Thesis (PhD) -- Stellenbosch University , 1992. / ENGLISH ABSTRACT: The maintenance of dental alignment following orthodontic treatment has been, and continues to be, a challenge for the orthodontist (McReynolds and Little, 1991). Orthodontists should endeavour to establish normal occlusions and function to the end that physiologic balance and retentive stability may be achieved (Goldstein, 1953). Many philosophies and theories have been formulated in response to this challenge, but few have successfully withstood the test of rigorous post-orthodontic evaluation. The present study comprises longitudinal assessments of dentofacial changes which occurred in South African Caucasian subjects during their orthodontic treatment as well as a mean of 7 years following active treatnent. The sample consists of 88 Caucasian subjects; 33 males and 55 female sUbjects who have undergone conventional edgewise orthodontic treatment (Lindquist; 1985). The treatment includes extraction (56%) and nonextraction (44%) therapy. Due to the intricate structure of the craniofacial complex, it is deemed important to discuss the major components of this complex separately and then to compare the variables describing the area with post-orthodontic lower incisor crowding. Lower incisor crowding or irregularity, most often referred to as relapse when occurring in the post-orthodontic dentition, is a phenom~non that is clinically visible and easily assessed using the Little Irregularity Index (Little, 1975). A variety of orthodontic study cast and cephalometric variables represent the changes which occur at the three time intervals selected for this study, namely pre-treatment (T1), post-treatment (T2) and following active treatment (T3). statistical analysis of th~ data was undertaken by the Institute for Biostatistics of the Medical Research Council, Tygerberg, RSA utilising the SAS (1985). The significance level of the results of this study is set at p = 0.05. x No previous study has documented the evaluated and described the various craniofacial skeleton in this format. literature parts or has of the The thesis is divided into thirteen chapters. / AFRIKAANSE OPSOMMING: Die instandhouding van tandbelyning na voltooiing van ortodontiese behandeling was en sal nag steeds in die toekoms 'n uitdaging bied vir ortodontiste (McReynolds en Little, 1991). Die ortodontis se strewe moet wees am 'n normale okkli'lsie in die ortodontiese pasient te veE)tig, waartydens die funksie van die kake herstel word, asook fisiologiese harmonie en stabiliteit van die okklusie gevestig ~lOrd (Goldstein, 1953) • Menige filosofiee en teoriee is al voorgestel om hierdie doelwitte te kan bereik, maar baie min het nag daarin geslaag. Tydens die huidige longitudinale studie is gepoog om In ondersoek te doen van die veranderinge wat plaasvind in die dentofasiale omgewing van agt-en-tagtig Suid-Afrikaanse Kaukasiese pasiente tydens hulle ortodontiese behandeling, asook na die verloop van 'n gemiddeld van sewe jaar sedert die behandeling voltooi was. Die monster het uit 33 manlike en 55 vroulike pasiente bestaan wat met 'n konvensionele vierkantsdraad ("edg~wise") ortodontiese tegniek behandel was (Lindquist, 1985). Die behandeling het 56% ekstraksie en 44% ni~-ekstraksie behandelingsbeplannings ingesluit. Weens die baie komplekse kraniofasiale omgewing is dit besluit am elke deel waaruit hierdie omgewing bestaan, afsonderlik te beskryf en te bespreek. Die veranderlikes wat elke deel beskryf is vervolgens gekorreleer met die na-behandelings ondersnytand-bondeling. Ondersnytandbondeling is 'n verskynsel wat klinies sigbaar is en meestal na verwys word as terugval indien dit voorkom in die na-behandelings resultaat. Dit kan maklik gemeet word met behulp van die "Little Irregularity Index" (Little, 1975). 'n Verskeidenheid van ortodontiese studiemodelle en kefalometrie~Je verander.likes is tydens die voor-behandelings (T1), na-behandelings (T2) asook na verloop van 'n gemidd.eld van sewe jaar na afhandeling van die behandeling (T3) gemeet. Die statistiese verwerkinge is deuI' die Institu,ut vir Biostatistiek van die Mediese Navorsingsraad, Tygerberg, R.S.A. gedoen deur middel van die SAS (1985). Die betekenisvolheidsperk van die studie is op P = 0.05 gestel. Geen studie het al voorheen die literatuur gedefineerde areas van die kranio-fasiale skelet formaat ondersoek of be~kryf nie. Die proefskrif bestaan uit dertien hoofstukke.

Dissertation (PhD)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: Introduction: Fetal alcohol syndrome (FAS) consists of multi-system abnormalities and is caused by the excessive intake of alcohol during pregnancy. The teratogenic effect of alcohol on the human fetus has now been established beyond reasonable doubt and FAS is the most important human teratogenic condition known today. The syndrome, first described by Lemoine in1968 in the French literature and in the English literature by Jones and Smith in 1973, has since been corroborated by numerous animal and human studies. This study has grown out of several epidemiological, prenatal and infant studies in areas of the Western Cape that are currently being undertaken by the Foundation for Alcohol Related Research (FARR). Preliminary data from studies in Wellington have confirmed that a significant proportion of school-entry children have FAS. The prevalence ofF AS in this community exceeds that for Down syndrome by a factor of30 times. The frequency ofFAS in high-risk populations of the Western Cape is the highest reported anywhere in the world. With this background, and the paucity of FAS literature related to dentistry, the aim of this study was to determine the craniofacial and oral manifestations ofF AS in a sample of school-going children in the Western Cape. Methodology: This study is a descriptive, case-control, cross-sectional study using a random cluster sampling method. On the day of examination, children were weighed, and their height and head circumference were measured. They then had photographs and radiographs taken, followed by an oral examination. For each child, the following information was recorded on the data capture sheet: date of birth, gender, head circumference, weight and height, enamel opacities, dental fluorosis, plaque index, gingival bleeding index, dentition status, oral mucosal lesions and dentofacial anomalies. Results: The total sample of90 children with diagnosed FAS and 90 controls, were matched for age, gender and social class. There were no significant age differences between the two groups (p=0.3363) and the mean ages were 8.9 and 9.1 for the FAS and control groups respectively. Head circumference (HC) differed significantly between the two groups (p<O.OOO 1) and the three photographic diagnostic measurements were all influenced by head circumference. The prevalence of enamel opacities between FAS and controls was not significantly different and averaged around 15% for both groups. The opacities were found largely in the maxillary central incisor and lower first molar teeth. More than three quarters of both the cases and the controls demonstrated the presence of plaque and almost two thirds demonstrated gingival bleeding on probing. FAS patients had statistically significantly (p<O.OO 1) more dentofacial anomalies than the controls. The mean dmft score for the FAS sample was slightly higher, though not significantly different from that of the controls and the decayed component (d) made up the largest part of the index in both groups. None of the FAS children had any missing or filled teeth, and in the case of the controls these were also rarely found. Thirty nine children (21.67%) of the total sample were caries-free. Discussion: This study represents one of the largest sample sizes documenting the craniofacial and oral and dental manifestations of the FAS to date. Forty two per cent of the FAS sample manifested growth retardation and this was statistically significant (p<O.OOOl) when compared to their controls. Analysis of the face using anthropometry supports many of the previous clinical descriptions of the effects of neonatal alcohol exposure and offers some new perspectives on the FAS facial phenotype. The characteristic dysmorphic facial features found included ptosis of the upper eyelids, epicanthic folds, short upturned nose, thin vermillion border of the upper lip and a smooth philtrum. Overall the analysis of the caries data for this study in respect of differences between cases and controls was found to be unremarkable. The lack of difference in the primary and permanent dentitions between the cases and controls could have been anticipated in this population due to the high prevalence of dental caries among children from the Western Cape. The FAS children showed significantly lower dental ages when compared to the controls. Dental maturation has previously been shown to be mildly, but consistently, delayed in children with delayed development and therefore this is a not surprising finding for the FAS children in this study. Differences between skeletal age and chronological age were noted for both boys and girls, but as a whole, in the present study groups (FAS and controls) showed little variation in skeletal development. Measurements related to the face height and mandibular size appear to be the most important in distinguishing the FAS children from the controls. Most (5 out of8) of the discriminating linear measurements studied lie in the front of the skull area. Most of the discriminating measurements are vertical measurements and only two of the measurements are lines between soft tissue points. When comparing the photographic analyses of the facial features versus the cephalometric assessments; the four facial features most typical of aF AS child had a Positive Predictive Value (PPV) of92% and a Negative Predictive Value (NPV) of90% and the eight linear measurements from the cephalometric analyses had a PPV of 92% and a NPV of 95%. One can therefore conclude that the external facial features are probably more reliable in discriminating between the two groups than the cephalometric measures. For further analyses, other models where a single angular measurement explains a combination of linear measurements need to be investigated. This might further improve the discriminating abilities of the cephalometric measurements as a whole. Conclusions: This study has shown the importance of the oral and craniofacial features ofFAS. FAS can no longer be viewed as just a rare and peculiar childhood disorder. Awareness and recognition of children with FAS is important so that they can be correctly diagnosed and referred appropriately. Prevention of the secondary disabilities and most importantly, the prevention of FAS in subsequent programmes can be planned. The dentist who treats children with FAS must recognise that such patients might be emotionally and mentally handicapped and may make treatment difficult and there may be a need for the child to be treated with behaviour modification and/or premedication before restorative treatment. The dentist should also be aware of the need for an accurate medical history, and possible medical consultations, before treatment can be undertaken safely. / AFRIKAANSE OPSOMMING: Fetale alkoholsindroom (FAS) bestaan uit multisisteem abnormaliteite en word veroorsaak deur oormatige inname van alkohol tydens swangerskap. Die teratogeniese uitwerking van alkoholop die menslike fetus word nie meer betwyfel nie en FAS is die belangrikste menslike teratogeniese toestand tans bekend. Die sindroom, soos aanvanklik deur Jones en Smith in 1973 beskryf, is sedertdien deur vele studies op mens en dier bevestig. Hierdie studie het gegroei uit vele epidemiologiese-, prenatale- en kleuterstudies in dele van die Weskaap wat tans onderneem word deur die Stigting vir Alkoholverwante Navorsing. Voorlopige data van die studies in Wellington bevestig dat 'n betekenisvolle deel van skoolbeginners FAS het. Die prevalensie van FAS in hierdie gemeenskap oortref dié van Down se sindroom met 'n faktor van 30. Die frekwensie van FAS in die Weskaap is die hoogste wat in die wêreld gerapporteer is. Met hierdie agtergrond, en die skaarste aan FAS literatuur wat op tandheelkunde betrekking het, was die doel van hierdie studie om die kraniofasiale en mondmanifestasies van fetale alkoholsindroom in 'n monster van skoolkinders in die Weskaap te ondersoek. Metodologie: Hierdie studie was 'n beskrywende, gevallebeheerde deursneestudie waarin 'n lukrake gebondelde monstermetode gebruik is. Op die dag van die ondersoek is die kinders geweeg en hulle lengte en kopomtrek bepaal. Hierna is foto's en x-straalopnames geneem, gevolg deur 'n mondondersoek. Die volgende inligting is vir elke kind aangeteken: geboortedatum, geslag, kopomtrek, massa en lengte, glasuur-opasiteite, tandfluorose, plaakindeks, gingivale bloedingsindeks, gebitstatus, mukosale letsels en dentofasiale anomalieë. Resultate: Die totale monster, bestaande uit 90 kinders met gediagnoseerde fetale alkoholsindroom en 90 bypassende kontroles, is vergelyk ten opsigte van ouderdom, geslag en sosiale klas. Daar was geen betekenisvolle ouderdomsverskille tussen die twee groepe nie (p- =0.3363). Kopomtrek het betekenisvol tussen die twee groepe verskil (p<0.0001), en die drie fotografiese diagnostiese afmetings is almal beïnvloed deur kopomtrek. Die prevalensie van glasuur-opasiteite tussen die FAS- en kontrolegroep was nie betekenisvol nie en het rondom 15% vir beide gewissel. Die opasiteite is hoofsaaklik gesien in maksillêre sentrale snytande en mandibulêre eerste molare. Meer as driekwart van beide groepe het plaak getoon, en byna tweederdes het gingivale bloeding met sondering gehad. Die gevallegroep het statisties betekenisvol meer (p<O.OO1) dentofasiale anomalieë getoon. Die gemiddelde dmft telling vir die FAS groep was effens hoër, alhoewel nie betekenisvol nie, as die kontrolegroep, en die "delayed" (vertraagde erupsie) komponent (d) het die grootste deel van die indeks uitgemaak in beide groepe. Geen van die FAS kinders het enige afwesige tande (m) of hers telde tande (f) gehad nie, soos ook gevind in die kontrolegroep. Nege-en-dertig kinders (21.67%) van die totale monster was kariesvry. Bespreking: Hierdie studie verteenwoordig een van die grootste monstergroottes tot op datum waarin ondersoek ingestel is na die kraniofasiale en mond- en tandmanifestasies van die fetale alkoholsindroom. Twee-en-veertig persent van die FAS monster het vertraagde groei getoon en dit was statisties-betekenisvol (p<O.OOOl)vergeleke met die kontrolegroep. Antropometriese analise van die gesig steun die vele kliniese beskrywings van neonatale blootstelling aan alkohol, en bied ook nuwe perspektiewe op die FAS gesigsfenotipe. Die kenmerkende dismorfiese gesigseienskappe wat gevind word, sluit ptose van die boonste ooglede, epikantusvoue, kort opgedraaide neus, dun vermiljoen rand van die bolip en 'n gladde filtrum in. In die geheel was die analise van die karies data ten opsigte van verskille tussen gevalle en kontroles onopvallend. Die afwesigheid van 'n verskil in die primêre en sekondêre gebitte in die gevalle en kontroles kon in hierdie bevolking verwag gewees het as gevolg van die hoë voorkoms van tandkaries onder kinders in die Weskaap. Die FAS kinders het betekenisvol-laer gebitouderdomme gehad as die kontrolegroep. Gebitmaturasie is in geringe maar deurlopende mate vertraag in kinders met vertraagde ontwikkelings, soos voorheen al getoon, en is daarom nie verbasend vir die FAS kinders in hierdie studie nie. Verskille tussen skeletale ouderdom en chronologiese ouderdom is gevind in beide seuns en dogters, maar in die geheel het dié huidige groepe (FAS en kontroles) min variasie in skeletale ontwikkeling getoon. Dit wil voorkom of afmetings wat verband hou met die gesigshoogte en grootte van die mandibula die belangrikste is om FAS kinders van die kontrolegroep te onderskei. Meeste (5 uit 8) van die diskriminerende lineêre afmetings wat bestudeer is, lê op die voorkant van die skedel. Die meeste is vertikale afmetings, terwyl slegs twee lyne tussen sagte weefsel punte. Waneer die fotografiese analises van die gesigseienskappe vergelyk word met die sefalometriese waarnemings, word gevind dat die vier gesigseienskappe tipies van 'n FAS kind 'n Positiewe Voorspelbare Waarde (PVW) van 92% en 'n Negatiewe Voorspelbare Waarde (NVW) van 90% het, en die agt lineêre afmetings vanaf die sefalometriese analise 'n PVW van 92% en 'n NPV van 95% het. Daar kan dus afgelei word dat die eksterne gesigseienskappe waarskynlik meer betroubaar is om te onderskei tussen die twee groepe. Vir verdere analise behoort ander modelle waar 'n enkel hoekige afmeting 'n kombinasie van lineêre afmetings verduidelik, ondersoek te word. Dit mag die diskriminerende vermoëns van sefalometriese afmetings in die geheel verder bevorder. Gevolgtrekking: Hierdie studie het die belang van orale en kraniofasiale eienskappe van FAS getoon. Die toestand kan nie langer as 'n seldsame en eienaardige aandoening van kinders beskou word nie, en bewustheid en herkenning van fetale alkoholsindroom pasiënte is belangrik sodat hulle korrek gediagnoseer en op gepaste wyse verwys kan word. Die tandarts wat FAS pasiënte behandel, moet besef dat sulke pasiënte emosioneel en geestelik belemmer mag wees en dus hantering en behandeling bemoeilik. Daar mag 'n behoefte ontstaan vir gedragsmodifikasie enlofpremedikasie voor herstellende behandeling. Verder moet die tandarts bewus wees van die behoefte aan 'n akkurate mediese geskiedenis, en moontlik konsultasie met 'n geneesheer, voor behandeling veilig ingestel kan word.

Thesis (MSc)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: It can safely be assumed that work is a central part of people's daily activities in modem times, and dentists and other health workers are no exception to this rule. The following benefits have been ascribed to having a job, namely that of being a source of money, activity, variety, temporal structure, social contacts, status and identity in society. To what extent does the job as dentist in the civil service provide fulfilment of these basic requirements of having a satisfying job? Considering the number of resignations in recent years of state employed dentists and the well known and often reported "brain drain" of South African professionals, it is important to assess the status of job satisfaction amongst our health professionals, especially those within the state employ. These dentists are responsible for the health care delivery to the impoverished masses who make up a large proportion of the South African population. This study set out to determine the level of job satisfaction among state dentists and how this is perceived by them and reflected in their work performance. It was the aim of the researcher to provide some insight into the working lives of a very important sector of the primary health care providers employed by the Department of Health of the Western Cape Provincial Government. The outcome of the study could be used as a basis for further research in this area. A survey was conducted among all state employed dentists in the Western Cape, excluding dentists attached to the military or academic institutions. The survey instrument consisted of a structured, quantitative questionnaire as well as an open-ended section for comment on specific issues. Furthermore, an indepth semi-structured interview was conducted with one dentist in order to write a case report on the work experience of a state employed dentist.The major fmdings of this study are the following: i) The main determinants of job satisfaction revolve around the work environment, and dentists in state employ enjoy staff support, feel good about what they do for patients, and the standard of work done, but are unhappy about income, lack of respect by patients, senior management and colleagues in private practice. Limited treatment options, poor procurement systems and frequent breakdown of equipment affect their sense of job satisfaction negatively. ii) The level of dissatisfaction is not of such a proportion to persuade them to leave the service, as most dentists would like to remain in their posts. However, most dentists agree that there are no incentives for improving work performance. iii) Dentists responded to their sense of job satisfaction in different ways. While some admitted that their performance is directly linked to how well it is going at work, a large percentage of respondents reported that they do not allow their work performance to be influenced by their perceived job dissatisfaction. iv) Ifwe look at the case study, it is evident that perceived satisfaction or dissatisfaction depends on the individual and how he or she views the world. In this particular case the dentist was very realistic about his ambitions as a person and as a dentist, and set goals for himself within these boundaries. The result is that he remains motivated and satisfied. / AFRIKAANSE OPSOMMING: Dit kan geredelik aanvaar word dat werk die kern uitmaak van mense se daaglikse aktiwiteite, en tandartse en ander gesondheidswerkers is geen uitsondering nie. Die volgende voordele word aan werk toegeskryf: bron van inkomste, aktiwiteit, afwisseling, tydsindeling, sosiale omgang, status en posisie in die gemeenskap. Tot watter mate voldoen die werk van 'n tandarts in die staatsdiens aan die basiese vereistes van 'n bevredigende werk? As mens die getal bedankings van tandartse uit die staatsdiens oor die afgelope jare in ag neem, asook die welbekende en gereeld vermelde "brein trein" van professionele mense in Suid-Afrika, voel mens dis belangrik om vas te stel watter werksbevrediging heers onder gesondheidspersoneel, veral diegene in die staatsdiens. Tandartse in die staatsdiens is verantwoordelik vir gesondheidsdienslewering aan die arm massas, wat die oorgrote meerderheid uitmaak van die Suid-Afrikaanse bevolking. Hierdie studie was daarop gemik om die werksbevredigingsvlak van staatstandartse vas te stel, asook hoe hulle dit ervaar en demonstreer in hul werkverrigting. Die navorser het dit ten doel gehad om insig te bring in die werksbestaan van 'n baie belangrike komponent van gesondheidswerkers in diens van die Departement van Gesondheid in die Wes-Kaapse Provinsiale Regering. Die bevindinge van die studie kan dien as basis vir verdere navorsing op hierdie gebied. 'n Meningspeiling is onderneem onder staatstandartse in die Wes-Kaap, met tandartse verbonde aan die weermag en akademiese instellings uitgesluit. Die opname-instrument het bestaan uit 'n gestruktureerde kwantitatiewe vraelys saam met 'n afdeling vir kommentaar oor spesifieke knelpunte. Verder was daar 'n semi-gestruktureerde diepte-onderhoud gevoer met een tandarts om verslag te doen oor 'n gevallestudie rakende die werksondervinding van 'n staatstandarts. Die kembevindinge van die studie was: i) Die belangrikste determinante van werksbevrediging betrek die werksomstandighede. Terwyl tandartse ondersteuning geniet van hul mede-personeel, goed voeloor hul diens aan pasiente, en die standaard van hul werk, voel hulle ongelukkig oor inkomste, gebrek aan respek van pasiente, senior bestuur en kollegas in die privaat sektor. Beperkte behandelingskeuses, swak voorsieningsisteme en knaende gebrek aan toerusting affekteer hul werksbevrediging negatief. ii) Die mate van werksbevrediging is nie van so 'n aard dat dit hulle motiveer om die diens te verlaat nie, want die meeste tandartse wil hul poste behou. Die meeste tandartse voel egter dat daar nie enige aanmoediging bestaan vir verbeterde werkverrigting nie. iii) Tandartse reageer verskillend op hul menmg omtrent werksbevrediging. Terwyl sommige erken dat hul werkverrigting direk gekoppel is aan hoe goed dit by die werk gaan, het 'n groot persentasie van deelnemers aan die opname aangedui dat hulle nie toelaat dat hul werkverrigting deur hulonbevredigende werksomstandighede geaffekteer word nie iv) As ons die gevallestudie beskou, is dit duidelik dat of bevrediging ondervind word, al dan nie, van die individu afhang, en sy of haar lewensbeskouing. In hierdie spesifieke geval, was die tandarts baie realisties omtrent sy ambisie as persoon en as tandarts, en het sy doelwitte binne hierdie perke gestel. Die uitslag is dat hy gemotiveerd en bevredig bly.

Dissertation (PhD)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: The purpose of this investigation was to explore the multiple variables involved in TACT® image generation in an attempt to optimize this imaging modality for the diagnostic task of primary dental caries detection. The work is divided in seven phases in which the variables are evaluated individually. Teeth from the study samples were mounted in dental stone and imaged with a solid state digital radiography sensor. As a requisite of TACT® imaging, multiple images of the teeth were acquired from different projection angles. These resulting basis images were then used to generate TACT® slices. Variables tested in the investigation included the number of iterative restorations to which the slices were submitted, the number of basis images, the angle formed between the basis images, the two- and three-dimensional distribution of the basis projections in space, and the method through which the slices were reconstructed. For all phases, observers were asked to assess the presence or absence of primary caries in the teeth imaged using the TACT® slices treated with the different variables. Finally, to determine whether the best combination of variables produced a significant improvement in diagnostic performance, a comparison with conventional digital radiography images was carried out. No statistically significant differences were found in caries detection between TACT® slices submitted to different numbers of iterative restorations, reconstructed from basis images bearing different angular disparities, spatial distributions (in both two and three dimensions), or through different reconstruction methods. A statistically significant difference was detected between TACT® slices reconstructed from different numbers of basis projections. The final comparison showed that TACT® was not statistically superior to conventional digital radiography for the task of caries detection. The results of this investigation suggest that, although TACT® has been shown to be useful in many tasks performed in dentistry, its application in caries detection is not essential inasmuch as there are modalities that are simpler, more practical, less expensive, and that submit the patient to smaller radiation doses. Keywords: TACT, tomosynthesis, image reconstruction, digital radiography, caries detection, ROC analysis, analysis of variance / AFRIKAANSE OPSOMMING: Die doel van hierdie proefskrif was om die veelvuldige veranderlikes wat betrokke is by gewysigde spleet rekenaartomografie (Tuned Aperture Computed Tomography (TACT)) te ondersoek in 'n poging om die beeldingsmodaliteit te optimaliseer in die diagnostiese opsporing van primere karies. Die proefskrif bestaan uit 'n ekstensiewe literatuur oorsig en word in 7 fases aangebied waarin die veranderlikes individueel geevalueer word. Tande is in gips ingebed en radiografiese opnames is gemaak met behulp van 'n digitale radiografiese sensor. As 'n voorvereiste vir TACT beelding is veelvuldige beelde uit verskillende projeksiehoeke van die tande gemaak. Die resulterende basisbeelde is dan gebruik om TACT snitte te produseer. Veranderlikes wat in die proefskrif getoets is, sluit die volgende in: 'n aantal herhalende herstellings waaraan die snitte blootgestel is, die aantal basisbeelde, die hoek gevorm tussen die basisbeelde, die 2 en 3 dimensionele verspeiding van die basis projeksies in die ruimte en die metodes waardeur die snitte gerekonstrueer is. In aIle fases is waarnemers gevra om die teenwoordigheid of afwesigheid van primere karies te evalueer wat met TACT afgeneem is met in ag neming van die verskillende veranderlikes. Ten slotte, om te bepaal of die beste kombinasie van veranderlikes 'n aansienlike verbetering in diagnostiese prestasies sou meebring, is 'n vergelyking met konvensionele digitale radiografiese beelding uitgevoer. Geen statistiese beduidende verskille is waargeneem in die opsporing van karies tussen TACT snitte wat blootgestel is aan verskillende aantal herhalende herstellings, rekonstruksie van basis beelding met verskillende hoek veranderinge, ruimtelike verspreiding (beide 2 en 3 dimensioneel) of deur verskillende rekonstruksie metodes nie. 'n Statistiese beduidende verskil is waargeneem tussen TACT snitte wat van 'n verskeidenheid basis projeksies gerekonstrueer is. Die finale vergelyking het aangetoon dat TACT nie statisties beter is as konvensionele radiografie in die opsporing van karies nie. Die resultate van hierdie proefskrif het getoon dat alhoewel TACT bruikbaar is in vele prosedures wat in die tandheelkunde uitgevoer word, is die toepassing daarvan in die diagnose van karies nie noodsaaklik nie, omdat daar in die tandheelkunde modaliteite beskikbaar is, wat meer eenvoudig, meer prakties en goedkoper is, met 'n laer stralingsdosis vir die pasient.

Thesis (MSc)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: The aim of this study at the Brooklyn Chest Hospital (BCH) was to assess the change in the oral carriage of Candida species in twenty-nine patients co-infected with the Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), before and after anti-fungal treatment. Each patient accepted onto the study underwent a comprehensive oral and peri-oral examination where the presence, site and clinical features of all oral and peri-oral lesions were recorded. The purpose of the examination was to provide a clinical diagnosis of oral candidasis. Each patient was also asked to provide a sample of oral fluid for laboratory analysis. This was collected using an oral rinse. The results of a variety of laboratory investigations were used to identify the species of Candida obtained from the oral rinse. Both the oral and peri-oral examination and the oral rinse procedure were repeated after one month and at three months. A sample from each oral rinse was inoculated on CHROMagar Candida chromogenic medium (CHROMagar Candida, France, Paris). CHROMagar is used for the isolation and presumptive identification of Candida sp. from other yeasts on the basis of strongly contrasted colony colours, which are produced by the reactions of species-specific enzymes with a proprietary chromogenic substrate. After forty-eight hours the CHROMagar plate was examined for growth, when a record of colony morphology and colour was made. A single sample from each different colour-coded colony was taken and streaked onto a Sabouraud plate (Oxoid, Basingstake, England) and then incubated for forty eight hours at thirty-seven degrees centigrade. A variety of laboratory investigations were subsequently carried out on a single colony taken from the Sabouraud agar plate (Oxoid). The results of these tests were used to identify the individual species of Candida isolated from each oral rinse. Oral candidasis was the most prevalent oral lesion observed on admission and at three months. Six different species of Candida were identified during this study, namely Candida albicans, Candida dubliniensis, Candida krusei, Candida glabrata, Candida parapsilosis, and Candida tropicalis. C.albicans was the most commonly identified species in study population. Candida dubliniensis was isolated and identified for the first time in a South African HIV population. Each specimen of Candida sp. identified by laboratory analysis was tested for sensitivity to Nystatin, Amphotericin B and Fluconazole anti-fungal agents. An additional sensitivity test was performed using Ajoene and Allicin (extracts of garlic) to assess the comparative antifungal properties of these compounds. / AFRIKAANSE OPSOMMING: Die doelwit van hierdie studie by die Brooklyn Borshospitaal (BCH) was om die verandering in orale draerstatus van die Kandida spesies in nege-en-twintig HIVfTB koïnfekteerde pasiënte vas te stel, voor- en na antifungale behandeling. Elke pasiënt in die studie het 'n volledige intra- en ekstra-orale ondersoek ondergaan. Die teenwoordigheid, area en kliniese voorkoms van alle letsels is noteer. Die doel van die ondersoek was om 'n kliniese diagnose van orale kandidiase te verkry. 'n Monster orale vloeistof is geneem van elke pasiënt vir laboratorium analise. Die monster is in die vorm van 'n mondspoel geneem. Verskeie toetse is gedoen om die verskillende Kandida spesies in elke monster te identifiseer. Die orale- en ekstra-orale ondersoek sowel as die mondspoelmonster is na 1 en 3 maande herhaal. Elke mondspoelmonster is op CHROMagar Kandida chromogene medium (CHROMagar Candida, France) inokuleer. CHROMagar word gebruik vir die vermoedelike identifikasie en isolasie van Kandida spesies teenoor ander swamme. Dit word gedoen op die basis van kontrasterende koloniekleure, wat teweeggebring word deur spesie-spesifieke ensiemreaksies op 'n chromogene substraat. Die CHROMagar plate is na 48 uur ondersoek vir groei en die kolonie-morfologie en - kleur is noteer. 'n Enkel monster. is geneem van elke verskillende kolonie (geskei op kleur) en is uitgestreep op 'n Saboraud plaat (Oxoid, Basingstoke, England). Dit is dan vir 48 uur inkubeer teen 37°C. Verskeie laboratorium ondersoeke is daarna uitgevoer op 'n enkel kolonie geneem vanaf die Saboraud agar plaat (oxoid). Die resultate van die ondersoeke is gebruik om individuele spesies van Kandida te identifiseer. Orale Kandidiase was die mees algemene orale letsel geïdentifiseer by toelating en 3 maande ondersoeke. Ses verskillende spesies Kandida is identifiseer tydens die studie, naamlik: Kandida albicans, K.dubliniensis, K.Krusei, K.glabrata, K.parapsilosis en K.tropicalis. K.albicans was die mees algemeen identifiseerde spesie in die studiepopulasie. K.dubliniensis is vir die eerste keer in Suid-Afrika in 'n HIV<+lpopulasie isoleer en geïdentifiseer. Elke monster van identifiseerde Kandida spesies is getoets vir sensitiwiteit teenoor Nistatien, Amfotensien B en Flukonasool. Addisioneel is ook getoets vir sensitiwiteit teenoor Ajoene en Allicin (knoffelekstrakte).

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.