Dissertação (mestrado) - Universidade Federal do Rio de Janeiro. Faculdade de Odontologia / Made available in DSpace on 2012-10-16T02:10:24Z (GMT). No. of bitstreams: 0

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This multifaceted study documents validates, and verifies the changes in oral surgery teaching in Dundee University Dental School, which have changed with time to accommodate the demands of an ever increasingly complex discipline. Availability of instructive teaching material in hard copy and as video and text on the internet combined with close clinical supervision and detailed assessment with feedback allows students to attain competency in exodontia with falling patient numbers. It has been demonstrated that the undergraduate training in the oral surgery clinics still attains competency or BDS standard of ‘safe beginner’ for simple extractions and minor oral surgery, despite fewer procedures being carried out. The criteria used for undergraduate assessment and marking of exodontia have been validated in house and nationally. These are appropriate, objective and reliable. Using Thiel cadavers is a valid and reliable method of teaching undergraduate students the technique of extraction with forceps prior to their clinical exposure. Further employment of the cadavers for continuing practice and the introduction of new skills has been mooted. The use of the ‘Blackboard’ was investigated and found not to be well used; the effort to produce the work was not well directed since it was not taken advantage of by the whole year nor very frequently by those who do use it. Alternative methods of engaging the student to investigate and research the discipline have been suggested. Encouragement of the students to interact more when the exodontia clinic time is available for this opportunity has been introduced and suggestions to increase this activity to enhance the teaching of core topics have been made. From apprehension to enjoyment our student assure us that they find this discipline worthwhile whilst acknowledging that it will not be a practice builder and that they are equipped to deal with simple oral surgery procedures.

Magister Chirurgiae Dentium (MChD) / The dental clinic of the University of the Western Cape provides oral health care for many preschool children. The clinical observation was that these children presented with rampant dental caries. A recent report compi1ed by an international Joint Working Group of the Internationale Dental Federation and the World Health Organisation identified the changes in oral health in children and factors associated with these changes. South Africa presents a unique opportuni ty to study the oral health status of different ethnic and socio-economic groups. A review of the relevant literature indicated that there was a lack of published data, especially on the oral health status of preschool children. A study was designed to investigate the oral health status of a selected group of preschool children ages 2-6 years in the Western Cape. The examinations were conducted at twelve different créches by two calibrated examiners. The examinees' weight and height were also measured. The data was recorded on a revised World Health Organization Basic Oral Health Assessment form. A total of 547 children were examined with an almost equal distribution of males and females. Only 18% of the sample had a compl ete sound primary dentition, dmft = O. The mean dmft was 5.37 which ranged from 2.73 for the 2 year age group to 7.01 for the 5 year age group. The mean dt of 4.09 made up 76% of the dmft, the mean mt of 1.22 made up 23% and the ft was negligible. Seventy-eight percent of the sample had decayed teeth present and 28% had missing teeth recorded. The treatment chosen by or for these children appeared to be extractions. Observations of extensively decayed teeth and the high prevalence of dento-alveolar abscesses suggested that this treatment was of an emergency nature. There was much unmet treatment as only 22% of subjects were free of decay and those with decayed teeth present had an average of 5. The dmft distribution showed 48% had a dmft.)5. There was a statistically significant linear association between the dmf and age for all the tooth types except the cani nes. There was no significant difference in caries prevalence between males and females. The phenomenon of bilateral symmetrical occurrence of dental caries in the primary dentition was demonstrated in the present study. The maxillary central incisors were the most frequently affected teeth (55%), followed by the mandibular second molars (47%) and maxillary second molars (42%). This is contrary to the findings in European communities where the primary second molars are the most susceptible tooth types. The present study found the fifth year of 1ife to be the critical one for the primary dentition. It was at this age that the greatest increment in dmft was observed, the greatest decrease in the number of caries-free subjects, more than a twofold increase in rampant caries, and a twofold increase in the number of subjects with dento-a1veo1ar abscesses. Few hard tissue anomalies were recorded. Localized enamel hypoplasia was quite common especially of the upper incisors and second molars. Most children claimed their teeth were brushed at least once a day. But soft deposits were present in almost all age groups in all the segments. Sixty percent of the sample had the sole responsibility of brushing their own teeth with no assistance from their parents. Parental assistance with toothbrushing was limited to the younger age group. In the present study soft deposits and gingivitis were recorded mostly on the buccal of the upper posterior segments and on the lingual of the lower posterior segments. The anterior segmentshad less plaque than the posterior segments. Thi s may be due to children finding it easier to brush anteriorly than posteriorly when they do brush. Also, the other areas are less accessible and require greater manipulative skill. There was a weak correlation between the total soft deposits and total gingivits. Although 60% of the sample had six segments of soft deposits present, only 4% had )six segments of gingivitis present. However, it was found that the higher the number of segments of soft deposits present, the greater the tendency for the presence of gingivitis. The association between dmft and soft deposits was not significant but between dmft and gingivitis was significant. This may be more preci se as these two are both cumulative measures. Soft tissue lesions were generally uncommon in this age group. The children in this community were generally lighter in weight and shorter in height compared to the NCHS (1979) percentiles. Recommendations regarding ways of redressing the obviously inadequate general and oral health of this sample of children were made.

A quantidade de trabalhos específicos sobre os traumatismos alvéolo-dentários de maior extensão encontrados na literatura é pequena. Este estudo mostra o resultado de 127 casos de traumatismos alvéolo-dentários diagnosticados no Hospital Municipal Arthur Ribeiro de Saboya, em São Paulo, entre junho de 2001 e dezembro de 2002. A análise dos dados permitiu identificar o grupo etário de 0 a 10 anos e o sexo masculino como os mais atingidos, a queda como o fator etiológico mais comum e a fratura alveolar como o principal tipo de lesão encontrada. A maioria dos pacientes apresentou lesões extra e intra orais e 73,2% tardaram até 05 horas para procurar atendimento após o acontecimento do trauma. / There are few specific reports in the literature bearing information on dento-alveolar injuries. A survey was done considering 127 patients recorded from June 2001 to December 2002 showing dento-alveolar injuries treated at the Arthur Ribeiro Saboya Municipal Hospital, Sao Paulo, Brazil. The analysis of data revealed that male patients and the age group 0–10 yr were most prevalently involved in this kind of trauma, the main cause was accidental fall and alveolar fractures were the most frequent type of injury. The majority of the patients suffered some kind of soft tissues injuries and 73,2% of the patients received the first dental assistance during the first 5 hours following the incident.

A quantidade de trabalhos específicos sobre os traumatismos alvéolo-dentários de maior extensão encontrados na literatura é pequena. Este estudo mostra o resultado de 127 casos de traumatismos alvéolo-dentários diagnosticados no Hospital Municipal Arthur Ribeiro de Saboya, em São Paulo, entre junho de 2001 e dezembro de 2002. A análise dos dados permitiu identificar o grupo etário de 0 a 10 anos e o sexo masculino como os mais atingidos, a queda como o fator etiológico mais comum e a fratura alveolar como o principal tipo de lesão encontrada. A maioria dos pacientes apresentou lesões extra e intra orais e 73,2% tardaram até 05 horas para procurar atendimento após o acontecimento do trauma. / There are few specific reports in the literature bearing information on dento-alveolar injuries. A survey was done considering 127 patients recorded from June 2001 to December 2002 showing dento-alveolar injuries treated at the Arthur Ribeiro Saboya Municipal Hospital, Sao Paulo, Brazil. The analysis of data revealed that male patients and the age group 0–10 yr were most prevalently involved in this kind of trauma, the main cause was accidental fall and alveolar fractures were the most frequent type of injury. The majority of the patients suffered some kind of soft tissues injuries and 73,2% of the patients received the first dental assistance during the first 5 hours following the incident.

Introduction : Le but de cette étude rétrospective est de comparer les changements squelettiques et dento-alvéolaires causés par trois appareils myofonctionnels, soit le Twin Block (TB), le Xbow (Xb) et le Carrière® Motion 3D™ Appliance (CMA), durant la première phase de traitement pour corriger une classe II. Méthodes : Les radiographies céphalométriques latérales prétraitement (T0) et post-traitement myofonctionnel (T1) de 43 adolescents traités par un TB (15), un Xb (7) ou un CMA (21) ont été récupérées et tracées; 12 mesures squelettiques et 10 mesures dentaires ont été analysées. Les différences (T1-T0) ont ensuite été comparées entre les appareils en utilisant l’analyse ANOVA, le test-t indépendant ou le test U de Mann-Whitney. Résultats : Le traitement était, en moyenne, d’une durée de 10,1 ± 3,2 mois avec le TB et de 7,4 ± 2,7 mois avec le CMA. Le groupe TB a connu de plus grands changements au niveau de la longueur et de la position sagittale de la mandibule en augmentant Cd-Pg (3,4 mm), Pg-Go (1,3 mm), N-B (//FH) (1,3 mm) et S-N-B (1,2°) plus que le CMA. Le TB a amélioré le Wits de 2,2 mm plus que le CMA. Le TB a également démontré une plus grande rétroclinaison des incisives supérieures en diminuant U1–FH (4,2°) plus que le CMA. Le CMA a restreint le mouvement antéro-postérieur de la première molaire supérieure tandis que le TB n’a pas eu d’effet significatif sur cette variable. Le seul changement cliniquement significatif résultant du CMA était en lien avec la proclinaison des incisives inférieures, L1–MP (4,1°). Les résultats associés au groupe Xb ont été exclus en raison de la petite taille de l’échantillon. Conclusion : La correction de la classe II est obtenue à l’aide d’une combinaison d’effets squelettiques et dento-alvéolaires avec le TB, mais principalement grâce à des effets dento-alvéolaires avec le CMA. Une taille d’échantillon plus grande est nécessaire afin de mieux comparer les effets du Xb. / Introduction: The objective of this retrospective study is to compare the skeletal and dento-alveolar changes caused by three functional appliances, the Twin Block (TB), the Xbow (Xb), and the Carrière® Motion 3D™ Appliance (CMA), during the first phase of treatment for class II correction. Methods: The pre-treatment (T0) and post-functional treatment (T1) lateral cephalometric radiographs of 43 adolescent patients treated with a TB (15), an Xb (7) or a CMA (21) were recovered and traced, and 12 skeletal and 10 dental measurements were analyzed. The differences (T1-T0) between the appliances will be compared using the ANOVA analysis, independent samples t-tests, or Mann-Whitney U-tests. Results: On average, the treatments lasted 10.1 ± 3.2 months with the TB and 7.4 ± 2.7 months with the CMA. The TB group experienced greater mandibular length and sagittal position changes by increasing Cd-Pg (3.4 mm), Pg-Go (1.3 mm), N-B (//FH) (1.3 mm), and S-N-B (1.2°) more than the CMA. The TB improved the Wits appraisal 2.2 mm more than the CMA. The TB also had a superior retroclining effect on the maxillary incisor inclination and position by reducing U1–FH (4.2°) more than the CMA. The CMA restrained the antero-posterior movement of the maxillary first molar while the TB had no significant effect on this variable. The only clinically significant change that the CMA displayed was in relation to mandibular incisor proclination, L1–MP (4.1°). The results related to the Xb group were excluded due to its very small sample size. Conclusion: Class II correction is achieved by a combination of skeletal and dento-alveolar changes with the TB, but primarily through dento-alveolar effects with the CMA. A bigger sample size is required in order to properly compare the effects of the Xb.