<p>HIV/AIDS is a major problem in South Africa with more than 25 percent of the adult population infected with HIV. Oral lesions and various opportunistic infections characterize the progression of HIV making it imperative for people living with HIV to have access to good quality oral care. There is a need to examine accessibility and use of dental services in South Africans living with HIV as very little research in this regard, has been undertaken. Aim: To investigate the barriers to oral health care for people living with HIV in the KZN and the WC. Research Design and Methodology: A cross-sectional study utilising a self-administered questionnaire and semi-structured interviews has been employed. Participants were people living with HIV older than 18 years attending HIV clinics located throughout Kwa-Zulu Natal and WC. Binary logistic regression was performed to determine the variables associated with not obtaining care.</p>

<p>HIV/AIDS is a major problem in South Africa with more than 25 percent of the adult population infected with HIV. Oral lesions and various opportunistic infections characterize the progression of HIV making it imperative for people living with HIV to have access to good quality oral care. There is a need to examine accessibility and use of dental services in South Africans living with HIV as very little research in this regard, has been undertaken. Aim: To investigate the barriers to oral health care for people living with HIV in the KZN and the WC. Research Design and Methodology: A cross-sectional study utilising a self-administered questionnaire and semi-structured interviews has been employed. Participants were people living with HIV older than 18 years attending HIV clinics located throughout Kwa-Zulu Natal and WC. Binary logistic regression was performed to determine the variables associated with not obtaining care.</p>

Magister Chirurgiae Dentium - MChD / HIV/AIDS is a major problem in South Africa with more than 25 percent of the adult population infected with HIV. Oral lesions and various opportunistic infections characterize the progression of HIV making it imperative for people living with HIV to have access to good quality oral care. There is a need to examine accessibility and use of dental services in South Africans living with HIV as very little research in this regard, has been undertaken. Aim: To investigate the barriers to oral health care for people living with HIV in the KZN and the WC. Research Design and Methodology: A cross-sectional study utilising a self-administered questionnaire and semi-structured interviews has been employed. Participants were people living with HIV older than 18 years attending HIV clinics located throughout Kwa-Zulu Natal and WC. Binary logistic regression was performed to determine the variables associated with not obtaining care. / South Africa

Faculty of Health Sciences School of Public Health 8900179x nmathabathe@eun.org.za / South Africa is ranked as the country with largest number of people living with the Human Immunodeficiency Virus (HIV) in the world. Oral health care workers have a role to play in the national response to the HIV epidemic through the provision of quality oral health services. The aim of this study was to determine the knowledge, attitudes and practices of oral hygienists and dental therapists on HIV/AIDS. A total of 1160 questionnaires were mailed to 831 oral hygienists and 329 dental therapists registered with the Health Professionals Council of South Africa in 2000. The questionnaire covered: demographic factors; general and oral health-specific HIV/AIDS knowledge; attitudes towards HIV/AIDS patients; infection control practices and ethical/legal issues. The response rate was 27.4% (n=318), 255 oral hygienists and 63 dental therapists. Overall, respondents in this study illustrated sound knowledge on oral manifestations of HIV/AIDS and modes of transmission of the virus although 10% reported that the virus could be transmitted through mosquito bites and 25% agreed that HIV could be transmitted via saliva. Respondents reported compliance with basic infection control practices although 35% did not agree that infection control measures that protect against the hepatitis B virus could provide adequate protection against HIV. In addition 73.8% of the respondents reported that additional infection control measures must be taken in the treatment of HIV/AIDS patients in the dental surgery. The results of this study indicate a need for continuous HIV professional education of oral hygienists and dental therapists in order to improve the quality of care provided to HIV infected patients.

Until recently, and since the inception of the National Health Service in 1948, general dental practitioners [GDPs] have worked in a stable environment. In recent years these GDPs have experienced dramatic changes in the way that primary oral health care is delivered to the public. This research aims to understand the strategic planning processes and the issues that are involved within the management of these changes that are currently occurring in general dental practice. The research question asks "What model could General Dental Practitioners use in their strategic approach to managing the enforced changes that are occurring within primary Dental Care". This thesis adopts the approach that all GDPs work within a “Small business” environment but that they are constrained by “professional” requirements. The changes now mean that these GDPs need to become proactive in their decision-making processes. The present system of primary oral health care within the U.K. is designed for the treatment and repair of damage caused by dental disease; it has not been prevention orientated. Changes such as disease processes, the financing of the NHS, demographic changes all mean that GDPs will require, in some degree at least, to re-evaluate their personal objectives and strategies. Historically, GDPs might be considered to have been reactive in their approach to these gradual changes. The ‘item of service’ payment system used within the NHS to remunerate GDPs is unique and therefore no existing small business model satisfies the requirements of GDPs. The research involved a population of 449 West Midland GDPs. The findings of the research indicated that certain core issues were significant in how dentists decided to operate their clinical practice. Significant gaps were revealed in the current literature and the research findings were used to develop a totally new decision making model. This model attempts to embrace the current changing scenario and by using this model, GDPs can evaluate their individual position within this changing framework of general dental practice and thus be better informed in their decision making processes. The need for further research is explained and suggestions are made for other areas that might be considered of importance to dentists and the delivery of primary oral health care.

Magister Scientiae Dentium - MSc(Dent) / Patient satisfaction is critical for the growth of oral health service and practice. The present study was a descriptive study on patient satisfaction with oral health care provided by a district dental clinic. The aim of the study was to determine whether patients attending the dental clinic of the Lagos State University hospital were satisfied with the care they received. / South Africa

Magister Chirurgiae Dentium - MChD / Lesotho has the third highest prevalence of HIV in the world with an estimated 23% of the adult population infected. At least 70% of people living with HIV/AIDS (PLWHA) present with oral manifestations of HIV as the first sign of the disease. While Lesotho has a population of fewer than 2 million people, it is faced with the harsh reality of a dire shortage of health care workers including oral health care workers (OHCWs). The high prevalence of HIV is of major concern to oral health workers who regularly encounter patients presenting with oral lesions associated with HIV disease. Oral health care workers need to have adequate knowledge of these conditions for effective management thereof. To determine the knowledge, attitudes and practises of oral health care workers (OHCWs) of Lesotho regarding the management of oral manifestations of HIV/AIDS. A descriptive cross-sectional survey was conducted on all 46 OHCWs in 26 public and private care facilities in all ten districts of Lesotho. A self–administered questionnaire was used to gather information on demographic characteristics of OHCWs and their knowledge, attitudes and practices regarding the management of oral lesions associated with HIV. A visual aid depicting seven colour images of lesions strongly associated with HIV was used to assess knowledge. Data was analysed using Microsoft Excel® and the R statistical package. The outcome of the study was then presented using tables and charts as appropriate. Frequencies, means and 2x2 contingency tables were generated and Fisher‟s exact tests were used for associations. A significance level of (p<0.05) was used.

Philosophiae Doctor - PhD / Background: Teledentistry is the use of information and communications technology (ICT) to provide oral health care services and enhance oral health care delivery to communities in geographically challenged areas. The public health services in South Africa needs to be overhauled to address the inadequacies in the current system. As an attempt to minimise or repair the inadequacies in the public health sector, South Africa has identified the use of ICT’s as a potential tool in improving the delivery of health care. However, although SA has recognised telemedicine as a potential solution to improve access to health care, teledentistry does not feature at all in the dental public health sector. Teledentistry and mobile health has the potential to eliminate or minimise the oral health disparities that exist in South Africa with the use of health information systems. Teledentistry can be initiated in an incremental approach by 'piggy-backing' on existing telemedicine sites, thus reducing ICT costs for the public health sector. Stake holders and government officials need to embrace technology to address some of the challenges that exist in the South African public health sector. This study could aid in providing evidence-based information to assist in the introduction of teledentistry in South Africa as an innovative dental screening and management tool. The most recent SA National Oral Health Survey showed that at least 80% of dental caries in children is untreated (Department of Health, 2003) and this poses a significant public health problem. To reduce the double burden of dental caries in children and human resource shortages in the public sector, the use of teledentistry as a school screening tool has been recommended. Teledentistry screening has the potential to improve access and delivery of oral health care to children in underserved and the rural areas. The aim of the study is to compare traditional dental screening versus teledentistry screening for dental caries in children. Methodology: This study consists of two parts: the first part a concordance study and the second part the determination of user satisfaction with regards to the technology used. The concordance study assessed the diagnostic agreement between traditional and teledentistry screening of dental caries in school children aged between 6-8 years old. The methodology included traditional face-to-face dental screening by two trained and calibrated evaluators, and the teledentistry screening method included the same two evaluators together with two trained and calibrated teledentistry assistants (who were of non-dental background). For the traditional face-to-face dental screenings the two evaluators examined 233 children at selected rural primary schools and scored them for DMFT. For the teledentistry screening method the teledentistry assistants captured intraoral images of the same children and web-based stored the images in corresponding eFiles. After a two week wash out period these intraoral images were then examined by the same two evaluators and scored for DMFT. To determine concordance across methods, Kappa Statistics was applied to the data and this revealed intra-examiner reliability. To determine user satisfaction levels, close-ended questionnaires were designed based on the role of the evaluators and TAs in the teledentistry screening process. Results: The intra-rater agreement and reliability across methods for evaluator one was 98.30%, and for evaluator two it revealed a result of 95.09%. Kappa statistics thus revealed that both evaluators were in agreement between a range of 95%-98.30% of the classifications, or 92.79% of the way between random agreement and perfect agreement (p=0.000). The high concordance level indicated that there was no statistical difference between the traditional dental screening method and the teledentistry screening method (intra-rater reliability), thus suggesting that the teledentistry screening method is a reliable alternative to the traditional dental screening method. For the user satisfaction part, both of the evaluators agreed with 8 of the 13 statements (62%). The statements that were agreed upon related mainly to user satisfaction on the technology which included accessing the intraoral images for screening and the ease of scoring decayed and missing teeth off the images; time and technology suggested the screening process of the images saved time; and indicated teledentistry as being an innovative and easy system to use that will save clinical time for dental professionals. The statements they disagreed with related to the clarity of the images, scoring interproximal caries off the images, and the dental screening method of choice. Both of the TAs agreed with 7 of the 11 statements (64%). They agreed upon statements related mainly to perception of children’s attitudes & behaviour which suggested the children were comfortable during the imaging process and in addition they were excited to see pictures of their teeth; they found teledentistry to be an innovative and easy system to use; they found teledentistry to be a sterile process and hence they were happy with infection control. Both TAs disagreed with the statement that suggested clear images could be captured irrespective of poor lighting. Discordant statements related mainly to user satisfaction on technology which related to ease of using the intraoral camera, ease of storing the captured images into the eFiles and ease of deleting unwanted images. Conclusion: The key findings of this study highlights the reliability of utilising teledentistry as a dental screening and diagnostic tool which can be valuable in the delivery of oral health care in South Africa. This research study further revealed valuable data on user satisfaction levels of the evaluators and TAs, and has an impact on the utilisation of the teledentistry screening system. To ensure adoption and adaptation of the screening process all users must be satisfied with the ICTs used in the teledentistry system. User friendliness can impact negatively on the adoption of teledentistry.

Background: Elderly today have an increased life expectancy and retaining their teeth longer than before, it is important that healthcare-professionals have knowledge about oral health and how to prevent oral diseases. Objective: To study knowledge and attitude of oral health among caregivers at nursing homes in Ga-Rankuwa, Pretoria, South Africa. Method: The study was a quantitative cross-sectional study. Data was collected by a questionnaire representing four dimensions; Internal Locus of Control, External Locus of Control, Self-Efficacy and Oral Health Care Beliefs (OHCB), consisting questions about oral health and oral hygiene. The population consisted of 130 caregivers. Result: A total of 50 out of 61 caregivers participated in the study, out of which 43 were females and 7 were males. The age-interval was between 20-75 years. Generally, no statistical significant differences in knowledge and attitudes between the two nursing homes and between the caregivers´ professional statuses was noticed. T-test showed a statistical significant difference (P=0.011) between the caregivers for OHCB-dimension, and (P=0.044) between nursing home “A” and “B” for OHCB dimension. Conclusion: The general level of knowledge and attitude among the caregivers was satisfactory but low. Monitored health intervention studies should be given to promote oral health care knowledge and beliefs. / Bakgrund: Äldre har idag en ökad livslängd och allt fler behåller sina tänder längre än tidigare. För att vårdpersonalen ska kunna förebygga orala sjukdomar hos dessa individer är det viktigt att dem har kunskap om oral hälsa samt hur man förebygger orala sjukdomar. Syfte: Att studera kunskap och attityder om oral hälsa bland personal på äldreboenden i Ga-Rankuwa, Pretoria, Sydafrika. Metod: Studien var en kvantitativ tvärsnittsstudie där datainsamlingen skedde genom ett frågeformulär som innehöll frågor om oral hälsa och munhygien. Populationen bestod av 130 vårdgivare. Resultat: Totalt deltog 50 av 61 vårdgivare i studien, varav 43 var kvinnor och 7 män. Åldersintervallen var 20–75 år. Generellt fanns det inga statistiskt signifikanta skillnader avseende kunskaper och attityder mellan dem två äldreboenden och mellan vårdpersonalens yrke. En tillfredsställande men låg kunskapsnivå och attityd uppmärksammades mellan äldreboenden och vårdgivarnas yrkesstatus. T-testen visade en statistisk signifikant skillnad (P = 0,011) mellan vårdpersonalen för OHCB-dimensionen och (P = 0,044) mellan äldreboenden "A" och "B" för OHCB-dimensionen. Slutsats: Generellt var deltagarnas attityd och kunskapsnivån tillfredställande men låg. Interventionsstudier med uppföljning bör göras för att bättra kunskap och attityd om oral hälsa.

<p>Patient satisfaction is critical for the growth of oral health service and practice. The present study was a descriptive study on patient satisfaction with oral health care provided by a district dental clinic. The aim of the study was to determine whether patients attending the dental clinic of the Lagos State University hospital were satisfied with the care they received.</p>