamel and it is difficult to predict the relative erosion rate of different kinds of wines according to their chemical compositions, as this process is most probably governed and affected by a large number of a combination of factors. The only reliable way to know the exact degree of erosion of a specific wine is by means of a laboratory study. Possible ways to decrease the damaging effect of erosion caused by wine are provided.

Infection control among dentists in private practice in Durban

The general fear, superstition and alarm surrounding HIV/AIDS warrant that the highest standards of care be available to our patients. A survey on infection control was undertaken in Durban to assess the current state of infection control procedures among dentists in private practice. A self-administered 44-item questionnaire was hand-delivered to a random sample of 75 dentists (31.3%)--see comments in Methods--in private practice. The response rate was 90.7% (68 dentists). The routine use of gloves, masks, and protective eyewear was reported by 97.1%, 82.4% and 52.9% of dentists respectively. Although 89.7% of dentists had autoclaves in their practices, only 45.2% autoclaved their high speed handpieces and 39.7% their slow handpieces. Almost 60% of dentists did not use rubber dam at all whilst 46.3% did not disinfect impressions before sending them to the laboratory. Approximately 6% of respondents reported re-using local anaesthetic cartridges and 1.5% re-used needles. Needlestick injuries in the previous six months were reported by 13.8% of dentists but two thirds of them did not follow any specific protocol after injury. Almost 90 per cent of dentists were immunised against Hepatitis B but more than 60% of their staff were not. The results of the study showed that adherence to universally accepted guidelines for infection control remain low amid a climate of an ever-increasing HIV pandemic.

The role of primary school teachers in HIV prevention in South Africa

South Africa has the fastest growing HIV epidemic in the world. The need for an intensive campaign against its spread cannot be overemphasised. Such efforts may be particularly effective if introduced prior to the onset of risk behaviour. The purpose of this study was to investigate the knowledge of grade 3 and 4 schoolteachers on HIV/AIDS and their opinion on educating their pupils about HIV prevention. A self-administered questionnaire with knowledge, perception and sociodemographic variables was sent to all 120 grade 3 and 4 teachers in the Southern Bushveld district of Northern Province. Descriptive statistics and multiple regression analysis were used to analyse the data. The response rate was 67% (N = 81) and 87.7% were females. The mean age of the respondents was 37.7 (+/- 8.7 SD) years, 55% had a 3-year teacher's training qualification and 27% had a 4-year training qualification. The average teaching experience was 12 years. Most respondents (93.8%) had knowledge of what HIV/AIDS is, but only 85.2% indicated it could be prevented. 14.8% either did not know HIV/AIDS could be prevented or were not sure. Some teachers had an incomplete understanding of the transmission and prevention of HIV/AIDS. Furthermore only 9% mentioned education as a way to prevent HIV/AIDS and 16% abstinence. Of the respondents, 58% indicated teaching HIV prevention to their pupils. Of those who do not teach HIV prevention, 41.2% believed that the pupils were too young, and 20.6% claimed non-availability of guidelines and resources as reasons for not teaching. A significant negative correlation was found between level of qualification and teaching of HIV to pupils (p < 0.05). In conclusion, many primary school teachers were found to be wanting in their HIV/AIDS knowledge. This suggests that the schoolteachers would need to be adequately trained prior to their involvement in HIV/AIDS education to pupils. Grade 3 and 4 teachers may be considered suitable to provide HIV education to their pupils, but there is a need for structured educational programmes they can follow. This study also suggests that teachers were not aware of the Department of Education's HIV policy of providing age-appropriate education to all pupils.

Perceptions of fluorosis in northern Cape communities

The objective of the study was to determine the perception of fluorosis in communities living in the Northern Cape Province of South Africa where there is a considerable range in fluoride levels of drinking water. The fluoride levels of the drinking water were categorised as suboptimal (0.40-0.60 ppmF), optimal (0.99-1.10 ppmF) or supra-optimal (1.70-2.70 ppmF). The teeth of 694 children aged 6, 12 and 15 years were examined. Dental fluorosis occurred among children of all ages in all areas studied. As anticipated there appears to be a direct relationship between fluoride levels in the drinking water and levels of dental fluorosis, and the severity of the condition increased with an increase in levels of fluoride in the water supplies. Children in low fluoride areas showed some form of mild fluorosis (37% very mild and 17% mild). However, 19% of this group experienced moderate or severe forms of fluorosis. In areas with optimal levels of fluoride 30% of children showed a questionable form of fluorosis and 21% mild fluorosis. Moderate or severe forms of fluorosis were recorded in 31% of children in the optimal fluoride area. The Community Fluorosis Index (CFI) scores for the sub-optimal and optimal areas were of medium public health significance and for the supra-optimal area of very high public health significance. Of concern is the high percentage of children (45%) in the supra-optimal area with severe forms of fluorosis. The awareness and concern for stains on teeth were mostly expressed by children with moderate or severe fluorosis. This study suggests that the proposed fluoride concentration (not more than 0.7 ppmF) prescribed in the Regulations on Fluoridating the Water Supplies for South Africa would minimise the risk of dental fluorosis.

Prevalence and impact of dental pain in 8-10-year-olds in the western Cape

The purpose of this study was to investigate the prevalence of acute dental pain in 8-10-year-old schoolchildren in the Western Cape. The study sample was drawn from schools in Stellenbosch, Malmesbury, Mitchells Plain, Mossel Bay and Robertson. Eighty eight per cent reported that they had experienced dental pain and 70% within the last two months. The prevalence and severity of pain in this study is much higher than reported studies in England and the USA. A high percentage of children not only live with pain on a daily basis, but also missed school on account of it (70%). There is an urgent necessity for oral health to be given a greater priority within the district health system to improve access to integrated oral health care services with appropriate preventive and treatment measures.

Perceptions of oral health: the South African Demographic and Health Survey of 1998

Oral diseases are widespread in South Africa and affect large numbers of people in terms of pain, tooth loss, disfigurement, loss of function and even death. The majority of South Africans have no access to private services and are dependent on the government for oral health care services, but less than 10% of the population utilises public oral health services. This underutilisation is due to limited resources and inaccessibility. This article reports on the data collected on adults, 15 years and older, from the South African Demographic and Health Survey carried out in 1998, relating to perceptions of oral health. The questions dealt with oral health problems, utilisation of oral health services, loss of natural teeth, oral health practices and knowledge of water fluoridation. The results are discussed in terms of age, gender, education, place of residence, province and classification according to the previous population registration act. A high proportion (36%) of people had experienced oral health problems. Teeth problems were most commonly reported in the higher age groups, non-urban areas, Eastern Cape, Northern Cape and Free State, people with little education and those classified as non-urban Africans. Significant differences were found in regard to periodontal disease, tooth loss, knowledge of fluoride between groups according to age, geographic location, race and level of education. 62% of the respondents reported that they had lost some of their natural teeth and in some communities almost a third of the respondents were edentulous. In comparing the goals of the current draft national oral health policy with the findings of this survey the following implications for policy development should be noted: A higher priority needs to be given to oral health issues; Improve access by increasing primary health care facilities through the delivery of oral health care services; The high prevalence of hepatitis and HIV/AIDS infection poses a higher risk to oral health personnel and the public and The successful implementation of water fluoridation depends upon public knowledge, understanding and support.

Noma (cancrum oris): case report in a 4-year-old HIV-positive South African child

Cancrum oris (noma) is a gangrenous infection that develops in the mouth and spreads rapidly to other parts of the face. The disease occurs mostly in conditions of poverty, poor hygiene and malnutrition. In sub-Saharan Africa the frequency in several countries is estimated to be 1-7 cases per 1,000 population, and as many as 12 cases per 1,000 in the most affected communities. About 90% of these children die without receiving any care, yet the disease can, and should, be prevented. With increasing numbers of children who are malnourished and who have compromised immune systems (compounded by the HIV pandemic) the prevalence of conditions such as noma is likely to increase. Among the earliest features of noma are excessive salivation, marked fetor oris, facial oedema and a greyish-black discolouration of the skin in the affected area. This devastating gangrenous lesion may involve the cheek, the chin, the infra-orbital margin, palate, nose, antrum and virtually any part of the face. This report describes a 4-year-old HIV-positive African girl, who was abandoned, discharged from the Plastics Unit and now lives in a child care sanctuary. Little is known about her history prior to her arrival at the home a few weeks previously. The clinical examination revealed a delay in growth and physical development equivalent to that of a 2-year-old child. The left cheek had a perforating ulcer in a healing phase. The perforation, about 1 cm in diameter, was surrounded by oedematous tissues showing a mild to moderate erythema. The peripheral oedema extended to the lower palpebral, the upper labial, left labial commissural, mandibular and pre-parotid regions. Submental, submandibular and cervical lymph nodes were mildly painful upon palpation. The child was not pyretic. The intra-oral examination revealed the features of acute necrotising gingivitis (ANG). ANG was generalised and showed classic interdental crater-like ulcers covered with whitish debris. Halitosis was pronounced. Examination of the second quadrant revealed a large ulcer extending from the distal aspect of the deciduous canine to the distal aspect of the second deciduous molar. The adjacent palatal mucosa was severely oedematous. The alveolar bone supporting the first and the second molars was completely exposed to the fundus of the vestibulum. It was not possible to obtain intraoral photographs or radiographs. Chlorhexidine gluconate (0.2% solution) and metronidazole tablets, 200 mg twice daily for 15 days were prescribed. The child was seen every alternate day for 10 days and her condition improved rapidly. Halitosis had subsided. She was then referred to the Johannesburg Hospital for further treatment under general anaesthesia. The proposed treatment plan was as follows: removal of dental accretions and polishing of all teeth, extraction of the left maxillary teeth supported by non-vital bone, resection of the necrotic bone in the left maxilla and reconstructive surgery in the left cheek.

Attitudes to water fluoridation in South Africa 1998. Part III. An analysis of pro- and anti-fluoridation attitudes in South Africa

A survey on attitudes to water fluoridation in the South African population (N = 2,220) was undertaken in 1998. The purpose of this study was to evaluate responses to, and underlying reasons for pro- and anti-fluoridation attitudes. In response to a structured questionnaire, 61.9% of respondents were in favour of fluoride being added to drinking water and 9% were against it. Reasons supporting and opposing this measure were as follows. Of those who favoured the measure, 30% of respondents said it was because it would reduce tooth decay and 30% said it 'affects health', presumably positively. Other reasons include, 'it purifies water' (10.3%), 'more people will be reached' (9.8%), 'it strenghtens bones' (6%), 'it prevents plaque' (4.6%) and it 'improves the taste of water' (3.1%). There was a 1.3% 'don't know' response. Those opposed to the measure said, 'water should stay as it is' (26.1%), 'if it stays in the system it will create other problems' (15.6%), it 'affects health', presumably negatively (12.3%) and 'it will increase the cost of water' (8.8%). The 'don't know' response was 10.5%. When asked to give reasons for their 'don't know' response in the 'uncertain' category, 90% said they did not know. Given the contradictory and variable responses in both 'yes' and 'no' categories, the possible reasons for these findings could include: the differences between knowledge and beliefs, alternative health and lifestyle practices, levels of education, resistance to change and personality factors, among others. Understanding the assumption people make about fluoridation would help to structure education programmes to provide accurate and comprehensive information.

Attitudes to water fluoridation in South Africa 1998. Part II. Influence of educational and occupational levels

The purpose of this report is to investigate the influence of education, income and occupation on public perceptions of water fluoridation (WF). A questionnaire on current knowledge, sources of information, the purpose of WF and its desirability was administered to a representative sample of 2,220 individuals over the age of 18 years. Knowledge of WF increased with educational level (range from 13.5% in the grade 0-5 group to 59% in the grade 12 plus group). Lack of knowledge decreased from 76% to 37% in these groups respectively. Knowledge levels varied from 19% to 68% across the occupational spectrum and from 13% to 88% across the income spectrum. In educational levels up to grade 12, electronic media were most frequently cited as dominant sources of information among 40-50% of respondents, whereas in the grade 12 plus group print media (37%) dominated. Sources of knowledge on fluoridation were largely obtained from print and electronic media for both categories. Only 28% in the educational level up to grade 5 thought the purpose of WF was to protect teeth against decay. This gradually increased to 55% in the grade 12 plus category. More than a quarter of the population in both the occupational and income categories indicated that the purpose of WF was to purify water and protect teeth from decay. The number of respondents who thought that water should be fluoridated increased with level of education from 58% to 70%, while those who disagreed decreased as qualifications increased. The lower- and middle-income groups were more supportive of WF than the very-high-income groups. Persons in high administrative professional and executive positions were more opposed (27%) to WF than semi-skilled and unskilled workers (5%).

Industrial dental erosion: a cross-sectional, comparative study

Occupational exposure to sulphuric acid mist (H2SO4) is a health hazard. The threshold limit value-time weighted average (TLV-TWA) of exposure to H2SO4 recommended by the American Conference of Governmental Industrial Hygienists (ACGIH, 1994-1996) is 1 mg/m3. This single-blind study conducted in an electro-winning facility in South Africa, compared dental erosion of anterior and premolar teeth of male workers exposed daily to H2SO4 in an exposed group (H2SO4 range: 0.3 mg/m3-1 mg/m3) and an unexposed group (H2SO4 range: 0.1 mg/m3-0.3 mg/m3). The exposed group comprised all workers at the facility exposed to the aforesaid range of H2SO4 (N = 103). A total of 102 unexposed subjects similar in composition with respect to age and length of service were randomly selected from the rest of the 700 workers at the facility. A questionnaire was administered to seek information on possible worker habits associated with dental erosion and to determine perceptions of oral function. Clinical examinations assessed prevalence and severity of dental erosion. The mean age of subjects was 31.4 years and mean length of service 4.2 years. In the exposed group 48% complained of pain and sensitivity on their teeth compared with the 31% of unexposed persons (P = 0.020). Dental erosion was present in exposed (96%) and unexposed (75%) subjects. Exposed subjects were more likely to develop erosion than unexposed subjects, the odds ratio being 5.531 within the confidence limits 2.167 < OR < 14.117. There was a significant difference in the severity of tooth surface loss between exposed and unexposed groups (P = 0.001). Dental erosion was most severe in the anterior teeth and occurred mostly on the labial and incisal surfaces.

Assessment of periodontal status and treatment needs of a disabled population using the CPITN

The Community Periodontal Index of Treatment Needs (CPITN) was used to assess the periodontal status of 213 handicapped persons attending seven institutions in Johannesburg. Fewer than 2% had healthy mouths, 8% had bleeding only, followed by calculus (46%), shallow pockets (40%) and deep pockets (4%). The mean number of sextants with bleeding or higher score was 5.9. Oral hygiene instruction was indicated for 98% and prophylaxis for 90% of the participants. The CPITN was easily used in the disabled population but may overestimate treatment need in view of the current understanding that periodontal disease does not automatically progress from a low CPITN level to the next. A more appropriate measure of treatment need in handicapped persons is required.

Oral health among Liberian refugees in Ghana

OBJECTIVE

To promote community involvement in the provision of oral health services.

DESIGN

The project consisted of a four-week training course in oral health for selected refugees, an oral health survey based on WHO guidelines and conducted by the refugees themselves and the provision of oral health care services to the community by the trained refugees.

SETTING

Liberian refugee camp, Gomoa Buduburam in Ghana.

SUBJECTS

Liberian refugees of all ages.

INTERVENTIONS

Twelve refugees were given short term training in oral health. In the oral health survey, 196 refugees were clinically examined for dental caries, periodontal disease and malocclusion.

MAIN OUTCOME MEASURES

DMFT (for dental caries), CPITN (for periodontal disease), and malocclusion scores for selected subjects. Also clinical services rendered.

RESULTS

Oral health survey revealed a mean age (+/- SD) of 25.7 (+/- 9.5) years. Only thirty nine (19.9%) of the subjects were caries-free, and total DMFT was 2.5 +/- 2.2. Based on the CPITN, 107 (54.6%) required oral hygiene instructions (OHI), and 41 (20.9%) required prophylactic scaling with OHI. Forty four (22.5%) of the subjects had normal occlusion and 152 (77.5%) mild to severe malocclusion. Periodontal (75.5%), prosthetic (52.5%) interventions and extractions (34.2%) constituted the bulk of the treatment needs required. Clinical treatment was rendered by the trained refugees to 846 patients over a twelve month period.

CONCLUSION

Relief programmes for refugees should emphasise a primary health care approach, focusing on prevention, based on appropriate technology, and promoting involvement by the refugee community in the provision of services.

A rapid epidemiological assessment of dental erosion to assist in settling an industrial dispute

A rapid epidemiological assessment (REA) of industrial dental erosion was undertaken with the aim of formulating a range of treatment strategies which could be used to settle an industrial dispute. This dispute concerned compensation for a group of adult male metalworkers who had complained of dental sensitivity and that their teeth had been "eaten by acid" at their workplace, an electroplating factory in Springs near Johannesburg, South Africa. The REA methods employed included a clinical examination, a structured socio-demographic questionnaire and colour photographs of each subject. Sixty per cent of the subjects reported pain and/or sensitivity to eating and/or drinking, 76 per cent showed varying degrees of loss of tooth structure, and 25 per cent reported teeth had been lost as a result of the industrial erosion. The project involved negotiating with mine management and trade union representatives, each with conflicting interests, and with people's oral health and large sums of money at stake. In this context, the aim of the research was to design an instrument to resolve conflict and to promote oral health at an industrial site, while retaining scientific objectivity and rigour. As a result of the REA, the workers who were examined are in the process of being compensated, while the National Union of Mineworkers and mine management are engaged in reaching a settlement. Preventive measures have been initiated at the factory. The area has been declared a "respiratory zone", which makes the wearing of respiratory masks obligatory.

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.

Student attitudes to dentistry in South African dental schools

The present study investigated student motives for choosing dentistry in five South African dental schools. An attitude questionnaire was complied and administered to all entering students at these schools. The study population comprised 161 students, 92 males and 69 females. Results indicate that in spite of the changing student populations at all universities, the motives for studying dentistry remain essentially the same. Similarities in attitudes to dentistry tend to outweigh differences. Similarities are shown with respect to service, the need for status, independence and financial security. Differences are reflected in the contradictions between service and status, service and regular working hours, service and financial security. The question these findings raise, is how and to what extent students selected for training, based on their current motivation and attitudes will best adapt to changes in the practice of dentistry, health policies, and increased population demands.

Promoting oral health in South Africa: public perceptions of water fluoridation

Public knowledge of water fluoridation (WF), sources of information, purpose of WF and the level of support for the implementation of WF was assessed in South Africa. Of the 2229 respondents interviewed, 23 per cent had heard or read about WF. Almost a third said they obtained their information from schools or community networks while 60 per cent mentioned either radio, newspapers/magazines, or television. About 25 per cent correctly recognized the protection of teeth as the purpose of fluoridation, while two-fifths believed the purpose of WF is to purify water. More than sixty per cent of respondents were in favour of WF, with almost a quarter of the sample feeling uncertain. This study demonstrates that a considerable amount of educational and political action is required for water fluoridation to be implemented in South Africa.

The effectiveness of a school-based fluoride mouth rinse programme

The objective of this study was to determine the effectiveness of unsupervised weekly fluoride mouth rinsing (FMR) with 10 mls of 0.2 per cent sodium fluoride on the caries increment of permanent teeth in schoolchildren aged 6-12 years over a 3 year period. Caries was assessed using DMFT and DMFS indices (WHO, 1987). Over 2000 children from 4 schools in the Johannesburg area were selected at baseline. For analysis purposes pupils were pooled into 2 groups, those who received and those who did not receive the FMR. There were significant differences in mean decayed scores after 3 years. The percentage caries reduction achieved with the FMR was approximately 15 per cent. Reductions of up to 30 per cent have been recorded in previous studies of this nature. The overall caries reduction for this study period can be considered low.

Diversity in South African dental schools

The present paper investigates the demographic distribution of incoming undergraduate dental students in 5 South African dental schools. Biographical data was acquired in 1992 using a questionnaire administered to students in each of the dental schools. Data for 1994 was obtained from the Department of Health. The students were categorized in terms of population group and gender. Frequency distributions for these categories were computed. The results indicate that there are wide discrepancies with regard to population groups in all schools suggesting a lack of representativeness in terms of the wider population. A number of recommendations are made to redress these imbalances.

Choosing dentistry as a career--a profile of entering students (1992) to the University of Sydney, Australia

The present study is an investigation of motives students have for wishing to become dentists. The study population comprised 85 first year dental students of the class of 1992 at the University of Sydney. A questionnaire which sought information on student demography, attitudes to dentistry, and motive rankings was administered. Demographic findings indicated that the majority of students came from countries in the Pacific rim and the male/female ratio was 62 to 38 per cent. Responses to the attitude questionnaire showed that Australian student motives for becoming dentists did not differ from those of students in other countries. The most predominant of these motives was to serve others, to become independent, to enjoy job satisfaction, and to acquire financial security. The least important motives were manual and communication skills, science and knowledge, and surprisingly, status and prestige. To attribute meaning and value to these motives, however, reflects inconsistencies which are expressed as contradictions between motive categories, between items within categories, and between motive categories and motive rankings. When one considers the basis upon which career decisions are made, disparity in the findings may be attributable to a decision-making process that rests on subjective rather than objective criteria.

Prevalence and severity of fluorosis in the primary and permanent dentition using the TSIF

This paper reports on the prevalence and severity of dental fluorosis in the primary and permanent teeth and the tooth surfaces of 262 school children aged 6-18 years from two communities in KwaNdebele (South Africa), the first with 8-9 ppm F-, and the second with 0.6-1.6 ppm F- in the drinking water. The Tooth Surface Index of Fluorosis (TSIF) was used to measure the degree of fluorosis. In both areas, the population prevalence, for primary and permanent teeth was more than 90 per cent. For the lower F- area, 40 per cent of tooth surfaces were free of fluorosis compared with only 22 per cent in the high F- area. Of the surfaces affected by fluorosis in the high F- area, 37 per cent scored in the categories 4-7, compared with 6 per cent in the lower F- area. This difference in severity was found to be statistically significant (P<0.001). This study has shown that, in two areas with significantly different levels of fluoride in the water supply, the population prevalences of fluorosis were similar, but significant differences existed in severity. The World Health Organization 1984 guidelines for Drinking-water Quality recommend that 1.5 ppm F- is the maximum acceptable concentration in drinking water but this may not be appropriate for South Africa.

The impact of a mobile dental system on a school community. Part I--Oral health status of schoolchildren

This cross-sectional study was designed to compare the caries status of children 8-10 and 11-13 years of age, at schools visited by and schools not visited by the Mobile Dental System (MDS). A total of 918 children from six primary schools participated in the study. For the experimental schools, Noordgesig and Cavendish were paired in Group 1 (curative services and brushing programmes), while Riverlea and Wilhelmina Hoskins were combined in Group 2 (curative services and weekly fluoride mouthrinse programmes). Kliptown II and Ernest Hobbs were grouped together as the control schools (Group 3) where no services were provided by the MDS. Dental caries examinations were conducted using the WHO criteria (1987). Statistical analysis was done using chi-square tests, ANOVA and pairwise t-tests. A comparison of mean DMFT scores revealed differences between the control and both experimental groups in the 11-13 year old age group that were significant. The filled and missing components of the DMFT differed significantly for both age groups when experimental and control schools were compared, which clearly showed the impact of the service provided by the MDS. There were however, no differences in the decayed component indicating the limitations of the system in preventing or controlling the development of new carious lesions.

The impact of a mobile dental system on a school community. Part III--Teachers and parents response to a mobile dental system at school

According to the principles of the Primary Health Care Approach, planning and implementation of community health programmes should be carried out with the full participation of the community concerned (WHO, 1978). The introduction of the Mobile Dental System to the school environment is an example of a "Community health care/technology approach" where the programme was determined by the professionals for the community and not by the community for itself. Teachers play an important role in the implementation of oral health care programmes in the school, while parents provide the vital and appropriate context and continuity for the success of such programmes. This paper, therefore, deals with the responses of teachers and parents to an introduction of a mobile dental system at their school. A self-administered mostly open-ended questionnaire was distributed to all teachers in the four schools that participated in preventive programmes and were served by the Mobile Dental System. Based on the results it seems that both the teachers and the parents were apathetic in their commitment to the programme although they were quite willing to participate. Their participation was confined to compliance with instructions or suggestions given by the health professionals. It is clear that under these conditions the potential to sustain the momentum created by the introduction of the MDS is limited. It seems that only if the community is involved in the determination of their preferential needs, planning of the appropriate programme and playing an active role in its implementation, will the programme have a chance of long term success.

The impact of a mobile dental system on a school community. Part II--Responses of recipients and providers of care

This paper is concerned with the impact of a Mobile Dental System (MDS) on the providers and recipients of oral health care. It focuses more specifically on children as patients of the MDS and MDS personnel as clinicians and oral health educators. Data, which were quantitative and qualitative in nature were collected from children and MDS members by means of questionnaires and interviews. Results indicate that the children had acquired some oral health information from the MDS, but many were fearful of clinical procedures. MDS personnel were gratified that they were able to provide a service to an otherwise underserved community, but also considered themselves inadequate child managers and oral health educators. The lack of a permanent career structure created feelings of insecurity amongst MDS staff. Recommendations arising from this investigation are the need for permanent and comprehensive services for all members of the community, and improved working conditions and continuing education courses for MDS personnel.

Dental caries experience and periodontal disease in institutionalised male psychiatric patients

The prevalence of caries and the periodontal disease in 240 adult male psychiatric patients was determined in order to recommend appropriate treatment strategies. Twenty seven per cent of the sample were fully dentate and 12 per cent were caries free. The mean DMFT was 7.92 with the D component reflecting many untreated carious teeth. All age groups require simple restorative care for the treatment of dental caries. None of the subjects were totally free from periodontal disease. Calculus and moderate periodontal pocket formation was the most common manifestation. Seventeen per cent of the sample needed complex periodontal care. Health education aimed at professional and lay staff, the implementation of a suitable plaque removal regimen and the removal of subgingival calculus by auxiliary personnel were seen as important therapeutic measures to enhance the oral health of this population.

Choosing dentistry as a career--Part II--The meaning of motives

This part of the study points out that concepts such as service to others, the need for regular working hours, financial security and independence have different meanings for different people. What is ultimately shown however, is that despite group and meaning differences, motives for a career choice in dentistry appear to operate on two levels. The first is on the level of the rational and the conscious and the second on the level of the irrational and the subconscious. Knowledge of this process has important implications for the selection and training of students.

Choosing dentistry as a career--Part I: A comparison of student motives

The race/gender composition of first year dental students at the University of the Witwatersrand, Johannesburg has changed over the years. Classes were previously characterised by a predominance of white males, but the race/gender distribution at present reflects a predominance of black students and a significant increase in female students. This may indicate that the motives for choosing dentistry as a career have changed and this possibility was explored in two classes of first year students, those of 1985 and 1990. The black/white and male/female distributions were 29/71 and 85/15 per cent in 1985 and 52.5/47.5 and 57/43 per cent respectively, for the class of 1990. Despite race and gender differences, motives for choosing dentistry appeared to relate to an image of the profession that is perceived as a vehicle for the achievement of personal goals.

Anti-calculus effects of dentifrice containing pyrophosphate compared with control

A 3-month, double-blind, randomized, longitudinal, parallel clinical study was conducted to compare the effects on supragingival calculus deposits of a dentifrice containing soluble pyrophosphate to a control MFP dentifrice, which did not contain pyrophosphates. During the pre-test phase, 247 teachers were examined for presence of calculus on the lingual surfaces of the 6 lower anterior teeth, using the Periodontal Probe Method of Calculus Assessment (Volpe et al. 1965). Statistical methods employed were the two-way analysis of variance as well as the paired and unpaired t tests. The level of statistical significance chosen was p less than 0.05. At the end of the 3-month pre-test phase, 88 candidates with the highest calculus index scores met the initial criteria and were stratified into two balanced groups based on their age and sex. Each group received an oral prophylaxis and participants were assigned to use either the dentifrice containing the pyrophosphate or the MFP and instructed to brush their teeth twice daily at home for the next 3 months (test phase). The results showed that the group using the pyrophosphate dentifrice experienced a 20% greater reduction in calculus formation when compared to the MFP control There was also a greater number of calculus-free subjects and tooth surface sites in the soluble pyrophosphate group. The change in the Volpe-Manhold Index revealed significant differences for both the pyrophosphate group (change = 1.7111; p = 0.0010) as well as, though less prominent, for the control group (change = 1.4186; p = 0.0313).

A mobile dental system in southern Africa

Recent studies indicate a great need for dental treatment and preventive services in dentally underserved communities in southern Africa. Geographic inaccessibility, limited financial resources, and a maldistribution of dental personnel are the main barriers to oral health care. This project describes the evolution and utilization of a unique, purpose-built, mobile dental unit (MDU). From a compact 2 x 2.5 meter box trailer, an enclosed area of 8 x 9 meters is formed by deploying a cover system housed on top of the trailer. Once deployed, the unit becomes four fully equipped dental operatories and a combined waiting and educational area, with all-weather protection. Comprehensive care is provided by dental auxiliaries. The underlying philosophy of the service is based on the primary oral health care approach. To date, the MDU has visited a wide variety of rural and urban communities where several thousand patients have been examined and treated. Assessment of the MDU indicates that it is an effective and viable alternative oral health delivery system.

Evaluation of stannous fluoride and chlorhexidine sprays on plaque and gingivitis in handicapped children

The objective of this study was to evaluate the effect of twice-daily oral sprays of 2 ml chlorhexidine (0.2%) and 2 ml stannous fluoride (0.2%) as the sole oral hygiene measure on plaque and gingivitis in handicapped children. 52 institutionalized mentally handicapped individuals (aged 10-26 years) were divided into 4 groups to participate in a 9-week, double-blind, randomized clinically controlled trial, which included a cross-over. For the first 3 weeks, groups 3 and 2 had their mouths sprayed with chlorhexidine and stannous fluoride, respectively. Following a 3-week wash-out interval, groups 1 and 4 were sprayed with chlorhexidine and stannous fluoride, respectively. The alternate groups received a placebo, water. Plaque (PI) and gingival indices (GI) were recorded. Subgingival plaque samples were collected and counts of spirochaetes, motile rods and cocci were taken using darkfield microscopy. By the 9th week of trial, the PI and GI were reduced by 48% and 52% for the stannous fluoride group. In the chlorhexidine group, reductions of 75% (PI) and 78% (GI) were achieved. Pair-wise comparisons of placebo, stannous fluoride and chlorhexidine using the U-test of Mann-Whitney revealed significant (p less than 0.05) differences for both PI and GI scores in the placebo/stannous fluoride and placebo/chlorhexidine pair by the 9th week of the trial. In the stannous fluoride/chlorhexidine pair, only the PI was significantly reduced for those on chlorhexidine. Coccoid cells were more dominant at sites with low PI and GI scores (stannous fluoride and chlorhexidine groups), while spirochaetes and motile rods were more frequent at sites with high PI and GI scores (placebo group).

Suitability of nurses and school-teachers as oral health educators in Gazankulu--a pilot study

This study investigated the suitability of nurses and teachers as potential oral health educators. The assessment was based on a concept of suitability that embraced biological and psycho-social variables. These included oral health status, knowledge, attitudes and reported oral health behaviour. The study population comprised 48 nurses and 43 school-teachers. DMFT of nurses was 4, 6 and teachers 2,5. More than 80 percent of both groups required some form of periodontal treatment. An adequate but basic knowledge of the causes and prevention of oral disease was demonstrated. More that 50 percent of both groups did not visit a dentist annually. Attitudes reflected the belief that teeth are expendable and easily replaceable. In terms of the theoretical model these nurses and teachers do not meet all the criteria that define "suitable" oral health educators. The findings of the present study have provided a profile which has highlighted certain deficiencies in knowledge, attitudes and behaviour. Further research using this model requires the inclusion of motivational and interest variables.

Suitability of teachers as oral health educators

In view of the vast number of people to whom dental services are not accessible, the WHO has proposed the use of lay persons as health educators. This study investigated the suitability of teachers in Gazankulu to fulfil this role. Two hundred and twenty-two teachers from the district of Letaba provided the study population. Oral health status was measured and a structured questionnaire was administered which probed areas such as knowledge, attitudes, reported behaviour, motivation and interest. The mean DMFT was 4,7 with an M component of 3,6 while 28 per cent of subjects were free from caries. The majority of subjects expressed an adequate knowledge of causes of decay, frequency of brushing, dental visits and fluoride. In terms of oral health status and knowledge the teachers appear to be suitable as oral health educators. With regard to utilisation of services, their self-assessment, attitudes, motivation and interest, several contradictions exist, which raise some doubt about their suitability. This however, can be minimised by adequate training and does not preclude the utilisation of teachers as oral health educators, especially in the context of the social reality in Gazankulu.

Dental caries prevalence and CPITN of 12-year-old rural schoolchildren in Transkei

The study investigated the prevalence and pattern of caries with particular reference to tooth and surface type and the CPITN of 12-y-old rural schoolchildren in Engcobo, Transkei. 349 schoolchildren, with a 4:6 male:female ratio were examined. The fluoride content of the water varied from 0-0.5 p.p.m. The results indicate that caries levels are low--47 per cent of the sample was caries-free. Both the median DMFT and DMFS was 1.0 (with a mean 1.7 and 2.8). The D component comprised 89 per cent, the M-10 and F-1 per cent of the total DMFT. Amongst boys, caries was distributed almost equally between the maxillary (112) and mandibular (114) arches whereas for girls more teeth were affected in the mandibular arch. Molar teeth in boys and girls accounted for 90 per cent of all teeth affected with the first molars accounting for 50 per cent and the second molars 40 per cent. In the maxillary and mandibular arch for the total group, a greater number of first molars were affected than the second molars. For girls in both the maxilla and mandible, the second molars were affected more frequently than the first molars. Overall the occlusal surfaces were affected most frequently followed by the buccal, distal, lingual and mesial. Gingival bleeding and calculus were prevalent in most sextants. Less than 6 per cent of the total subjects had no periodontal disease. Calculus was found in over 70 per cent of the children. The vast majority of the sample (94 per cent) needed oral hygiene instruction.

Racial classification in dental literature: is it always necessary?

The purpose of the present study is to describe and analyse the use of terms (black, coloured, white, indian, african and non-white) that classify people for research purposes along racial lines. All scientific articles published in the Journal of the Dental Association of South Africa, from Jan 1979 to Dec 1988, were reviewed. Of the 493 articles covered, 92 made use of one or more of the terms, and 10 (11 per cent) either explained, defined, referenced and/or justified their use, while 09 per cent of the articles did not do so. Based on these reviews, it may be concluded that the use of these terms is not always necessary or justified and can reinforce thinking in racial rather than in social and behavioural terms. The unjustified usage of racial variables may limit our theoretical perspectives and lead us into questionable research.