<p>The aim of this study was to compare the oral health status between well and malnourished children under five years old attending Mother and Child Health clinic in Queen Elizabeth II Hospital in Maseru, Lesotho.</p>

This study reviews the three-year Bachelor of Dental Therapy curriculum, which was introduced at the University of KwaZulu-Natal in 1980. The dental therapist was introduced to the health care system during the apartheid era, to improve access to basic dental services to disadvantaged sectors of the population. However thirty years later, this situation has not improved. Therefore the purpose of this study is to evaluate the dental therapy curriculum offered at this university, to determine whether it is able to produce graduates who are adequately prepared to practice competently, according to the scope of practice prescribed by the regulatory body, and to meet the oral health needs of the population. To conduct a comprehensive evaluation, it was necessary to evaluate the multiple influences on this curriculum. As a result, the Hicks model called Typical Influences on Curriculum was selected to serve as the theoretical framework. This resulted in the use of the mixed methods research approach. Pragmatism was consequently selected to form the philosophical foundation of this study due to the fact that it allowed for the combination of methodological tools to answer the research questions. The first question defined the role of the dental therapist in the health care system. Qualitative interviews with all stakeholders who are associated with this profession, in the context of the needs of the country, provided the answer to this question. The second question, on how the curriculum prepared its graduates to perform this role, was conducted by a combination of methods. The evaluation of the form and content of the curriculum, and the training facilities, were combined with the interviews conducted with students, graduates and academics, on their perceptions of the educational process and the competence of graduates. The third question about the perceptions of stakeholders on the appropriateness of training and clinical competence was established by qualitative interviews. This led to the development of the inferences and recommendations for this study. The overall inference was that the dental therapy curriculum did not produce appropriately-trained graduates to meet the needs and challenges of South Africa. This resulted in the development of a new curriculum evaluation model for health science education, which was considered to be an extension of the Hicks model. Recommendations were also made on how this model could be implemented with respect to the dental therapy curriculum. / Thesis (Ph.D.)-University of KwaZulu-Natal, Edgewood, 2011.

<p>The aim of this study was to compare the oral health status between well and malnourished children under five years old attending Mother and Child Health clinic in Queen Elizabeth II Hospital in Maseru, Lesotho.</p>

[Truncated abstract] Periodontal disease is a common and underdiagnosed disease in humans that may have adverse effects on pregnancy outcomes. The aim of this thesis was to investigate the effects of periodontal disease in pregnancy by means of two observational human studies and the development of animal models of fetal and uterine exposure to periodontopathic bacteria and lipopolysaccharide. I performed a prospective study examining the rates of preterm birth, small for gestational age neonates and neonatal inflammation in 277 women who had undergone a detailed antenatal periodontal examination and oral health questionnaire. Periodontal disease was associated with small for gestational age neonates, and increased CRP levels in umbilical cord blood, but no effect was seen on the rate of preterm birth. Maternal oral health symptoms predicted both periodontal disease and newborn biometry. In a retrospective case control study, I examined the role of periodontal disease in perinatal mortality. Participants included 53 women who had experienced a perinatal loss for which no cause could be found after thorough investigation, and 111 control women. Women who had experienced a perinatal loss were more than twice as likely as controls to have periodontal disease. The incidence of periodontal disease was even higher in women in whom the perinatal loss was due to extreme prematurity. In contrast to my prospective study, risks to the pregnancy could not be predicted by maternal oral health behaviours or oral health symptoms. In order to better understand the mechanisms regulating the associations described in the human studies, two animal models were developed; one to investigate acute exposure and the second to investigate long-term exposure to periodontal pathogens. The first study examined the effects of administration of a bolus of periodontopathic bacteria and lipopolysaccharide to the pregnant sheep. Injection of bacteria and lipopolysaccharide in the amniotic fluid of the pregnant preterm sheep caused a high rate of fetal lethality, disturbance of fetal acid base status and inflammation of the fetus and membranes. Given the circumstances of exposure to periodontopathic pathogens in human periodontal disease, a model investigating long-term exposure to periodontopathic lipopolysaccharide on pregnancy outcomes was developed. ... Overall, I have demonstrated that maternal periodontal disease is associated with adverse pregnancy outcomes including fetal growth restriction and possibly perinatal loss. Mechanisms regulating these effects are likely to be mediated by fetal adaptations to intrauterine inflammation resulting in altered fetal development, growth or survival. Randomised controlled trials that are currently in progress will provide further information on the effects of periodontal disease in human pregnancy, and the efficacy of treatment to reduce these adverse outcomes.

Orientadores: Rosana de Fátima Possobon, Gláucia Maria Bovi Ambrosano / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-27T03:24:32Z (GMT). No. of bitstreams: 1 Ferreira_LualeLeao_D.pdf: 1787266 bytes, checksum: 2462e51df97412a947920a0fe6605173 (MD5) Previous issue date: 2015 / Resumo: Considerando o crescente interesse da odontologia em conceber a saúde bucal para além do paradigma biomédico, visando atender aos preceitos do modelo biopsicossocial e de prevenção e promoção da saúde, o presente trabalho teve como objetivo geral avaliar comportamentos em saúde bucal e variáveis biopsicossociais que permeiam a saúde bucal em escolares. Para tanto, foram desenvolvidas três análises baseadas em levantamento epidemiológico observacional com delineamento transversal, que apresentou os seguintes objetivos específicos: 1. Avaliar as variáveis de desfecho frequência de consultas odontológicas e prevalência de cárie, investigando sua associação com variáveis psicossociais e nível socioeconômico; 2. Investigar a ansiedade frente ao tratamento odontológico nos escolares, e testar associações entre a ansiedade, condições clínicas odontológicas, variáveis psicossociais e socioeconômicas; 3. Avaliar a existência de associações entre odontalgia e fatores socioeconômicas, condições de saúde bucal e variáveis psicossociais. Para o estudo 1 e 2, a amostra foi composta por de 532 escolares de 15 anos de idade, provenientes de escolas públicas estaduais de Piracicaba, São Paulo. Para o estudo 3, a amostra contou com 592 escolares. Foram coletados dados clínicos relativo a presença de cárie dentária, avaliada pelo índice CPOD segundo recomendações da OMS, e sangramento gengival. Informações relativas à ansiedade frente ao tratamento odontológico foram coletadas por questionário validado para população brasileira. Os escolares também responderam a questões referentes ao acesso do adolescente a consultas odontológicas, aos comportamentos de higiene bucal, ao motivo de última consulta odontológica, à ansiedade frente ao tratamento odontológico, à coesão e à adaptabilidade familiar e à alimentação do adolescente em ambiente escolar. Os pais ou responsáveis pelos adolescentes responderam às questões sobre o nível socioeconômico. A análise dos dados foi realizada por meio de estatística descritiva, teste qui-quadrado, Odds Ratio e regressão de Poisson. Em relação ao estudo 1, controlando variáveis confundidoras, observou-se que a baixa higiene bucal diária, renda familiar menor que três salários, mais que quatro pessoas residentes na mesma habitação e alta ansiedade odontológica foram associadas à baixa frequência de consultas odontológicas. A presença de dente cariado foi associada à baixa frequência de consultas odontológicas e a presença de dentes obturados foi associado à alta frequência de consultas e ao gênero feminino. A experiência de cárie associou-se à baixa higiene bucal diária, à alta frequência de consultas odontológicas e pai com até 8 anos de escolaridade. Para o estudo 2, verificou-se que a baixa frequência de consultas odontológicas e a baixa frequência de higiene bucal foram estatisticamente associados à ansiedade frente ao tratamento odontológico dos adolescentes. No estudo 3, a odontalgia foi associada à baixa renda familiar, ao maior número de pessoas residentes no mesmo domicílio, a baixa frequência de escovação diária, à baixa frequência de consultas odontológicas, ao maior tempo da última consulta odontológica, à ansiedade frente ao tratamento odontológico, ao consumo de alimentos cariogênicos em ambiente escolar, à experiência de cárie e à presença de dente cariado. Conclui-se que a frequência de consultas odontológicas e cárie dentária associaram a variáveis socioeconômicas e psicossociais (Capítulo 1). Além disso, a ansiedade frente ao tratamento odontológico foi associada a frequência de consulta e comportamento de higiene bucal (Capítulo 2). Já a odontalgia associou-se a fatores socioeconômico, a variáveis psicossociais e a condições clínicas bucais (Capítulo 3), demonstrando a importância da avaliação de variáveis comportamentais e psicossociais em aspectos relacionados à saúde bucal em escolares. A associação estabelecida entre estas variáveis indica a importância de uma abordagem biopsicossocial de atenção em saúde, com atuação centrada no adolescente e em seu âmbito familiar / Abstract: Considering the interest to con in designing oral health beyond the biomedical paradigm, meeting biopsychosocial model¿s precepts and prevention and health promotion, this study aimed to assess oral health behavior and biopsychosocial variables that permeate oral health in adolescents. Thus, three analyzes were developed based on observational epidemiological survey with cross-sectional design, which presented the following specific objectives. 1. To assess the frequency of dental visits and oral health, investigating its association with psychosocial variables, and socioeconomic status; 2. To investigate dental anxiety, and test associations between oral health, psychosocial and socioeconomic factors; 3. To assess the association between toothache, socioeconomic factors, oral health status and psychosocial variables. For the study 1 and 2, the sample involved 532 15-year-old adolescents from public schools in Piracicaba, São Paulo. For the study 3, the sample consisted of 592 students. We collected clinical data on dental caries, assessed by DMFT index according to WHO recommendations. Information concerning dental anxiety was collected by a validated questionnaire. The students also answered questions regarding adolescent access to dental visits, oral hygiene, reason for last dental visit, dental anxiety, family cohesion and adaptability and adolescents¿ food intake. Parents answered the socioeconomic status questionnaire. Data analysis were performed using descriptive statistics, chi-square test, odds ratio and Poisson regression. Regarding the study 1, controlling variables, low oral hygiene, low family income, more than four persons living in the same house and high dental anxiety were associated with low frequency of dental visits. Decayed teeth were associated with a low frequency of dental visits. Filled teeth was associated with a high frequency of dental visits and the female. Caries experience was associated with low oral hygiene, high frequency of dental visits and father with more than 8 years of schooling. For the second study, it was found that low frequency of dental visits and low oral hygiene was statistically associated with dental anxiety. In study 3, toothache was associated with low family income, more than four persons living in the same house, low oral hygiene, low frequency of dental visits, high dental anxiety, consumption of cariogenic foods, caries experience and decayed teeth. We conclude that the frequency of dental visits and oral health associated the socioeconomic and psychosocial variables (Chapter 1). In addition, dental anxiety was associated with frequency of dental visits and oral hygiene behavior (Chapter 2). Toothache was associated with socioeconomic factors, psychosocial variables and oral health status (Chapter 3), demonstrating the importance of behavioral and psychosocial variables in aspects that relates to oral health in school. The association established between these variables indicates the importance of a biopsychosocial approach, with activities centered on the adolescent and their family environment / Doutorado / Saude Coletiva / Doutora em Odontologia

MPH / Department of Public Health

On t.p.: Degree MSc Dental Science (Community Dentistry) / Thesis (MSc)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: The purpose of this review was to investigate the management of oral candidiasis in HIV/AIDS patients and to evaluate the different guidelines that are available for its management. To achieve this aim, three objectives were identified: (i) to identify and report on the different interventions used to manage oral candidiasis, in patients with HIV/AIDS, (ii) to determine the efficacy of these interventions, and (iii) to provide guidelines for management. A thorough systematic search of the literature was carried out and all relevant papers were graded into three levels of evidence (A, B, and C) and scored for quality according to set criteria. A number of topical and systemic antifungal medications are used to treat oral candidiasis in HIV-positive patients. These include the poleyne antibiotics, nystatin and amphotericin B. Milder episodes of oral candidiasis respond to topical therapy with nystatin, clotrimazole troches or oral ketoconazole. Fluconazole has been extensively evaluated as a treatment for candidiasis. With HIV-infection, a cure rate of 82% has been achieved with a daily oral dose of 50 mg. Fluconazole was found to be a better choice of treatment for relapsing oropharyngeal candidiasis, resulting in either better cure rates or better prevention of relapse. Intravenous amphotericin B has been found to be effective therapy in azole refractory candidiasis where it was shown to be safe and well tolerated. Topical therapies were found to be effective treatment for uncomplicated oropharyngeal candidiasis, however patients relapsed more quickly than those treated with oral systemic antifungal therapy. Overall, nystatin appears less effective than clotrimazole and the azoles in the treatment of oropharyngeal candidiasis. With regard to the resolution of clinical symptoms, clotrimazole was found to be just as effective as the azoles, except when patient compliance was poor. Fluconazole-treated patients were more likely to remain disease-free during the fluconazole follow-up period than with those treated with other interventions. Relatively few studies were qualified to address the provision of guidelines for the management of oral candidiasis in primary health care settings. Most of the studies found were of moderate and low quality level of evidence. These studies included the assessment of different guidelines for identification, treatment and dental needs. They stressed that patients with HN need dentists who will act as primary health care providers, together with other providers to ensure adequate overall care. Given the level of interest and importance of candidiasis associated with treatment of HN -positive patients, it is surprising to find that little high quality research has been undertaken. As such, it is hoped that this review would provide researchers, oral health care workers and other health care providers with an overview of the management of oral candidiasis associated with HN/AIDS. / AFRIKAANSE OPSOMMING: Die doelstelling van die oorsig was om ondersoek in te stel na die hantering van orale kandidiase in HIV/AIDS pasiënte asook om die verskillende beskikbare riglyne vir die behandeling daarvan te evalueer. Ter verwesenliking van hierdie doelstelling is drie doelwitte geïdentifiseer: (i) om die intervensies wat gebruik word in die hantering van orale kandidiase behandeling te identifiseer, (ii) om die effektiwiteit van hierdie intervensies te identifiseer en (iii) om op grond hiervan riglyne vir die hantering voor te stel. 'n Sistematiese literatuursoektog is uitgevoer en alle relevante artikels is in drie groepe geklassifiseer (A, B en C) op grond van die data kwaliteit. 'n Verskeidenheid topikale en sistemiese antifungale middels word gebruik om orale kandidiase in HIV-positiewe pasiënte te behandel. 'n Sukseskoers van 82% is met die gebruik van 'n daaglikse dosis van 50 mg medikament gerapporteer. Fluconazole was die beter keuse van middel vir die behandeling van terugkerende orofaringeale kandidiase. Topikale behandeling was effektief in die behandeling van ongekompliseerde orofaringeale kandidiase, hoewel die kans op terugkeer van die toestand groter was as met die sistemiese middels. Pasiënte wat met flukonasool behandel is, het 'n groter kans gehad om siektevry te bly vergeleke met pasiënte op die ander intervensies. Meeste van die studies was van middelmatige tot lae kwaliteit en gevolglik was dit moeilik om behandelingsriglyne te stel. Wat egter wel duidelik is, is dat HIV pasiënte primêre mondsorg benodig wat saam met ander versorging omvattende sorg sal verseker.

Lifelong learning for adults has almost become compulsory for the maintenance of employability. In the South African context, The National Plan for Higher Education advocated an increase of adult learners entering higher education to facilitate lifelong learning. This study will focus on adult learners returning to institutions of higher education on a full-time basis. The study will determine factors that motivate adults to enter the learning environment, and it will identify inhibitors and contributors during their studies. A qualitative research design has been employed. Analysis of data collected by open-ended questionnaires and in-depth interviews indicated that the motivation to return to higher education was mainly personal and career driven. Students reported on situational, dispositional, and institutional inhibitors they experienced and had to overcome. Contributors identified included various support systems. Recommendations are made in view of the results of the empirical study to assist institutions of higher education in South Africa to meet the unique needs of the adult learner. / Educational Studies / M. Ed. (Adult Education)

Lifelong learning for adults has almost become compulsory for the maintenance of employability. In the South African context, The National Plan for Higher Education advocated an increase of adult learners entering higher education to facilitate lifelong learning. This study will focus on adult learners returning to institutions of higher education on a full-time basis. The study will determine factors that motivate adults to enter the learning environment, and it will identify inhibitors and contributors during their studies. A qualitative research design has been employed. Analysis of data collected by open-ended questionnaires and in-depth interviews indicated that the motivation to return to higher education was mainly personal and career driven. Students reported on situational, dispositional, and institutional inhibitors they experienced and had to overcome. Contributors identified included various support systems. Recommendations are made in view of the results of the empirical study to assist institutions of higher education in South Africa to meet the unique needs of the adult learner. / Educational Studies / M. Ed. (Adult Education)

no / Aims and objectives To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. Background Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. Design Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. Methods A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. Results Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. Conclusion Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice.