Dental INTERACTIVE

Editorial: Ethics and dental care in the 21st century

There is a growing interest amongst health care providers globally about the demands of professionalism, about the vulnerability created by illness in our patients and about our obligations to our patients in their various states of vulnerability. At the end of it all what does it mean to be a good dental health care professional in the 21st century?

SADA communique

Dentists and the environment SADJ March 2010, Vol 65 no 2 p52
J Michelson: Senior Manager, SADA. E-mail: jeffm@sada.co.za

Letters: The dream continues

SADJ March 2010, Vol 65 no 2 p53
Y Osman: Acting Dean, University Western Cape The November 2009 issue of the South African Dental Journal (Vol 64, No 12) is testimony to the close co-operation and complimentary roles of the Dental Faculties in South Africa as producers of oral health care workers and the South African Dental Association as the custodian responsible for the professional well-being of these oral health care workers during their professional careers.
This special issue of the Journal, although focusing on the Dental School at UWC - which celebrated its 35th anniversary since being commissioned to relieve the shortage of dentists, especially dentists of colour in South Africa - is representative of the calibre of the publications of the South African Dental Association which fulfils an important aspect in the continuing professional development (CPD) of the busy practitioner, thereby ensuring that practitioners update and develop their knowledge, skills and ethical attitudes that underpin competent practice and at the same time, comply with statutory requirements of the HPCSA for ongoing registration as dentists.
Prof Chikte and his editorial team must be complimented on the production of this special commemorative issue of the Journal. UWC is committed to further develop its teaching, research and service rendering roles to meet the challenge of being an excellent university in a global environment, according to our Rector Prof O�Connell, and this is underpinned in our graduates� desire for life-long learning which can be addressed through active participation in the activities of the South African Dental Association and its Journal.
Over the past 35 years funding to fulfil the mandate of the faculty of dentistry was initially obtained from the National Department of Health and more recently from the Provincial Department of Health. However, due to the mounting pressures of service delivery and the high costs associated with replacing ageing equipment, the budget has been strained recently. Fortunately the National Department of (Higher) Education has recently made available a clinical grant to Universities with Medical, Dental and Allied Health professions to assist with upgrading of teaching and training facilities for health practitioners. This grant has enabled UWC to establish a state of the art techniques pre-clinical laboratory where dental and oral hygiene students can develop clinical skills prior to interacting with patients. This laboratory facility will be made available to the profession for on-going professional development courses provided by the faculty and the Dental Traders Association.
With the advent of 2010, 190 newly qualified dentists commenced their year of community service through posts scattered throughout the nine provinces and the South African Medical Services. They bring much needed oral health care to places as far afield as Atlantis in the Western Cape to Tzaneen in the Northern Province and Upington in the North-West Province to Umtatha in the former Transkei. Of these 190 dentists 90 graduated from the University of the Western Cape.
The training of the UWC dentists is largely undertaken at the Oral Health Centres in Mitchells Plain and Tygerberg (Ravensmead) areas where comprehensive oral health care is made accessible to over a million residents in the poorest areas of the Western Cape through the Provincial Government�s service platform. The Mitchells Plain-Khayelitsha area is regarded as the fastest growing metropolis in South Africa making this Oral Health Centre ideally located to provide a community-based training programme in Oral Health through service rendering.
Dentistry in 2010 is still a sought after profession. There were in excess of 350 suitably qualified applicants for the 90 seats available in the first year dentistry class at UWC. This demand together with the ongoing support of the SADA bodes well for the future of dentistry in South Africa.
Yusuf Osman

Case report: Common things are common

Common things are common: A case series of oral foreign bodies in paediatric patients SADJ March 2010, Vol 65 no 2 p54 - p59
S Gale: BDS, MFDS RCS(Eng), Senior House Officer in Paediatric Dentistry, Birmingham Dental Hospital
E Hall: BDS, MFDS RCS(Ed), Clinical Lecturer in Orthodontics, Birmingham Dental Hospital
N Bhujel: BDS MFDS RCS(Glasg), Specialist Registrar in Paediatric Dentistry, Leeds Dental Institute
S McKaig: BChD, FDS RCS(Ed), MPaedDent(Glasg), FDS(PaedDent) RCS(Ed), Consultant in Paediatric Dentistry, Birmingham Dental Hospital, Birmingham, UK
This article is re-printed with permission from Dental Update 2009; 36: 53�58 Abstract
Reports of foreign bodies in the oral cavity are few in number. Three cases of children of varying ages, presenting with oral foreign bodies, and their subsequent diagnosis and management, are described. The importance of considering foreign bodies, as part of a differential diagnosis in paediatric patients, where aetiology is uncertain and clinical appearance is unusual, is highlighted.
Clinical Relevance
Children often place objects in their mouths which, if they become lodged, may present to the dental practitioner as a foreign body. These can have potentially adverse effects on associated hard and soft tissues. Reports of young children attending accident and emergency departments with small objects that have been placed in ears and noses are relatively common.1,2 There are few reports documented which describe presentation and management of foreign bodies in the oral cavity. It is normal behaviour for children to place objects in their mouths as part of their development and learning whilst exploring the environment around them.3

Scientific: Salt fluoridation

Salt fluoridation: a meta-analysis of its efficacy for caries prevention SADJ March 2010, Vol 65 no 2 p60 - p67
V Yengopal: MChD, Community Dentistry, Division of Public Oral Health, University of the Witwatersrand Johannesburg, 7 York Rd, Parktown, Johannesburg 2193, South Africa
UME Chikte: PhD, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, South Africa
S Mickenautsch: PhD, Division of Public Oral Health, University of the Witwatersrand Johannesburg, 7 York Rd, Parktown, Johannesburg 2193, South Africa
L B Oliveira: PhD, São Leopoldo Mandic Research Center, Campinas, São Paulo, Brazil
A Bhayat: MDent, Community Dentistry, Division of Public Oral Health, University of the Witwatersrand Johannesburg, 7 York Rd, Parktown, Johannesburg
Corresponding Author:
Dr V Yengopal: Division of Public Oral Health, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa. Tel: +27 011 717 2240. Fax: +27 011 717 2625. E-mail: veerasamy.yengopal@wits.ac.za ABSTRACT
The aim of this meta-analysis was to assess the caries preventive effect of Salt fluoridation (SF) in the permanent dentition in children.
The objectives were to compare: (1) the caries preventive effects of SF versus no exposure in different age cohorts (6-8; 9-12; and 13-15 years old); (2) SF versus other community based interventions (milk or water fluoridation [WF]).
Methods: 9 English and 2 non-English databases were searched for papers that reported on the caries preventive effect of groups (with controls) that were exposed to SF in the form of mean DMFT scores with standard deviations. Differences in exposed and non-exposed groups were computed on the basis of weighted mean differences (WMDs) with 95% confidence intervals (CIs).
Results: For 6-8 year olds, the pooled reduction in DMFT scores was -0.98 [95% CI: -1.68 to -0.29]; for 9-12 year olds, it was -2.13 [95%CI: -2.55 to -1.70] and for the 13-15 year old groups, -4.22 [95% CI: -6.84 to -1.55]. All the analyses favoured the SF groups (p Conclusion: Within limitations, the pooled estimates of the WMDs for the different age cohorts favoured SF versus no exposure.
Keywords: salt fluoridation, meta-analysis, systematic review

Communication

Communication Flexibility of experimental Alumina/Feldspar and sr adoro® dental composites SADJ March 2010, Vol 65 no 2 p68 - p72
A R Le Roux: D Tech, Senior Lecturer, Department of Dental Services, Faculty of Health Science. Durban University of Technology, Durban, South Africa
N Lachman: PhD, Professor, Department of Human Biology, Faculty of Health Science, Durban University of Technology, Durban, South Africa
Corresponding Author:
André R. Le Roux: Department of Dental Services, Faculty of Health Science, Durban University of Technology, P O Box 1334, Durban, 4000. Tel: +27 031 373 2051. Fax: +27 031 373 2047. E-mail: andrelr@dut.ac.za ABSTRACT
Introduction: Flexure of a dental composite can be detrimental to the success of a restoration. Flexibility considerations are thus important when comparing dental materials to optimize the success of resin restorations.
Aims and objectives: Flexibility of 5.6 x 18.0 x 2.0 mm3 experimental alumina/feldspar and SR ADORO® dental composites specimens were compared. It was hypothesized that alumina/feldspar composites would be less flexible under a load than SR ADORO® composites and that the flexibility would decrease significantly as the feldspar content was increased.
Methods: Alumina was chemically sintered or bonded with 40%, 50% and 60% feldspar mass, silanized and infiltrated with urethane dimethacrylate (UDMA) to prepare the alumina/feldspar dental restorative composite specimens. Three point bending tests were performed in the Instron 44® machine for flexural comparison to SR ADORO®.
Results and conclusions: The alumina/feldspar specimens showed lower flexibility (mm displacement) than SR ADORO® (p3 specimens. Flexibility comparisons performed with 5.6 x 18.0 x 2.0 mm3 specimens indicated that experimental alumina/feldspar dental composites may provide added marginal seal benefit. However confirmation via in vivo function of alumina/feldspar dental composites is recommended.

Radiology corner

General practitioner`s radiology case 80 SADJ March 2010, Vol 65 no 2 p73
Prof CJ Nortjé: BChD, PhD, ABOMR, DSc, Faculty of Dentistry, University of the Western Cape. E-mail: cnortje@uwc.ac.za

Implantology

A single implant with tissue training in the aesthetic zone SADJ March 2010, Vol 65 no 2 p76 - p80
S Sethi: BDS(Lond), Square Mile Dental Centre, White Kennett Street, London, E1 7BS, UK.
This article is re-printed with permission from Dental Update 2009; 36: 366�372 Abstract
This paper presents a case study for replacing a single maxillary central incisor with a single implant, in conjunction with grafting lost hard and soft tissue. Using staged protocols, the maturity and stability of the implant was ensured prior to finalizing the case. In this respect, it was originally planned that a minimum healing period of nine months would be observed, but in fact the patient did not return for one year.
Taking time to stage phases of the case and observe any changes provides an opportunity to evaluate each phase before the next step is carried forward. By staging the challenges faced in this case, the author was able to progress to each subsequent step with added assurance. By the time the final restorations were fitted, the graft and tissues were stable. The time involved not only placed biology on the clinician�s side, but also helped the patient to spread the cost.
Clinical Relevance
In modern aesthetic dentistry harmonious results can be relatively quickly achieved when the prerequisites for aesthetic success have already been met but, as this case demonstrates, human biology often requires more time and patience for augmented hard and soft tissues to heal and mature.

Case book: Oral medicine case book 24

SADJ March 2010, Vol 65 no 2 p82 - p83
S Stander: Registrar, Division of Oral Medicine and Periodontics, University of the Western Cape
WP Dreyer: Division of Oral Medicine and Periodontics, University of the Western Cape; Emeritus Professor, Stellenbosch University
J de Waal: Division of Oral Medicine and Periodontics, University of the Western Cape
Corresponding author
WP Dreyer: PO Box 19063, Tygerberg, 7505, E-mail wpd@sun.ac.za

Dental ethics

Ethics in dental practice: An overview SADJ March 2010, Vol 65 no 2 p84 - p85
K Moodley: Bioethics Unit-Tygerberg Division, University of Stellenbosch, Email: km@sun.ac.za
S Naidoo: Professor/Principal Specialist, Department of Community Dentistry, Faculty of Dentistry, University of the Western Cape
Clinical ethical reasoning and analysis are skills that are crucial to good patient care in much the same way as biomedical knowledge and procedural skills are essential to diagnosis and management of dental problems. As clinicians, we encounter a broad spectrum of ethical dilemmas during the course of practice. Practising dentistry in the 21st century has become ethically complex. The commitment to patients as persons in a manner that transcends biological disease calls for a holistic bio-psycho-social approach to care that is fraught with ethical complexity.