Needle Stick and Other sharps Injuries: The Occurrence and Risk Factors among University Dental Students

Emma Musekene and Perpetua Modjadji
Department of Public Health, Sefako Makgatho Health Sciences University, School of Health Care Sciences, PO Box 215, Ga-Rankuwa MEDUNSA, 0204, South Africa


Dental students, in particular, are at a high risk of needle stick and other sharps injuries attributed to the restricted working space of the oral cavity and the routine use of sharp instruments, among other risks. Despite this growing body of knowledge on needle stick and other sharps injuries in the dental setting, data is limited among dental students in South Africa.
To determine the occurrence and contributing factors of needle stick and other sharps injuries among dental undergraduate students in a university in South Africa.
A cross-sectional study was conducted among 248 dental students in the School of Oral Health Sciences using census sampling. An anonymous self-administered questionnaire was used to collect data. STATA 14 was used to analyse data.
The mean age of students [male (43%, n=107) and females (57%, n=141)] was 24 years (SD=±4). Needle stick and sharps injuries was reported among 41% students. Most injuries occurred among students studying Bachelor of Dental and Surgery (45%) and among students in the 4th year (57%). The Departments of Periodontology (39%), and Maxillofacial and Oral Surgery (25%) experienced most injuries. Most injuries were caused by syringe needles (52%), and the scalers (31%), while injecting a patient (34%), and scaling and polishing (26%) were common procedures. Needle recapping was common (75%) among students. The result show significantly associated to injuries on students who were  in 3rd year (AOR = 3.0, 95%CI: 1.4 – 6.3), 4th year (AOR = 5.0, 95%CI: 1.9 – 11) and 5th year (AOR=4.6, 95%CI: 2 -12.5) as compared to students in the 2nd year of study, while lack of concentration (36%) and anxiety (19%) were implicated.
The burden of needle stick and sharps injuries among the dental professionals can be reduced by adhering to the current and universally accepted standard precautionary measures against needle stick and sharp injuries.

Email: emma.musekene@gmail.com


A 5-year review of the scope of Paediatric Maxillofacial and Oral Surgery at Wits Oral Health Centre

Rikhotso RE1
Department of Maxillofacial and Oral Surgery, Wits Oral Health Centre


Aim: to review paediatric maxillofacial and oral surgery procedures performed at Wits Oral Health Centre (WOHC) over a 5-year-period.
Materials and Methods: This was a retrospective record review study at WOHC, University of the Witwatersrand, Johannesburg. Records of paediatric patients who had treatment from 2013 to 2017 were included in the study.  Data collected included the age of patients, gender, distribution of scope and type of treatment. Data was analyzed and results presented as frequencies and percentages.
Results: A total of 694 paediatric patients presented for treatment during the study period. There were more males (54.2%) than females (46%), and majority of the patients were in the 11-17 year category. Oral surgery, pathology and trauma were the most common surgical procedures at 34 %, 29% and 20.5% respectively.  There was a statistically significant difference between the number of surgical procedures carried out under general anaesthetic and that under local anaesthetic (p < 0.001). A high occurrence of paediatric trauma was observed in males aged between 11-17 years. Mandibular fractures, followed by dentoalveolar fractures, were the most common fracture types.  The most commonly diagnosed pathology conditions were odontogenic cysts (23.15%), benign odontogenic tumours (22.31%) and fibro-osseous lesions (19.02%). Mucous extravasation cyst was the most common salivary gland pathology
Most oral and maxillofacial surgical procedures in paediatric patients are performed in the 11-17 year category. Ameloblastoma appears to be the most common odontogenic tumour in this age group. Future studies are required to provide insight into the reasons, patterns and distribution of paediatric maxillofacial surgery. Results from such studies, especially prospective ones, will form the basis for design of educational campaigns and preventive strategies aimed particularly at the 11-17 year age group.

Email: Risimati.Rikhotso@wits.ac.za

Central Kaposiform Hemangioendothelioma of the mandible: A case report

 Sehume MG1
The University of Witwatersrand


Introduction: Kaposiform Hemangio-endothelioma (KHE), is a rare vascular tumour that generally occurs in infancy and early childhood. The tumour is locally aggressive in behavior, with a high mortality rate, especially when associated with Kasabach-Merrit syndrome or phenomenon, a life-threatening disease characterized by clinical constellation of thrombocytopenia, coagulopathy and purpura. KHE presents as a solitary, firm, blue-red or erythematous soft tissue tumour. Although KHE tumours may occur in the head and neck, they generally have a predilection for the trunk, extremities and retroperitoneum. Although there is lack of consensus on the best treatment for KHE, a number of treatment modalities have been proposed. These include corticosteroids, chemotherapy, surgery, interferon, propranolol, transarterial embolization and radiation therapy. None of the currently recommended treatment modalities are however uniformly effective and often combination therapy is required.
We present a case of mandibular KHE that was treated with combined surgical and medical therapy.
Case Report: Eleven months old boy presented with a non-tender, bony-hard swelling on the left side of his mandible Intraorally, a rubbery firm swelling in the left alveolar ridge was noted. An expansile intra-bony lesion with large feeding vessels was observed on CT SCANS. An angiogram confirmed feeding vessels from the maxillary artery on the same side. The decision was made to embolize the feeding vessels and proceed with surgical excision. Embolization was done to the left maxillary artery followed by surgical excision and curettage. This was followed by treatment with sirolimus for one year.
Conclusion: The rarity of KHE has precluded development of optimum treatment guidelines as neither randomized nor prospective studies have been carried out. Combined surgical and medical treatment has proven effective in the present case, and no recurrence was noted after the one year follow-up.

Email: 8905511F@students.wits.ac.za

Ewing Sarcoma in an adult patient: A Rare Case Presentation

Premviyasa V1,
Department of Maxillofacial & Oral Surgery, School of Oral Health Sciences, University of the Witwatersrand


Introduction: Ewing sarcoma (ES) is a rare, locally aggressive, malignant neoplasm belonging to the Ewing sarcoma family of tumors (ESFT), reported to have a high recurrent rate. This family of tumors includes: ES of bone; extraskeletal ES; peripheral primitive neurectodermal tumors (PNET); and Askin’s tumors. Genetically, a characteristic translocation involving EWS and ETS-family genes occurs. Ewing sarcoma is the second most common primary bone tumor and accounts for 2% of all childhood cancers diagnosed. This tumor is usually seen in the first two decades and is rarely reported in adults, with a predilection for males. Management of ES requires a multidisciplinary team approach.
Case report: A 27-year old Caucasian female (referred by medical oncology for surgical treatment) presented to our clinic with a main complain of pain and swelling on the left side of the face, with a feeling of her eye being pushed up. History was significant for Ewing Sarcoma diagnosed 7 months previously. Patient has had 3 cycles of chemotherapy with minimal reduction in the size of the tumour. Extra-orally, there was a tender, bony hard swelling in the left maxillary, infraorbital and malar regions. Intra-oral examination revealed mild obliteration of the left buccal vestibule by the tumour. Surgical treatment involved resection of the tumour via combined hemicoronal and intra-oral approach. Reconstruction of the post-ablative defect was undertaken using a titanium mesh. Post-operatively the patient was referred for radiotherapy.
Conclusion: ES is rare, particularly in the adult population. Early recognition and treatment of this condition improves survival. Treatment of our patient consisted of neoadjuvant chemotherapy along with surgery and radiation. Usage of the mesh allowed for optimum cosmesis. It is envisaged that this report will help create awareness of ES, potential disease course and response to therapy.

Email: 9501760j@students.wits.ac.za

Title the anticipated effect of Zamzam water on tongue tissues and associated lingual salivary glands of diabetic albino rats, (Histological and Ultrastructure evaluation). 

Ghareed NMB1


Objective: The objective of this study was to evaluate the anticipated effect of Zamzam water on tongue tissues and associated lingual salivary glands of diabetic albino rats, (Histological and Ultrastructure evaluation).

Materials and Methods: Eighteen male albino rats were selected and divided into three groups. Group I (control group) received no drugs, while rats of group II (diabetic group) received a single dose of alloxan intraperitoneal injection, rats of group III diabetic and received zamzam water for 3 months. All rats were sacrificed tongue was dissected and processed for hematoxylin & eosin and transmission electron microscopy evaluation.

Results: The diabetic group showed histological & ultrastructural changes in the tongue epithelium and underlying lamina propria, a condition which almost restored to normal in zamzam treated group.

Conclusion: Zamzam water provides safer alternative nutritional strategy in restoring the integrity of the damaged epithelium of the tongue tissues after degenerative effect of DM. causing improvement of the damaged epithelium especially in basal cell layer, keratin layer and blood vessels in lamina propria of tongue tissue.

First Name(s): Kannan
Institution: Lincoln University College, Malaysia
Department: Oral Medicine and Maxillofacial Radiology
Telephone no(s): +919014150647
Cellphone no: +91-9490471078
Email: dentkan1@gmail.com
Postal Address: Narayana Medical Campus, Chinthareddypalem
Postal Code: 524003
HPSCA Reg. No:
2. Title of Presentation
Title of Presentation: Randomized Controlled Trial Comparing the Efficacy of Virgin Coconut Oil with Artificial Saliva in Improving Quality of Life in Patients undergoing Radiation Therapy for Head & Neck Cancers



Aims & Objectives: To compare efficacy of virgin coconut oil with that of artificial saliva in the reduction of the severity of radiation mucositis and improving the quality of life in the head and neck cancer patients undergoing radiotherapy.

Materials & Methods: Institutional ethical committee approval was obtained for the study followed by registration of the same with Clinical Trials Registry of India. Computer generated block randomization was done with allocation of trial participants into Group A(Virgin Coconut Oil) & Group B(Artificial Saliva) followed by their recruitment (80 in each group)after taking their informed consent. Clinical Research Assistants and their supervisors were trained as to the protocol to be followed. Identical bottles containing Virgin Coconut Oil & Artificial Saliva(CMC based) were labeled as A & B respectively and were dispensed according to the group to which the patients were assigned due to the randomization. Patients were instructed to rinse their mouth with 5ml of the medication 4 times daily & then spit out the same during the entire duration of the radiotherapy. Quality of life questionnaires(E.O.R.T.C. QLQ-H&N 35) were administered prior to and at end of every week till the end of the radiotherapy. Radiation Mucositis scoring(W.H.O.) was done along with photographic documentation of oral status at the end of every week The entire process was supervised by professor of radiotherapy to ensure veracity and quality of data collected. Data was subjected to statistical analysis for scientific validation.

Results: The Results showed statistically significantly reduced score of radiation mucositis and improved quality of life in patients receiving virgin coconut oil as compared to those receiving artificial saliva.

Conclusion: Our Study is suggestive that use of virgin coconut oil would be likely to provide improved quality of life in head and neck cancer patients receiving radiation therapy.

Implementation fidelity of School Oral Health Programs in Tshwane

Molete M1
University of the Witwatersrand


Background: Implementation fidelity refers to the degree to which an intervention is delivered as intended by policy. This has been shown to be critical in achieving successful implementation outcomes.
Objectives: The purpose of the study was to assess the level of fidelity achieved by school oral health programs in Tshwane and to determine elements of fidelity that predict the risk of dental decay.
Methods: A cross-sectional study design was utilised. A multistage sampling technique was employed to randomly select 10 schools, two grades in each school were selected and all learners in the selected grades were included in an oral health examination. Ten oral hygienists were observed and interviewed as they carried out the activities of the program and records were reviewed. Data collection tools included an oral health examination form, and an implementation fidelity checklist.
Results: The average level of fidelity obtained was 40% and it was shown to be inversely correlated with levels of decay, as decay was predicted to decrease with increasing levels of fidelity. The fidelity elements that were found to directly predict the outcome of decay included duration (IRR, 0.49; p=0.02) coverage (IRR, 0.54; p=008), content (IRR, 1.36; p=0.03) and age (IRR, 2.14; p=0.00). Moderating factors of fidelity which indirectly influenced the outcome of decay included facilitation strategy, duration and age. These were predicted to reduce the risk of decay by 92%, 83% and 48% respectively.
Conclusion: The school oral health programs exhibited high levels of learner coverage; however, implementation fidelity was low. In addition, there was limited human resource and time to bring about quality implementation.

Keywords: Fidelity; Oral Health; School Health; Implementation.



Fibrodysplasia Ossificans Progressiva: A case report and review of the literature

Pillay L1
University of Witwatersrand, Maxillofacial and Oral Surgery


Fibrodysplasia ossificans progressive (FOP) is an extremely rare, heritable disorder of connective tissue metamorphosis, characterised by congenital malformation of the great toes and progressive postnatal heterotopic ossification of skeletal muscles, tendons, ligaments and fascia, which is preceded by soft tissue flare-ups. Soft tissue trauma from biopsies, surgical procedures, intramuscular injections, or local anaesthetics for dental procedures have been reported to cause iatrogenic harm resulting in acute soft tissue flare-ups and heterotopic ossification. Dental management of patients with FOP continues to pose a problem for many dental practitioners around the world. This case is of particular interest in that correct and early diagnosis resulted in treatment under strict conditions.
Case presentation
We report a rare case of FOP in a 6-year-old female, with a chief complaint that “my tooth hurts”, who was referred for further management. Patient’s history was significant for FOP, diagnosed when the patient was 3-years. Clinical examination confirmed caries associated with 55, 85 and abscess in relation to 75. Extraction of involved teeth was done under general anaesthesia using strict guidelines in view of the patient’s diagnosis. Postoperative recovery was uneventful.
Due to the rarity of this condition, it is imperative for dentists to be aware of this condition to make an early diagnosis and to prevent iatrogenic harm, particularly in the maxillofacial and oral surgery region. In addition, with this information, dentists, can take the necessary precautions in the prevention of oral disease and maintenance of meticulous oral hygiene.

Email: 712097@students.wits.ac.za

Analysis of malocclusion and its characteristics in the referred free state orthodontic patients

Nyakale MD1
Senior Specialist, Faculty of Dentistry, Department of Orthodontics, University of the Western Cape (South Africa).


Aim: To analyze the distribution of malocclusion and its occlusal characteristics in the referred Free State orthodontic patients with regards to age, gender and Angle’s malocclusion.
Materials & Method: Study models of 391 orthodontic patients (235 female and 156 male) of the age ranging from 6 to 35 years were analyzed to determine the distribution of malocclusion using Angle’s classification and other occlusal characteristics such as overjet, overbite, open bite, cross bite and the degree of incisor irregularity.
Result: The malocclusion status among the Free State patients seeking orthodontic treatment was recorded as 72.1% for Class I, 17.1% for Class II, and 10.8% for Class III subjects respectively. The occurrence of occlusal discrepancies were increased overjet in 30.4%, increased overbite in 25.8%, anterior open bite in 9.2%, anterior crossbite in 61.4%, posterior crossbite in 27.4% and increased incisor irregularity in 75.4% of the total sample.
Conclusion: 24.5% of the subjects required little or no treatment, 33.4% required borderline treatment, and 42.1% required great/severe treatment according to DHC scores.
Key words: Angle’s classification, dental health component, malocclusion, orthodontic patients

Email: mnyakale77@gmail.com

Radiographic comparison of mandibular symphysis dimensions in patients with differring skeletal patterns  

Gininda DM11, Khan MI2
Department of Orthodontics, School of Oral Health Sciences, Sefako Makgatho Health Sciences University


Objective: INTRODUCTION: Orthodontic treatment often involves planned tooth movement within the confined spaces of the alveolar bone trough. The mandibular symphysis limits tooth movement due to the thin labial and lingual cortical plates and narrow alveolar trough. Moving lower incisors beyond the mandibular symphysis dimensions may result in damage to roots and alveolar bone.
Aim: to determine and compare the mandibular symphysis dimensions in subjects with differing skeletal patterns
Materials: Lateral cephalometric radiographs of 180 black South African subjects were grouped into three classes, based on their skeletal relationship. The sample was equally divided into Class I, Class II and Class III subjects with equal gender distribution. Descriptive statistics, t-test, ANOVA test and Pearson Correlation Coefficient were utilized to analyze the data and p values of <0.05 were considered statistically significant.
Results: Bone thickness: The bone labial bone to lower incisors (LA) in Class I and III were similar but thicker than that of Class II subjects. The LA was thicker in females than males with Class I subjects. The bone lingual to incisors (LP) was similar across skeletal patterns and gender.
Total bone width (LA + LP) is similar across skeletal patterns.
Bone height: The bone inferior to lower incisors (LH) was longer in males than in females in Class III subjects but was longer in females than males in Class I subjects.
Face types: The bone inferior to lower incisors (LH) was the shortest in short faced subjects, medium in subjects with average faces and the longest in long faced subjects. Total bone width is thick in short faced subjects and narrow in long faced subjects.
Conclusion: Caution should be exercised when treating subjects with long faced facial patterns especially when invasive procedures within the bone are planned.

Email: dikeledigininda@yahoo.com

Characteristics and complications associated with supernumerary teeth: A radiographic study.

E Thomas1
Department of Orthodontics, School of Oral Health Sciences, Sefako Makgatho Health Sciences University

Objective: To determine the characteristics and distribution of supernumerary teeth (SNT) found in Black South African dental patients and catalogue orthodontic complications if any associated with this condition.
Methods: Clinical records and panoramic radiographs of 12005 non syndromic dental patients between three to forty years of age were reviewed to identify patients with SNT. The number, morphology, location, eruption status and orientation of SNT were assessed. Associated orthodontic problems were also noted.
Results: 298 patients with 473 SNT were recorded. SNT showed a similar distribution among males (50.32%) and females (49.68%). The SNT were tabulated according to four different types of morphology as supplementary (72.94%), conical (15.86%), tuberculate (1.48%), and other (9.73%). There was no significant difference in the distribution of these various forms of SNT among males and females.
Generally the maxillary jaw had a higher predilection (67.02%) for SNT compared to the mandible. However, the mandibular premolar region recorded a high number of SNT (64.74%). The relationship between orientation of SNT and their eruption status was explored. SNT with a vertical orientation had a greater probability of erupting into the oral cavity. Similarly SNT with a conical morphological pattern had a greater chance of eruption (42.67%).
Regardless of their eruption status SNT were found to cause a range of orthodontic problems (P=0.0551). Displacement (P=0.0002) and impaction of adjacent teeth (P=0.0006) were the most significant problems seen.
Conclusion: Knowledge of the distribution, characteristics and the effects of SNT is invaluable for diagnosis and treatment planning of displaced and impacted teeth where the causal agent is SNT. In addition, due to the increased incidence of SNT (64.74%) in the mandibular premolar region caution is advised when planning the placement of mini implants for additional anchorage in this population

Email: lizathomas67@gmail.com


Prevalence of malocclusion amongst school children in Sedibeng district, Gauteng Province

Makhado TM1, Ramphoma KG2, Sethusa MPS3
Department of Orthodontics, School of Oral Health Sciences, Sefako Makgatho Health Sciences University 


Introduction: Malocclusion   traits vary between individuals, age groups and among ethnic groups.  Knowledge of a population’s epidemiological situation is essential for the planning and provision of dental services. Early detection of developing malocclusion is important for implementation of interceptive orthodontic treatment, however this is not practiced in Gauteng dental clinics due to lack of resources and skilled clinicians.
Aim: The   aim   of the study was to assess the profile of malocclusion in school children amongst 9 to 11 year olds.
Design: A descriptive, cross sectional and retrospective epidemiological study.
Methods: Data collected  for  the  study  was  sourced  from  records  of  the  screening  of 223 nine to eleven year old children done  at  Seeiso  primary  school in 2019.  Data obtained was entered into an excel spreadsheet and analysed using an SPSS programme, version 25.5.
Results: The overall prevalence of malocclusion was 63.7%. Angle Class I malocclusion   prevailed at 81%, followed  by  Class III at 13.4% and Class II at 5.6%.The  most  prevalent  malocclusion  traits  were  anterior crowding  40.8%, excessive  overjet  36.6%  and  anterior  crossbite  19.1%.There  was  no  significant  gender  difference  in  either  the  overall  prevalence  of  malocclusion  or  in  the  occurrence  of  different  occlusal  traits.
Conclusion: The high prevalence of malocclusion emphasises the need for early intervention of malocclusion with Interceptive orthodontics treatment. Most cases are of Class I skeletal origin and do not warrant complex management. The latter further supports the need for training and resourcing general dentists to employ interceptive measures.

Email: khadosm@yahoo.com


Prevalence of malocclusion amongst school children in Westrand District, Gauteng Province

Mathabathe DTD1, Ramphoma KG2, Sethusa MPS3
Department of Orthodontics-School of Oral Health Sciences, Sefako Makgatho Health Sciences University - South Africa.


Introduction: The World Health Organization report that malocclusion has the third highest prevalence among oral pathologies, after dental caries and periodontal disease. Malocclusion has a large impact on the affected individual, which leads to discomfort, impaired quality of life as well as social and functional limitation. Early treatment of malocclusion by general dentists could help to manage most cases however clinics are not well equipped to manage such cases and baseline data is not available to justify this.
Aims: The aim of the study was to determine the prevalence of malocclusion amongst eight to eleven-year-old school children.
Materials and methods: A descriptive, cross sectional and retrospective epidemiological study was carried among 371 school children in a West rand district school. A structured form was used by the researcher in 2019 to record information gathered during screening process.  The following data: gender, age, type of malocclusion trait as well as the facial profile was extracted from records collected in 2019. Data was analyzed using the SPSS version 25.5 software program.
Results: The prevalence of malocclusion was 38.9%. The most prevalent malocclusion trait was anterior crowding 18.7% followed by anterior crossbite 8.4% and increased overjet and deep bite at 5.4% each. Class I, Class II and Class III malocclusions were 96.8%, 1.4% and 1.9% respectively. There was no statistically significant gender difference in malocclusion traits in this study. Male to female ratio was 42% and 36% respectively.
Conclusion: The prevalence of malocclusion in this study was low compared to most reported studies. This could be due to an effective school tooth brushing program which is practiced in this area. The high Class 1 prevalence of malocclusion supports the need for early intervention.      

Malocclusion profile of school children at Vosloorus township, South Africa   

Msimang-Vilakazi Y1, Sethusa MPS2, Ramphoma KG3
Department of Orthodontics, School of Oral Health Sciences, Sefako Makgatho Health Sciences University


Introduction: Malocclusion may not be perceived as a health threat but it is the third most common oral health problem in the world and hence has serious economic implications. Interceptive orthodontic treatment is a cost effective method of early management of malocclusion which can be applied to a larger sector of the community, however it is not practiced in most government dental clinics. Determining the prevalence of malocclusion will add value when planning dental services for the public sector.
Aim: To profile malocclusion of school children aged between 9 to11.
Objectives: To determine number of children presenting with malocclusion and the common malocclusion traits that can be intercepted.
Design: Retrospective, descriptive and cross sectional study.
Methods: School children aged between nine and eleven years from three primary schools in Vosloorus, Gauteng were screened in 2019. Information from the data included: number of children who presented with malocclusion, different malocclusion traits such as the overjet, overbite, cross bite (which may be anterior, posterior or both), anterior crowding, retained teeth, early loss of deciduous teeth as well as malformed teeth to name a few. Data was analysed using SPSS version 25.5 program.
Results: 559 children consisting of 51.6% females and 48.4% males were examined.  55.8% presented with malocclusion. The common skeletal malocclusion was Class I skeletal base (91.1%), followed by Class III (6.2%} and Class II (2.1%). Anterior crowding was the most prevalent trait (22.5%), followed by anterior (12. O %) and posterior cross bite (6.2%). Conclusion: The prevalence of malocclusion, especially those with Class I Skeletal malocclusion is high and supports the fact that general dentists should be upskilled to manage these cases early. Most Class I problems do not need extensive, complex and expensive management by orthodontists at this stage.

Email: yvonnesisim@gmail.com

A three year audit of dental services at Gauteng PHC facilities

Bhayat A1
Department of Community Dentistry, University of Pretoria


Objectives: Dental services at Primary Health Care (PHC) facilities have not been routinely monitored and this has impacted on the type and quantity of services offered.
The objective of this study was to determine the types and trends of dental services offered over three months (April, May and June) every year from 2017 till 2019 at all full time PHC facilities that render dental services in Gauteng, South Africa.
Methods: This was a record based retrospective study. Data was collected for the months of April, May and June in 2017, 2018 and 2019 from all full time PHC facilities that offer dental services in Gauteng. The data was obtained from the attendance registers at each facility and included the number of patients, personnel and the type and number of procedures performed.
Results: A total of 90 PHC facilities were included. The number of clinicians remained stable while the mean number of patients per month increased from 587 (2017) to 654 (2019). This resulted in an increase in the mean monthly patient to clinician ratio from 376 (2017) to 428 (2019). On average, 459 extractions; 64 restorations and 43 fissure sealants were performed monthly per district. Clinicians treated on average 19 patients per day and on average 15 extractions for every restoration. The mean operator to dental assistant ratio was 1.3:1.
Conclusion: Although there were differences in the types of services rendered and the workloads of clinicians across the province, there was a significant increase in the number of patients over the study period. The most common services rendered were extractions and the extraction to restoration ratio was fairly high. Mangers need to carry out regular audits to ensure that the facilities are operating optimally.

Email: ahmed.bhayat@up.ac.za

COVID-19 impact in the dental setting

Layloo N1, Kathree BA2, Khan SB3, Ahmed R4, Maart R5, Asia-Michaels W6.
University of Western Cape, Prosthetics


Introduction: The scoping review examined the evidence related to infection control and transmission measures of the SARS-CoV-2 virus in a dental setting during this pandemic. Dental practitioners are normally guided in practice by set ethical principles, thus the researchers wanted to determine how these rules are managed during this pandemic.
Methods: A protocol was developed according to the criteria for a scoping review. Relevant databases (Pubmed, Scopus, Elsevier, Science Direct, Wiley), including online access to health/ dental organizations (World Health Organization, Centre for Disease Control, American Dental Association) and health authority websites, were searched to identify appropriate evidence which was restricted to the English language for the period 2015-2020. Predetermined eligibility criteria were applied, evidence was assessed and data extracted for each included article. Relevant outcomes assessed were: infection control measures, transmission of the SARS-CoV-2 virus, such as the modes and sources of transmission and the ethical principles related to the dental setting.
Results: Searches yielded a total of 402 articles: 387 from electronic databases and 15 from other sources. Of these, 102 were duplicates, and 231 were unrelated to the objectives of the current scoping review. The full text of 69 studies was assessed for eligibility, of which 26 were finalized for inclusion following the objectives and inclusion criteria set for the scoping review. Most of the included articles were reviews, recommendations and guidelines for dentists with only one being a cross-sectional study. A narrative explanation of the pre-specified outcomes is reported for the 3 areas covered for this review. There is no clinical evidence available that can support the positions recommended or stated by individuals or dental organizations or health authorities related to the objectives of this review. A different ethical framework is required during a pandemic and these must be informed by evidence.

Email: nlayloo@uwc.ac.za

Validation of the modified Child Oral health Impact Profile (COHIP) among Adolescents in Johannesburg

Malele-Kolisa Y1, Maposa I2, Yengopal V3, Igumbor J4
Wits, South Africa

Introduction: Oral health-related quality of life (OHRQoL) is described as the effect of oral conditions on the overall functioning and well-being of individuals.
Aim: The study sought to ascertain the validity of a modified measure of OHRQoL of HIV-infected and HIV-undiagnosed adolescents and, establish the determinants of OHRQoL among adolescents in Johannesburg.
Methods: A cross-sectional study design involving adolescents living with HIV-infection (ALHIV) and adolescents attending public schools was conducted. An interviewer-administered modified- COHIP-29 questionnaire was used, followed by an oral examination for hard and soft tissue caries and, a review of the medical records.
Results: A total of 504 adolescents (HIV Wellness site n=226 and School site= 278) were included in the study. The overall mean decayed teeth for permanent dentition was 1.6(SD 1.99) and caries prevalence was 62.2 %( n=309) amongst all adolescents. The tool’s overall Cronbach’s alpha was 0.88. The overall OHRQoL score was 59.6(18.2). The overall modified COHIP/OHRQoL scores for those not in care (Schools) were higher [62.88] than those ALHIV [55.54]. The poor M-COHIP scores were associated with reporting toothache, having active decay, poor oral health-self-rating, (p<0.005).
Conclusion: The M-COHIP displayed acceptable initial reliability and validity. The adolescents’ OHRQoL scores were related to the high untreated caries, toothache reports, a poor self-rated oral health and being in schools. More studies are suggested to retest the new contextual subscales.


Physical properties of nanodiamond-modified glass ionomer restorative cements  

Mulder R1, Mohamed N2
Restorative Dentistry, University of the Western Cape1

Paediatric Dentistry, University of the Western Cape2


Objective: The aim of the study was to assess selected physical properties of glass ionomer restorative cements (GICs) after nanodiamond modification. The hypothesis was that the surface roughness, surface micro-hardness, compressive strength and the proportional limit of the modified GICs would be improved in relation to their respective commercial materials.
The compressive strength assessment was based on the International Organization for Standardization Standard (ISO) for water-based dental cements (2007; 9917-1).
Methods: Three different commercially available hand-mix GICs were used in this study: Fuji IX GP (FN), Ketac Universal (KU) and Riva Self Cure (RSC). The three GICs were modified in the powder phase per weight percentage (w/w%) by adding 5% or 10% of a commercially available nanodiamond (ND) particle (PlasmaChem, item: PL-D-G01) to the GICs. The specimens were prepared using a standard powder liquid ratio in a Teflon mould and polished with 1200 grit wet silicon carbide paper, weighed and subsequently stored in neutral de-ionised water at 37 ºC for 24 hours after which the experiments were completed.
Results: The one way ANOVA test for homogeneity of the mean values of FN, KU, RSC and their respective nanodiamond modifications indicated the presence of significant differences (p < 0.00001) for compressive strength, proportional limit and surface micro-hardness.
Conclusion: Overall, the nanodiamond particles had no significant differences and did not perform significantly worse than their respective control materials. In accordance with the ISO 9917-1, the compressive strength (CS) in MPa above 100MPa was only observed for FN, KU, RSC, FN10%ND and KU5%ND.

Email: rmulder@uwc.ac.za

It’s not easy, but it’s worth it: CPD for Dentists

MM Beetge MM1 Keiller L2

University of Pretoria, SA1, Stellenbosch University, SA2

Introduction: Maintaining professional competence via CPD is required in South Africa. There is no record of Oral Health Practitioners (OHP’s) perceptions of, experiences and motivation for selecting and taking part in specific CPD activities.
Objectives: The main objectives of this study were to explore OHP’s perceptions, experiences and motivation for selecting and attending reported CPD activities in South Africa.
Methods: This descriptive (transcendental) qualitative research study purposively selected 20 Private and Public OHP’s to participate in 5 focus group discussions across two South African Provinces. Focus group discussions were recorded and transcribed verbatim. Data were analysed using a thematic network analysis by two researchers.
Results: Analysis of the data identified that CPD provides opportunities for learning and renewal of skills, attitudes and knowledge to offer both personal and professional benefits. However, CPD attendance is dependent on a number of factors. Participants perceived the availability and type of CPD activities to be accessible within specific metropolitan areas, but often unaffordable.
Conclusion: OHP’s perceive that CPD can be beneficial within the profession of OHP’s, but should recognise the needs of stakeholders to mitigate the legitimate barriers to CPD participation.
Take home message: CPD requires a high level of commitment personally and professionally, therefore CPD for OHP’s require contextually relevant design to support its’ intended purpose.

Email: michaela.beetge@up.ac.za

Dental educators’ views and knowledge of competencies required within a competency framework.

Maart R1
Prosthetic Dentistry Department, Dental Faculty, University of the Western Cape


Background: The Medical and Dental Professions Board of the Health Professions Council of South Africa, adapted the CanMEDS core competency framework to inform medical and dental curricula in South Africa. This adapted version of CanMEDS is referred to as the AfriMEDS competency framework.

Objectives: The aim of the study was to explore and describe the UWC’s dental educators’ views of competencies required within the AfriMEDS core competency framework.

Methods: A case study approach to qualitative inquiry was used in this study. Participants were purposefully selected and two focus group semi structured interviews (14 participants) were conducted. The inclusion criteria was dental educators who were course coordinators in clinical disciplines. An interview protocol was used to guide the interviews. Interview transcriptions were uploaded to the Atlas ti programme for data analysis. Themes were identified in the literature and thematic analysis was performed using the Atlas ti programme.

Results: Dental educators considered the following as essential competencies for a dental graduate: Health care professional, Communicator, Collaborator, Critical thinker, Health Advocate, Digital competence, Ethics, Evidence based dentistry, Internationalization and Professionalism. Interestingly, participants were more concerned about factors that influence the achievement, teaching and assessment of these identified competencies.

Conclusion: Although the importance of the AfriMEDS core competencies was recognised, concerns regarding factors affecting its successful implementation were raised. Two of these competencies: evidence-based dentistry and private practice were highlighted as core competencies in this study, however in AfriMEDS only aspects of this is described. The results of this study suggest that dental educators are able to make valuable recommendations on additional competencies to prepare the dental graduates for the changing world of work.

Email: rmaart@uwc.ac.za

The ‘Digital Access Divide’ at a South African Dental School – A cross-sectional study  

Postma TC, Sykes LM, Uys A, Brandt P, Crafford E
University of Pretoria, Patient management


Objectives: Access to information through digital technology remains a challenge for many disadvantaged students in higher education in South Africa. Many rely on university loaned devices and subsidised data. Exposure to unreliable information and inadequate Internet speed are further factors resulting in negative digital learning experiences. Socio-economically disadvantaged individuals have less access to necessary resources which may impact on graduate unemployment rates, especially in South Africa, where there is a noticeable digital divide driven by social dynamics and inequality.
Method: This study investigated the digital divide, from an access perspective, of dental students at the University of Pretoria. Second to final year students (n= 218) completed a custom-designed survey at the end of 2017. The investigation enquired about digital devices and infra-structure they owned and used to study, to report on networks and resources they used to access online platforms and to comment on related access issues such as quality of Internet, speed, reliability, cost and personal implications.
Results: A high percentage of dental students owned mobile digital devices, laptops and smartphones. However unequal access to quality information was noticeably evident off campus where a 15% of students experienced major challenges.
Conclusion: Many students struggle to use the internet at convenient times, venues and programs, as well as due to high costs of data. Management and lecturers must ensure that no students are disadvantaged due to this and must seek individual targeted solutions, and implement the necessary changes to ensure an equitable and fair online learning experience for all students.

Email: corne.postma@up.ac.za

Dental students’ self-perceived competency and usage of the internet for learning and evaluation

Sykes LM1, Postma TC2, Uys A3, Brandt P4, Crafford E5
Department of Prosthodontics, University of Pretoria


Objectives: Dental lecturers are moving away from providing hand-out notes to students and rather posting lecture material and tutorials on the internet using the various university platforms such as clickUP. Students also query the need to purchase prescribed text books due to high costs, and dated content. The presumption is that all students have unrestricted and equal access to this material, and are competent using digital technology for learning and assessment, however there has been no formal investigation into this.
Methods: This study investigated students’ preferences with regards to the mode of learning and their self-perceived competencies using the internet for various academic purposes. The project took the form of an anonymous, structured questionnaire given to all dental students from the second to fifth year of study.
Results: Over 90% of the students felt competent to access and use internet search engines for research and assignments, to connect with friends, and to download or watch videos. Less (70- 90%) were confident using it for independent research, learning from lecture material, using e-dictionary, searching for extra learning material, completing short quizzes and assignments, or undertaking independent reading. Most needed access on a daily or weekly basis for work related issues, yet 40% reported to not being able to do so at suitable times or venues.
Conclusion: Lecturers should not penalise students who struggle to submit requisite material on time. The university must commit to changing traditional teaching and embracing blended learning platforms, and help students make up for lost time due to the Corona virus pandemic. However, they need to work together to ensure that all students have the necessary skills and technology needed to use these platforms, and provide necessary tuition and changes if they wish to be truly committed to the wellbeing and education of their students.

Email: leanne.sykes@up.ac.za

Zygomatic complex and coronoid process post-traumatic ankylosis. A case report.

Legalamitloa BR1, Van Wyk HJ2, Munzhelele TI3, Syebele K4.
Department of Maxillofacial and Oral Surgery - Oral Health Centre - Sefako Makgatho Health Sciences University - South Africa.


Bony or fibrous union between the coronoid process (CP) and the zygomatic arch is a rare cause of extra-articular (EA) temporomandibular joint ankylosis. Traumatic injuries involving concomitantly or not, the zygomatic complex and/or the coronoid process fractures seem to be the most prevalent etiologic factor. Other possible causes include infection affecting the infratemporal fossa, local surgical complications, inflammatory condition such as the myosis ossificans. It may also be the result of the intracapsular ankylosis extension.
We present a rare case report of a post-traumatic extra-articular ankylosis as a complication of a neglected concomitant fractures of the zygomatic complex and the coronoid process.
Case presentation
A 34-year-old male patient was referred to the department of Maxillofacial and Oral Surgery, with difficulties in mouth opening as main complaint. The medical history mentioned an assault incident followed by an admission in ICU (neurosurgery) for three months, for treatment of head/brain injuries.
The physical examination revealed post- traumatic and post-surgical scars on the right temporal region. Step defects on the right lateral and infra orbital rim with a depression of the zygomatic arch were noted. The mouth opening was restricted to two mm, due to severe trismus.
The clinical diagnosis was that of a neglected right zygoma-complex fracture with probably a post traumatic temporomandibular joint (TMJ) ankylosis.
Special investigations: CT scan, panoramic radiograph and CBCT scan confirmed a final diagnosis of extra-articular ankylosis, following concomitant neglected fractures of the right zygomatic arch and the coronoid process. The fractured coronoid process with the ectopic bony mass was resected using the intraoral approach. The postoperative results were satisfactory. The mouth opening could stretch up to 34 mm intra operatively, and 30 mm nine days later.
Zygomatic arch and coronoid process ankylosis may result from delayed treatment due to precedence of other vital associated head injuries.

Email: blegalamitloa@gmail.com

Tooth extraction related to orofacial pain symptoms. The dentist dilemma

Syebele K1, Munzhelele TI2.
Department of Maxillofacial and Oral Surgery - Oral Health Centre - Sefako Makgatho Health Sciences University - South Africa.


Objectives: Genuine orofacial pain symptoms may originate from odontogenic conditions (endo-periodontal). Tooth extraction may be one of the therapeutic means at the dentist disposal. However, tooth extraction is not a “one fits all” solution for the management of this multifactorial condition.
“To extract or not to extract”? This is the critical therapeutic dilemma facing the dentist during the management of orofacial pain. We highlight the limited impact of multiple tooth extractions and underline the need for multidisciplinary approach.
Methods: Clinical records of patients presenting with facial pain symptoms were retrospectively analyzed. Variables considered were age, gender, pain location, results of special investigations, and most importantly, the therapeutic outcomes after multiple tooth extractions.
Results: Twenty-six patients, 23 females and three males, presenting with facial pain symptoms were recorded. Eleven patients had vascular findings on MRI / CT scan in the form of either proximity of superior cerebellar artery to the trigeminal nerve or vascular loop with or without compression. One patient presented a cerebellopontine angle meningioma. Four patients were diagnosed with HIV infection. One patient had a history of facial herpes zoster. Multiple tooth extractions were performed in 22 patients, predominantly in those with complaints of facial pain in more than one quadrant. Facial pain symptoms were not relieved after multiple tooth extractions.
Conclusion: The facial pain symptoms may originate from complex and multifactorial clinical conditions. The performance of any odontogenic related therapy, such as tooth extraction, by the oral health practitioners, should be carefully planned and justified, especially in cases of multiple quadrants involvement. Dental treatment must be limited to clearly identified odontogenic causes. A multidisciplinary approach is recommended for comprehensive management of facial pain symptoms.

Email: kabunda.syebele@smu.ac.za

Mycobacterial cervical lymphadenitis (Scrofula) in HIV-infected patients – Case report.

Syebele K1, Munzhelele TI2, Dikgale IT 3, Lebaka CS4.
Department of Maxillofacial and Oral Surgery - Oral Health Centre - Sefako Makgatho Health Sciences University - South Africa.


Objective: The mycobacterial cervical lymphadenitis, also known as “scrofula”, is an extra pulmonary form of tuberculosis (TB). Scrofula is a historical disease that affects the lymph nodes and the skin. Its prevalence has seemingly increased in modern times, probably due to the reported increase in the incidence of TB co-infection amongst HIV-infected patients.
We present a case series of patients diagnosed with scrofula and emphasize the importance of early medical treatment.
Case presentation # 1: A 21-year-old male patient presented with multiple cervical lymphadenopathy involving all the lymph node chains. Neither cough nor fever were reported. The multilobular cervical masses were firm, with no inflammatory signs or sinus tracks on the skin. Similar axillary masses were noted. He was a known HIV positive patient.
Case presentation # 2: A 24-year-old female patient was admitted with fever, dyspnea and dysphagia with no history of cough. She was recently diagnosed with HIV infection.
Clinical examination revealed, multiple and bilateral cervical lymphadenopathy. Some of them were erythematous and fluctuant (cold abscess). Others presented draining fistulas with skin scarring. The intraoral examination revealed bilateral tonsillar hypertrophy, partially obstructing the oro-pharynx.
The chest radiograph had no signs of active pulmonary TB. However, the CT scan revealed multiple cervical lymph nodes at all levels with advanced central necrosis.
In both cases, the biopsy results strongly suggested cervical tuberculous lymphadenitis. However, no acid-fast bacillus could be demonstrated on special stains.
The first patient succumbed to the disease before treatment initiation. The second patient was immediately treated with a combination of anti-tuberculosis drugs and Highly Active Antiretroviral Therapy with satisfactory results.
Conclusion: Early diagnosis and medical treatment of cervical tuberculous lymphadenitis in HIV-infected patient remains the key to the patient’s survival.

Email: kabunda.syebele@smu.ac.za

Mandibular fractures: Assessment of profile and outcomes of treatment modalities

Dikgale IT1, Tlholoe MM2, Munzhelele TI3, Syebele K4
Department of Maxillofacial and Oral Surgery - Oral Health Centre - Sefako Makgatho Health Sciences University - South Africa.


Objective: The local working conditions, availability of skilled personnel, adequate infrastructure and surgical equipment may all influence the choice of treatment modality as well as final treatment outcomes of mandibular fractures. Furthermore, social and economic conditions may also determine the epidemiology and clinical presentation of mandibular fractures in a specific region.
Aim: The study aimed to evaluate the epidemiology, clinical presentation, factors that influence the choice of treatment modality by the surgeon and the clinical outcomes of mandibular fractures in patients treated at Medunsa Oral Health Centre (MOHC) of Sefako Makgatho Health Sciences University over a period of 6 years.
Methods: This retrospective study was based on complete clinical and radiographical records of patients who presented with mandibular fractures during the period 2011 to 2016. Variables analysed included demographics, aetiology, anatomical location, clinical presentation, treatment modalities utilised as well as complications.
Results: A total of 965 patients, with a male: female ratio of 5.6:1 were recorded. Sixty-five per cent were between 20 and 35, with the mean age of 32 years. Most fractures (78%) were as a result of assault. Closed reduction (47.5%) and Open reduction (47.1%) treatments were mostly implemented as compared to 5.4% of conservative management. The outcomes of treatment were satisfactory in 89.5% (1265/1414) of fractures. Complications were observed in 10.5% (149/1265). The most common complication was post-operative infection (5.2%) mostly recorded in patients with compromised immunity and smokers.
Conclusion: The results in the present study appear to be partly in line with both local and international literature. However, we noted some variations concerning mandibular fracture aetiology and treatment modalities in comparison with findings in some international studies.

Email: itanidik@gmail.com

Closure of oronasal fistula using a tongue flap

Dikgale IT1, Leballo KG2, Tlholoe MM3, Munzhelele TI4, Syebele K5
Department of Maxillofacial and Oral Surgery - Oral Health Centre - Sefako Makgatho Health Sciences University - South Africa.


Oronasal fistulas may occur congenitally in cases of cleft palate, postoperatively or post trauma. The primary goal of closing oronasal fistula is to re- establish the separation between oral and nasal cavities.
The present case report aimed to highlight the effectiveness of the posteriorly based dorsal tongue flap in the management of a cicatricial oronasal fistula
The margins of the fistula at the junction of the soft and hard palate, measuring approximatively 1 X 0.8 cm were revived and a fistulectomy was performed. The posteriorly based myomucosal tongue flap of approximatively 5X 1.5 X 0.6 cm was raised. The mobilised flap was rotated back with the raw surface facing the fistula. The distal part of the flap was secured using interrupted vicryl 3/0 sutures to close the fistula. The base of the flap remained attached and the donor site was closed. After three weeks of intermaxillary fixation, the proximal part of the flap was severed.
The functional and aesthetic post-operative results were satisfactory at 6 months follow up.
Posteriorly based tongue flap is a viable alternative to successfully close a cicatricial oronasal fistula where other techniques have been attempted.

Email: gkleballo@gmail.com

A five-year retrospective review of potentially malignant oral mucosal lesions

Nkosi MM1, Bunn BK2, Mthethwa R3
Department of Oral and Maxillofacial Pathology, Oral Microbiology and Oral Biology, Sefako Makgatho Health Sciences University, South Africa


Objective: This cross-sectional descriptive study aims to document the spectrum of potentially malignant lesions (PMLs) diagnosed by means of histopathology within the Department over a 5-year period. The prevalence of the various forms of PML is of public health significance. The findings are useful for augmenting community programmes in oral cancer screening. Furthermore, such results yield findings related to the aetiology of PMLs within the community served by our institution.
Methods: Archival histopathological reports of incisal biopsies received between October 2015 and September 2020 together with the corresponding tissue sections were retrieved for all cases diagnosed as any recognised form of PML and examined for confirmation. Data related to demographic characteristics, health status, medical history as well as frequency, type and site of occurrence of lesion was gathered and then captured in Microsoft Excel software. Collected data was then transferred and analysed in SPSS software. Frequencies, medians and proportions were calculated.
Results: 82 patients were diagnosed with potentially malignant lesions. Male patients constituted the majority of cases. Leukoplakia associated with variable degrees of dysplasia denoted as mild, moderate, or severe was most prevalent lesion. It was found in the gingiva, floor of mouth and ventral surface of the tongue. Actinic cheilitis of the lower lip with mild or moderate dysplasia was the second most common lesion. Contrary to expectations, oral lichen planus was the third most common lesion. A lone case each of discoid lupus erythematosus and oral submucous fibrosis were also recorded.
Conclusions: The high prevalence of the diagnosis of leukoplakia in this study is in keeping with documented trends. The malignant potential of oral lichen planus remains disputed. The lack of diagnosis of other PMLs may be due to the short period of investigation as lesions such as proliferative verrucous leukoplakia can only be made retrospectively.
Keywords: Potentially malignant lesions, oral cancer, malignant transformation, leukoplakia
(Corresponding author – Dr Belinda Bunn, belindabunn@gmail.com)

Herpes simplex ulceration of the maxillary gingiva masquerading as squamous cell carcinoma

Singh L 1, Bunn BK 2
Department of Maxillofacial and Oral Pathology, Sefako Makgatho Health Sciences University, South Africa

Objective: This case report documents a suspected malignant ulcer on the maxillary gingiva in a 63-year-old female patient with a 20-pack-year history of smoking. Histological examination contradicted the clinical findings and showed a large punctate area of ulceration caused by recurrent herpes simplex infection.
Method: Incisional biopsies from the region of ulceration were evaluated and serial sections requested for suspected squamous cell carcinoma (SCC) in a high-risk patient. Morphological and immunohistochemical staining confirmed the presence of herpes simplex intranuclear and cytoplasmic inclusions.
Results: A 63-year-old female patient with a chronic history of smoking presented with a large area of ulceration in the region of teeth 26 & 27. The clinical impression was that of malignant ulceration with suspected squamous cell carcinoma. Histological examination showed portions of soft tissue largely surfaced by hyperplastic stratified squamous parakeratinising epithelium. Central ulceration was identified. Fungal elements were not morphologically observed within the superficial parakeratin layers. The epithelium showed features of marked hyperplasia with acanthosis. There were no definitive features of epithelial dysplasia. The rete ridges were markedly elongated but did not exhibit features of verrucous hyperplasia. In the section of tissue located closest to the anterior resection margin was a punctate area of ulceration in which the adjacent keratinocytes showed features of a herpes simplex viral cytopathic effect. There were both intranuclear and intracytoplasmic nuclear inclusions. Occasional viral syncytial cells were identified. There was no evidence of a malignant infiltrate.
Conclusion: This case report documents a herpes simplex related ulcer masquerading as a malignant infiltrate in a patient with a clinical history considered to be of high-risk.
Keywords: Herpes simplex, squamous cell carcinoma, viral cytopathic effect
Corresponding author: Dr Belinda Bunn, belindabunn@gmail.com


Masha LR1, Bunn BK1



Objective:  A cross-sectional study was conducted to identify the number of oral squamous cell carcinomas (SCC) and their histopathological variants.  The many subtypes of oral SCC’s have significant prognostic outcomes.  

Method:  The departmental database allowed us to retrieve the reports from 24 male and 11 female patients diagnosed with oral SCC between October 2015 – September 2020.  Written histological reports were examined.  In most cases, the variant may be easily recognized by the tumour growth pattern (e.g. ulcer, papillary, crusted sore, or polypoid swellings). 

Results:  Archival case selection in descending order from most frequent to least frequent was utilized to obtain our results.  35 cases of oral SCC were diagnosed for the selected time period.  Of these, 24 cases were in male patients whilst 11 cases were in female patients.  The majority of patients were 45 years old or older.  Variants from most to least prevalence included the following:

1. Basaloid SCC (22/35) - Detected most often in the floor of the mouth, retromolar trigone areas, and ventral tongue. These are high grade neoplasms with central comedonecrosis which have a poor prognosis.

2. Spindle cell SCC (6/35) – May have a good prognosis if detected early as they are exophytic polypoid lesions. If they persist for long, tumour cells begin to invade more deeply which then makes the lesion much higher grade.

3. Papillary SCC (2/35) – These generally arise on the attached gingiva, larynx, and buccal mucosa. If noted early the exophytic nature of the lesion makes surgical excision easier which improves the prognosis.

4. Acantholytic SCC (3/35) – These tumours tend to have progressive separation of cells in tumour islands. It is speculated that as these cells separate, they undergo epithelial-mesenchymal transition increasing their potential for metastatic spread.

5. Verrucous carcinoma SCC (2/35) – Two cases showed large extensive low-grade verrucous carcinomas which both showed transformation to conventional SCC, upgrading these tumours to high grade.

Conclusion:  Epidemiological findings of differences in variation between two unrelated lesions may assist to create awareness for dental practitioners of these variants so that they may more easily recognize these lesions and treat them by complete excision when necessary. 

Authors: Chetty M, Roomaney I, Beshtawi K, Sudi S, Aborass M 

Title:  Macrodontia in KBG Syndrome

Aim: This case report aims to provide a brief overview of macrodontia along with a documentation of a case of the rare, KBG syndrome in South Africa.
Methods and results: A 16-year-old female of mixed ancestry heritage, with a confirmed diagnosis of KBG Syndrome, was referred to the Faculty of Dentistry complaining of “bleeding gums and crooked teeth”. Extra-oral examination revealed characteristic KGB features as well as macrodontia of upper and lower incisors intra-orally. When compared to a previous study, larger than normal upper and lower incisor tooth dimensions was noted. Flattening of the supraorbital ridge and a Welcher-basal angle of 158.5° was observed which is suggestive of noted Platybasia.
Conclusion: The dental manifestations are often overshadowed by other more conspicuous and complex syndromic features. Recognition of both the clinical and oral changes that occur in KBG syndrome facilitates accurate diagnosis and appropriate management of this condition.

Email: mchetty@uwc.ac.za

Taurodontism in Hereditary Conditions.

Sudi S1, Chetty M 2, Roomaney I 3, Aborass M 4, Beshtawi K 5


Objectives : The developing dentition is prone to influences from environmental and genetic factors leading to various anomalies in size, shape, number, eruption pattern, and the compositions in enamel and dentin. The anomalies of developing dentition may occur independently or in association with various syndromes and conditions affecting the craniofacial region. The study aimed to describe the occurrence of taurodontism in patients with hereditary “thin bone disorders”.
Method: An extensive study of various hereditary “thin bone disorders” was undertaken in the Republic of South Africa aiming to document and elucidate the dental and craniofacial manifestations. A total of 64 Black South African individuals with a confirmed phenotypic diagnosis of Osteogenesis imperfecta (OI) type III, were assessed clinically, radiographically and at a molecular level. Of these, 23 individuals were further confirmed to have a genotypic diagnosis of OI type XI. In addition, an individual with Pyle Disease (PD) and another with the Torg-Winchester syndrome(TWS) were also assessed.
Results: The features of taurodontism were documented in the dentition of ten individuals with OI type XI, and individuals with PD and TWS. The type of taurodontism observed was mostly hypotaurodont in OI type XI, mesotaurodont in PD and hypotaurodont in TWS.
Conclusion: Taurodontism is a rare dental anomaly defined as an enlargement of the pulp chamber of a multirooted tooth with a consequent apical displacement of the floor of the pulp and the bifurcation of the roots. Taurodontism can occur as either an isolated trait or as a component of a hereditary syndrome.
The difficulties in endodontic treatment due to the configuration of the pulp chamber and roots and complicated extractions as a result of dilated roots, are some of the clinical significance of a taurodontism. Taurodontism can be a screening feature due to the high association with craniofacial syndromes.

Email: stephen.sudi@gmail.com

Charge syndrome

Aborass M1
University of Western Cape


Background: CHARGE syndrome (CS) is a rare genetic condition (OMIM #214800). The condition has a variable phenotypic expression. Historically, the diagnosis of CHARGE syndrome was based on the presence of specific clinical criteria. The genetic aetiology of CS has since been elucidated and attributed to pathogenic variation in the CHD7 gene (OMIM 608892) at chromosome locus 8q12.
Case Presentation: A South African female of mixed ancestry heritage, aged 4 years, was referred for dental assessment to the Faculty of Dentistry, University of the Western Cape, in 2018. She had a diagnosis of CHARGE syndrome confirmed by a Medical Geneticist from the Division of Molecular Biology and Human Genetics at the University of Stellenbosch.
The patient had a long prior history of health and developmental problems, with the correct diagnosis becoming apparent over time. She presented with many oral and craniofacial features warranting consideration by the dentist including micrognathia, hypoplastic nasal bones, cranial nerve dysfunction, bruxism, craniofacial anomalies and compromised sensory perception. The treatment was mainly preventive and, although she fed through a percutaneous endoscopic gastrostomy tube (PEG), maintenance of her oral hygiene was necessitated.
Conclusion: CS is a multisystem condition and the optimal care for an individual is with a specialist multidisciplinary team. The numerous systemic problems affecting these individuals take precedence in their care, and often there is neglect of their dental concerns. Given the abnormalities frequently present in the oral and craniofacial region, the authors recommend that a team of dental and other medical specialists be involved in the management of individuals with CS.
Key words: charge syndrome, CHD7 gene, rare condition.

Email: 3523042@myuwc.ac.za

Clinicopathological evaluation of focal reactive lesions of the gingiva

Karuma CM1, Ngwenya SP2 Shangase SL3
Department of Oral University of the Witwatersrand1, Department of Oral Pathology, University of the Witwatersrand 2,
University of Pretoria3


Aim and objectives: Focal reactive gingival lesions are elicited by chronic irritation primarily due to poor oral hygiene, over-hanging dental restorations and ill-fitting dental prosthesis. Persistent irritation of the gingiva can lead to tissue injury and trigger inflammation leading to proliferation of endothelial cells, multi-nucleated giant cells, fibroblasts and tissue mineralisation. The aim of the study was to report on the clinicopathological features of focal reactive gingival lesions.
Methods: This was a retrospective cross-sectional study. Convenient sampling of patient records retrieved from the Department of Oral Pathology and the Department of Oral Medicine and Periodontology at the Wits Oral Health Centre was done. Sociodemographic variables and clinical features were evaluated.
Results: Female patients accounted for 70.8% (n = 172) of all focal reactive gingival lesions, with the majority of the lesions having occurred on the maxilla (56.4%; n = 137). The age of patients ranged from 3 months to 88 years.
Conclusion: Contrary to findings in other studies, the peripheral ossifying fibroma was the most common focal reactive gingival lesion, after analysing 243 cases.

Email: sizakele.ngwenya@wits.ac.za


Black A1, Bunn BK2, Van Wyk H3


Objective:  To present a case of an exceedingly rare, newly recognized benign mixed odontogenic neoplasm recently included in the 2017 WHO classification.  Only 15 such cases have been described to date.  In addition, we document multiple additional dental pathologies identified on panoramic radiograph of this patient.  The primordial odontogenic tumour (POT) described here showed locally aggressive behavior but was conservatively enucleated with surgical success to date.  Evaluation of the histogenesis of POT will provide insight and awareness of the biological behavior in order to expedite and conservatively manage it.

Method:  The enucleation specimen received for pathological processing was meticulously examined and photographed macroscopically followed by thorough microscopic examination.  Appropriate immunohistochemical evaluation was also done to both elucidate the histogenesis as well as to confirm the features of this rare new entity.

Results:  A 36-year-old patient presented with a painless lesion in the third quadrant which showed buccal and cortical bone expansion.  Radiological examination revealed a well-demarcated radiolucent lesion extending from the mesial aspect of tooth 36 to the mesial aspect of tooth 41.  Root resorption was noted in association with teeth 34, 35 and 36.  An unerupted tooth 33 was identified in association with the lesion and it was displaced towards the inferior border of the mandible.    Unrelated to the lesion, but adjacent to it, is a complex odontoma which showed focal POT-like areas microscopically.  Co-incidental pathological findings on radiograph included a rotated tooth 22 demonstrating a talon cusp morphology, taurodont morphologies of teeth 37 and 47, as well as a solitary true pulp stone in tooth 46.  Histological examination confirmed a POT comprising a solid myxoid connective tissue wall lined by a layer of low cuboidal cells.  The entire lesion is surrounded by a fibrous capsule.

Conclusion:  We hereby add an additional case of POT to the current body of literature and histologically explore this neoplasms histogenesis to differentiate it from dentigerous cyst-like lesions whilst emphasizing conservative management.

Keywords:  Primordial odontogenic cyst, Odontoma, benign mixed odontogenic tumour

Corresponding author: Dr Belinda Bunn, belindabunn@gmail.com

African Traditional Health Practitioners Methods to Treat Oral Health Conditions

MKI Modisha1, TA Muslim2
University of the Witwatersrand 1, University of KwaZulu-Natal2


Objective: African and traditional medicine is widely used in South Africa. African and traditional health practitioners treat patients who present with a variety of medical conditions, including oral health conditions. The objective of this study was to determine the knowledge, and practices of African traditional health practitioners on treating and managing oral health conditions.
Methods: A cross-sectional survey of 11 African traditional health practitioners in the Johannesburg area were recruited to participate in a structured questionnaire survey, followed by focus group interviews with 10 practitioners. Ethical approval was obtained from the UKZN Biomedical Research Ethics Committee (BREC ref. no 451/19). Following the collection of data from the questionnaire administration, a focus group interview was conducted. Data on the knowledge, treatment practices, and post-treatment management of four common oral conditions was collected and analysed.
Results: The average age of the 11 participants was 44.1 (±8.1) years, with a range of 21-67 years, and a slight majority of female (55.5%, n=6). Ten participants took part in focus group interviews. Participants were asked a series of questions, in non-dental terminology or language, related to their knowledge (causes); practise and attitudes (what do you use to treat?, What advise do you give to the patient?) of four common oral health conditions. These are: sores on the lips, sores on the tongue, swollen gums and toothache. Participants reported using a variety of practices such as throwing bones, burning incense, using plants and animal product, as well as commercially manufactured products to treat and manage patients.
Conclusion: The results reveal vast differences in knowledge, management practices and treatment modalities of African traditional healthcare practitioners. Further research in the knowledge, practises and treatment of needs to be conducted especially as these are non-aerosol generating procedures, which may be beneficial in this time of SARS-CoV-2.

Email: kindermodisha@gmail.com

Title: Utilizing community health workers to improve health outcomes in a health setting: A Scoping Review

Gordon NA1
University of Western Cape

Introduction: The inclusion of community health workers (CHWs) within the healthcare system has been promoted to increase access to primary healthcare.
Objective: To explore: types of interventions provided by CBWs; the success of interventions offered and barriers and enablers to the success of these interventions.
Methods: A protocol was developed according to the criteria for a scoping review. Relevant databases (Pubmed, CINAHL, Medline, Scopus) were searched to identify appropriate evidence related to these objectives, restricted to the English language for the period 2010 to 2020. Predetermined eligibility criteria were applied, evidence was assessed and data extracted for each included article. Relevant outcomes: programme type, the intervention including access to healthcare, lifestyle changes, health outcomes, change in knowledge and empowerment/agency to use healthcare services.
Results: Searches yielded a total of 2075 articles: 2073 from electronic databases and 2 from other sources. Of these, 71 were duplicates, 44 full text studies were assessed for eligibility, of which 23 were finalized for inclusion.
Results: Programmes focussed primarily on women’s health including the health of children (maternal health, antenatal care, breastfeeding) followed by chronic and infectious diseases and lastly oral health. Interventions included health education, promotion of healthy lifestyles, skills development, screening and referrals to health facilities, treatment and advocacy. Interventions took place in community settings and at home visits. Interventions that appear to be more successful are those involving education, screening and facilitation of treatment- particularly where such treatment can be provided within the home. Enablers include access to resources to implement programmes and barriers include the social, economic and cultural context as well as training and remuneration of CHW.
Conclusion: CHW have the potential to contribute to health outcomes on a population level.

Email: ngordon@uwc.ac.za

Compulsory Community Service for Dentists – Opportunity for Meaningful Reform.

Machete ML1,
Department of Community Dentistry, School of Oral Health Sciences, Sefako Makgatho Health Sciences University

Introduction: Previous studies indicate that the delivery of compulsory community service (CS) program was far from the intended objectives. This is evidenced by the lack of leadership, structural and logistical support, resulting in CS dentists not practicing as per their scope of practice. It is plausible that the intended vision of the program for the young graduates to “… develop skills, acquire knowledge, behaviour patterns and critical thinking that would help in their professional development and future careers” may not be realizable.
Objective: This study evaluated the extent to which CS program enabled the honing of clinical skills of CS dentists.
Methods: A national cross-sectional study was undertaken on CS dentists. Adapted visual analogue scale (VAS) assessed the frequency of work and levels of skills or competency acquired.
Results/Discussion: A total of 217/235 dentists participated, (response rate of 92.34%). Participants were below 35 years (69.7%), female (58.6%), black African (78.0%), unmarried (78.3%).
CS dentists infrequently performed duties as per their scope of practice; Dentists never or rarely undertook specialised procedures X̄ (SD) 1.10 (0.326) and gained the lowest level of competency 1.10 (0.359). The level at which clinical work was undertaken and skills/competence acquired were positively correlated; (M = 1.10 SD = 0.326), (M = 1.10 SD = 0.359); r = 0.945, p = < 0.000, n = 217 respectively. This finding validates the associated loss of skills and competence because of lack of clinical exposure during CS.
Conclusion: CS in its present form disrupts continuing education and interrupts the development of learning and clinical skills. Given the minimal clinical exposure, these cohorts of dentists, will enter independent practice less prepared, yet expected to provide quality care to the unsuspecting public. The program is regressive, and requires urgent review and reform.

Email: lesley.machete@smu.ac.za


The severity of the malocclusion and orthodontic treatment needs of patients referred to the orthodontic department of 1 Military Hospital, Pretoria.

Dasoo S1, Sethusa MPS2, Sathekge RM3
1-Military Hospital

Objective: To objectively assess the severity of the malocclusion and orthodontic treatment needs of patients referred for specialist orthodontic treatment to 1 Military Hospital, Pretoria.

Methods: A descriptive, retrospective, cross-sectional study was carried out on a study sample of 240 cases, randomly selected from a population of patients referred to the Orthodontic Department of 1 Military Hospital between January 2016 and December 2018. The pre-treatment orthodontic study casts of the study sample were evaluated according to the Dental Aesthetic Index (DAI) to establish the severity of malocclusion and orthodontic treatment need.
Results: The sample was equally distributed between the genders. The age range was between 9 to 40 years. The mean age was 13.93 (± 2.95), with not statistically significant difference between the genders (p = 0.835, t-test).
The most prevalent malocclusion traits included anterior maxillary irregularity (96.67%), anterior mandibular irregularity (94.58%) and crowding in the incisal segments (85.83%). The least common traits were missing teeth (15.42%), mandibular overjet (15.00) and anterior open bite (14.58%). The distribution of the malocclusion traits of the DAI did not differ significantly among the genders for (p = 0.177, z-test)
The overall mean (±SD) DAI score of the study population was 34.17 (±7.82), with no gender predilection (p = 0.954, t test). The mean DAI scores among the different age categories showed a statistically significant variation, (p = 0.050, ANOVA). The prevalence of normative orthodontic treatment need was very high (90.84%). Treatment was highly desirable for 27.92 %, while a minority of referred patients (9.17%) presented with minor malocclusion with a slight need for treatment.
Conclusions: Orthodontic treatment is indicated for majority of the referred patients with a mandatory orthodontic treatment need.

Email: drsdasoo@yahoo.com

Management of ocular defects: A case report. 

Ntseke TV1, Kabini SN2, Motsepe I3
Department of Prosthodontics, School of Oral Health Sciences, Sefako Makgatho Health Sciences University

Objectives: The department of Prosthodontics of the Sefako Makgatho Health Sciences University is involved with the treatment of patience that require the corrections of the ocular defects. Most of these cases are referred from the Dr George Mukhari Academic hospital, and comprises of young adults with few paediatric cases. The ocular defects are commonly due to tumors, infection, congenital malformations, or trauma. The aim of treatment is to correct the defects that resulted from evisceration of the left eye thereby improving the quality of life.
Methods: A close-fitting eye conformer which resembles the right eye was fitted and the patient was sent home to evaluate the aesthetics and adaptability to the prosthetic eye. On the second appointment, an impression of the damaged eye was taken with the conformer (prosthetic eye) using a light body President material which has a high viscosity and could flow easily through the damaged eye and was able to accurately record all the surfaces. The impression was sent to the inhouse dental laboratory to reline the conformer for a better fit.
Results: The prosthesis with a better fit was delivered to the patient and her quality of life was improved.
Conclusions: Evisceration involves the removal of the contents of the eye while maintaining an intact scleral shell attached to the extraocular muscles and it is successfully treated with a better fitting eye conformer to improve aesthetic and the quality of life

Email: drtvntseke@gmail.com

Comparison of flexural strength of bisphenol-a-glycidyl methacrylates to polymethylmethacrylates as provisional crown materials

University of Western Cape

Objectives: The study aims to assess the flexural strength of five interim commercially available crown materials under conditions that simulates the stresses when used for a fixed prosthesis. The objective of this study was to evaluate and compare the flexural strength of Bisphenol-AGlycidyl Methacrylate (BisGMA) to polymethylmethacrylate (PMMA) materials and their clinical efficacy in dentistry.
Methods: An experimental invitro study was planned for the study. Standardized specimens of following dimensions: 25mm in length, 10mm in breadth and thickness of 2mm were made with mold space made up of stainless-steel die. The heat-cure PMMA and other new composite materials include Tempron, Structur2SC and Protemp-III Garant were mixed and packed into the mold space of same dimensions and allowed to bench cure for 20 minutes under a constant load of 500N. The heat-cure PMMA specimens were packed into the mold space polymerized at 90°C for 2 hours. Fifteen specimens of each material (Total N=75) were fabricated in the same dimensions and their fracture resistance was tested using an Instron testing machine whilst simulating the oral conditions.
Results: Protemp-III Garant (BisGMA) provisional material displayed highest values of fracture resistance, followed by Structur 2SC, then heat-polymerizing PMMA, Tempron and selfpolymerizing
PMMA materials. The material with highest elastic modulus (MPa) of elasticity was recorded Structur 2SC followed by Protemp III, then the heat-polymerizing PMMA, Tempron, and then self-polymerizing PMMA materials. Bonferroni statistical analysis was performed to compare the fracture strength of provisional materials. No statistical difference between the mean modulus of elasticity is noticed among the five materials.
Conclusion: The new material, Protemp III Garant shows the highest flexural strength compared to other commonly used PMMA (heat and self-cured types) materials, Structur2SC and Tempron.
Thus, BisGMA (Protemp-III Garant) is highly recommended material as provisional crown material than other commercially available materials for clinical use.

Email: palakurthykiran@gmail.com

A simplified method to fabricate ocular prostheses: a case series

Morweng-Mokgatlha RPN1, Moipolai PD2, Kabini SN3, Essop ARP4, Motsepe IA5, Thage AH6
Department of Prosthodontics, School of Oral Health Sciences, Sefako Makgatho Health Sciences University


Objectives: The loss of an eye can have a negative impact on the psychology and self-confidence of a patient. This loss can be due to various causes such as neoplasms, infection, and trauma. The MOHC Prosthodontic clinic is inundated with patients in need of ocular prostheses. Patients present with ill-fitting un-aesthetic ocular buttons, and most present without any prostheses at all. A simplified method to fabricate an ocular prosthesis is herein presented.
Method: The patients were provided with custom made clear Polymethymethcrylate (PMMA) resin ocular conformers that were fabricated from an irreversible hydrocolloid ocular impression. An interim stock ocular button was provided to each patient for use to address aesthetic concerns. A mould of a conformer was fabricated, out of which the baseplate wax pattern was fabricated. It was tried in for fit, and ideal positions of the iris and pupil marked on it using the adjacent eye as a guide. The stock button was adjusted on the wax pattern to assess the position of the iris and pupil. In the laboratory, the wax was replaced with a white coloured PMMA resin and characterized to match the patient’s eye. An overlay coat of clear acrylic was then applied and the prostheses were processed for delivery to the patients as definitive ocular appliances.
Results: Aesthetic custom made ocular prostheses were provided to patients.
Conclusion: Affordable ocular prostheses that are satisfactory in fit and colour can be provided to patients using the method described above.

Email: mokgatlharp@yahoo.com

Laser differentiation of Human Adipose Derived Stem Cells to Temporomandibular Joint Disc Cells

Karic V1, Chandran R2, Abrahamse H3
Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, South Africa1,2
Department of Prosthodontic and Oral Rehabilitation, and Laser Therapy in Dentistry Division, School of Oral Sciences, Health Sciences Faculty, WITS University, South Africa3

Objective: The objective of this study was to observe the photobiomodulatory effects of 660nm and 940nm diode laser on Adipose Derived Stem Cell (ADSC) differentiation into Temporomandibular Joint (TMJ) Disc Cells, fibroblasts and chondrocytes. The proliferation and viability of these cells were also determined to identify a future alternative method of treatment for patients with TMJ disc degenerative changes.
Background: Current treatment modalities including occlusal splint and relaxation therapy often do not ensure permanent results for TMJ degenerative changes. Hence, the application of laser and ADSCs in TMJ complications presents a promising treatment modality. Method: The morphology, proliferation and increase in ATP production of the ADSCs were analyzed at different time intervals, post-irradiation. To determine the percentage differentiation of ADSCs to fibroblasts and chondrocytes, flow cytometry and immunofluorescence were used.
Results: A proliferation in ATP was recorded in all experimental groups of ADSCs with above 90% viable cells. Flow cytometry and immunofluorescence confirmed differentiation of ADSCs to fibroblasts and chondrocytes at 1- and 2-weeks post irradiation.
Conclusion: This study confirmed a post irradiation increase in proliferation and ATP production with clear evidence of ADSCs differentiation to fibroblasts and chondrocytes. Therefore, the study presents a positive prospect for the use of lasers and stem cells in the treatment of the degenerative TMJ disc disorders. Keywords: Temporomandibular Joint Disc, Photobiomodulation, Adenosine Triphosphate (ATP), Adipose Derived Stem Cells (ADSCs).

Email: vesna.karic@wits.ac.za




Essop M1


Introduction: Irreversible hydrocolloids are materials of choice for primary impressions when constructing dental prostheses. An accurate impression and dental cast are essential for a retentive, stable, and adequately supported final prosthesis. Two brands of impression materials, Blueprint 20+ (Hydrocolloid A) and Phase Plus Chromatic Alginate (Hydrocolloid B), were tested for dimensional stability over extended timeframes.
Objectives: Determine the dimensional change of irreversible hydrocolloid impression materials after Immediate Pour (IP); 60’(minute); 180’; 300’; 480’ and 1440’ delayed pouring of gypsum and to compare the two selected alginates at each time delay. Further, to characterise the alginates using Field-Emission Scanning Electron Microscopy to determine the organic and inorganic composition by means of Energy Dispersive Spectroscopy.
Method: Specially designed titanium dies, engraved with precision machined parallel lines to standardize measurements, were placed into plastic moulds to make ten impressions each using the two alginates. The impressions were disinfected using 0.2 % Gluteraldehyde for 60 seconds, where after the impressions for each time delay, except for IP, were wrapped in a paper towel soaked with 90ml of distilled water and stored in a cupboard. At the specified time delay, gypsum was poured into the impressions and allowed to set, dried and surface area measurements made by using a Zeiss Discovery V20 Stereomicroscope with Zen® image analysis software for statistical analysis.
Results: Hydrocolloid A was significantly (p<0.05) stable for all delayed times. Hydrocolloid B demonstrated significant (p<0.05) dimensional change across all delayed times. Elemental analysis confirmed a higher Ca: Na ratio for Hydrocolloid A.
Conclusion: Delayed pouring of impressions taken with Hydrocolloid A would not adversely affect the dimensional stability provided that the impressions are stored according to the manufacturers’ instructions. For Hydrocolloid B, stability was adversely affected over time, therefore it was concluded that these casts must be prepared immediately.

Email: messop26@gmail.com

Immediately loaded zygomatic implants used for a functional and aesthetic rehabilitation following a combined maxillectomy and rhinectomy

Naidu K1, Department of Prosthodontics, School of Dentistry, University of Pretoria


Malignancies of the nasal vestibule are rare, yet may result in massive destruction of the face if left untreated, and will require extensive ablative surgery. The position and extent of the resulting defects is not only a rehabilitative challenge but also a major psychological burden for the patient.

Objective: This paper describes a technique for designing and fabricating an immediate surgical obturator and nasal prosthesis to help minimize the post-surgical impact following a total rhinectomy and partial maxillectomy procedure in a patient diagnosed with a squamous cell carcinoma of the nasal septum.

Method: The patient was assessed in the multidisciplinary maxillofacial clinic at the University of Pretoria (South Africa) prior to surgery. Conventional impressions of the dentition and a moulage of the nasal defect were taken. The master casts were poured and used for design and fabrication of the obturator and nasal wax pattern Colour matching of the nose and facial areas was performed with the aid of a digital spectrophotometer (Quickweigh; Spectromatch Ltd., Bath, UK), and a silicone nasal prosthesis was fabricated.

Result: The restoration consisted of bilateral zygomatic implants attached to a resin framework housing a central magnet. The latter was used to retain the nasal prosthesis and help support an interim maxillary obturator.

Conclusion: This case demonstrated how both a functional rehabilitation and reduced psychological trauma was achieved by delivering an immediate surgical obturator and facial prosthesis.

Placement and replacement of direct restorations

Adam RZ1

Department of Restorative Dentistry, Faculty of Dentistry, University of the Western Cape.


Introduction: Each time a restoration is replaced, there is loss of healthy tissue thus increasing the size of the tooth preparation and the restoration. This cycle could eventually lead to the unintended consequence of tooth loss as well as abuse of patients’ time and financial resources. Common reasons for the replacement of restorations include: secondary caries, bulk fracture, marginal fracture and degradation. Several studies have documented the experience of dentists’ globally but little information is available from South African dentists.

Objective: The purpose of this study was to determine how often replacement restorations were performed and how choice of materials affected replacement rates.

Method: Case study methodology was used to collect data from 15 purposively selected general dentists in the Western Cape as part of a larger study. Dentists were requested to record each new restoration placed over a two week period including the tooth number, cavity classification, the new restorative material choice, possible reasons for placement, reasons for replacement and the previous restorative material used. Statistical analysis was conducted using chi-square tests and logistic regression analyses.

Results: Data of 468 restorations placed were analysed. Only 12% (n=56) of the restorations were replacements and 62% (n=294) were new restorations placed due to primary caries. The most commonly restored teeth were 46 (n=32) and 47 (n=32). The most common previous restorative material used was dental amalgam (n=46) while the most common restorative material for a new restoration was resin composite (n=357) compared to dental amalgam (n=11).

Conclusions: Replacement of restorations are not a significant feature in the day to day activities of a South African dentist. The prevalence of dental caries in the region supports the need for intervention. The use of dental amalgam is negligible as the trend for increased resin composite use is noted in recent years.

Email: rzadam@uwc.ac.za


Clinical approach to calcific metamorphosis: Case report

Sibuyi I1, Gwengu P2, Jonker C3
Department of Operative Dentistry, School of Oral Health Sciences, Sefako Makgatho Health Sciences University


Introduction: We present a case report which describes the practical and clinical treatment approach for an anterior tooth with calcific metamorphosis or pulp canal obliteration (PCO) utilizing a variety of equipment, materials and techniques. Digital imaging using different angulations for each clinical stage was performed.
Objective: To outline clinical challenges associated with the location of the canal orifice of an anterior tooth with calcific metamorphosis, endodontic treatment thereof and the ultimate restoration of a challenging case.
Results: The clinical challenges associated with tooth morphology, extent, size and shape of this tooth which is complicated by calcific metamorphosis case are documented together with a detailed step-wise approach for averting such complications by use of basic and specialized equipment (micro-files, C+ files, K-files, magnification and rotary nickel-titanium instruments). An acceptable endodontic and aesthetic result was achieved with patient satisfaction and functionality.
Conclusion:  We have shown successful endodontic treatment with associated pleasing aesthetics in a tooth which was complicated by calcific metamorphosis.  This provides the detailed approach to cases of this nature which may be successfully treated conservatively for a good overall prognosis.

Email: sibuyiisaac@gmail.com





Makwakwa LN1
Department of Community Dentistry, Sefako Makgatho Health Sciences University


Introduction: Since time in memorial dental jewellery or tooth adornment has been associated with higher social status or cultural practices. The current increase in demand in dental jewellery is attributable to mainstream attraction of hip-hop culture and icons.
Aim: The study sought to analyse the trend of anterior tooth inlays in Durban, South Africa.
Method: A cross sectional descriptive surveys was used to collect data on patients with tooth inlays at dental practices in metropolitan areas of Durban. Results The study population consisted of 503 participants, of which of 296 (58.8%) were Indian, 265 (52.7%) Female. The ratio for matric to tertiary education was 3:2. The mean age was 27.52 (6.7), ranging from 16 to 78 years. The average time that the inlay was in the mouth was 7.44 (5.9), range (1 - 53). The inlays were maxillary incisors 469 (93.29%), gold 320 (63.6%), silver 153 (30.4%). The main reasons for placing the inlays were as a fashion statement 303 (60.7%), use of medical aid benefits 89 (17.7%), gifted 80 (15.9%). Majority of inlays were on virgin teeth 417 (82.9%), and participants were not aware of the harmful effects 417 (82.7%) yet 327 (65%) liked it.
Discussion and conclusion: Level of education is inconsequential to the uptake of gold of inlay. The inlay phenomenon is young, driven by popular culture, hence the rise of silver as an alternative material choice. Its concerning that medical funds are used to procure inlays unjustifiably. Regrettably, this culture will persist as majority of participants request it and like it despite the harmful effects

Email: nokukhanya.makwakwa@smu.ac.za

Clinical management of a tooth that presented with necrotic and an open apex: A case report.

Sithole MP1, Kabini SN2,
Department of Integrated Clinical Dentistry, School of Oral Health Sciences, Sefako Makgatho Health Sciences University


Objectives: The department of Integrated Clinical Dentistry (ICD) of the Sefako Makgatho Health Sciences University is involved with the treatment of patients that require the restoration of traumatized dentition. Most of these cases are referrals from the surrounding clinics, and comprises of pediatric and young adult patients. These traumatic injuries are commonly caused by traumatic fall injuries and some due to assaults. Most of the cases occur when the tooth apex is still developing and they tend to cause incomplete fusion of tooth apices, and this may also lead to internal root resorption. A 14-year-old female patient presented at the undergraduate ICD clinic with a fractured right central incisor tooth. Upon radiographic examination, an open apex with internal root resorption was observed. The aim of treatment was to initiate the formation of apex and also to stop the progression of internal root resorption.
Methods: The tooth was filed and shaped with ProTaper Next files (PTN, Dentsply Tulsa Dental Specialties) and irrigated with sodium hypochlorite. Calcium hydroxide was place in the root canal and the tooth was temporary restored with glass ionomer material (3M ESPE, St Paul, MN, USA). The patient was seen after six weeks to evaluate the progress of treatment.
Results: There were signs of apex formation and narrowing of the root canal after the placement of calcium hydroxide
Conclusions: Apexification is defined as ‘a method to induce a calcified barrier in a root with an open apex or the continued apical development of an incomplete root in teeth with necrotic pulp, and was successfully treated with calcium hydroxide

Email: sitholemp@gmail.com

Invitro antibacterial activity of 3 root canal sealers against enterococcus faecalis

Mukorera TF1
University of the Western Cape

Introduction: The goal of root canal treatment is to eradicate microorganisms in the root canal system of the tooth. However; it has been found that no method of tooth preparation is efficient in eliminating all microorganisms present in root canals. Therefore obturation materials with anti-microbial properties are advantageous, so that any residual microorganisms in the root system of the tooth can be eliminated.
Objectives: 1. To investigate the antibacterial effect of 3 endodontic sealers: Sealapex, Endorez, Guttaflow Bioseal against Enterococcus faecalis.

  1. To determine the longevity of the antibacterial effect of the different sealers on Enterococcus faecalis.

Method: Direct contact test was used to assess the antibacterial effect of the 3 sealers against E. Faecalis. Sample size was n=50 per sealer. A 250μl of bacterial suspension was carefully placed on the surface of each sealer. Bacterial suspensions placed on the wall of uncoated wells were used as control. The incubation was done in 100% humidity at 37 ⁰C for 2, 5, 20, and 60 minutes. The survival of bacteria was assessed by culturing aliquots of 100 μL onto Tryptic Soy Agar plates after 10-fold serial dilutions. After incubation for 24 hours at 37⁰C, colonies on the plates were counted, and the CFU/mL was calculated. The experiments were performed in duplicates. Testing after setting enabled the assessment of the antimicrobial activity of aged sealers after 24 hours, 7 days, 14 days, 21 days and 28 days.
Results: All 3 sealers displayed evidence of antibacterial activity against E Faecalis with various degrees of antibacterial activity after day 0, 7, 14, 21 and 28.
Conclusion: Antibacterial activity was displayed by all 3 sealers against E Faecalis which will have an effect on entombed bacteria.

Email: 3820840@uwc.ac.za