Situational Awareness in the Context of Clinical Practice.

In the context of clinical practice, situational awareness refers to conscious awareness (knowledge), which is a mental model of a given clinical situation in terms of its elements and the significance of their interrelation. Situational awareness (SA) facilitates clinical reasoning, diagnostic accuracy, and appropriate goal-directed performance, and it enables clinicians to immediately adapt treatment strategies in response to changes in clinical situational actualities and to modify the course of goal-directed activities accordingly. It also helps clinicians prepare future operational plans and procedures based on the projection of situational developments. SA, therefore, is an important prerequisite for safe clinical procedures. The purpose of this narrative review is to highlight certain cognitive and external (environmental) situational factors that influence the development of situational awareness. Understanding the dynamic, adaptive, and complex interactions between these factors may assist clinicians and managers of healthcare systems in developing methods aimed at facilitating the acquisition of accurate clinical situational awareness and, in turn, may bring about a reduction in the incidence of SA, diagnostic, and operational errors.

Oral Health Status of Illicit Drug Users in a Health District in South Africa.

OBJECTIVES: The prevalence of illicit drug use and its associated oral health complications have been increasing in South Africa (SA). There has been a paucity of studies to determine the oral health status among illicit drug users in SA. This study aimed to determine the oral health knowledge, practices, and status of illicit drug users at rehabilitation centers in a district in SA. MATERIALS AND METHODS: This was a cross-sectional study conducted at four rehabilitation centers in Pretoria, SA. Data were collected using a validated self-administered questionnaire and an oral examination. The questionnaire consisted of three parts: demographics, oral health knowledge, and oral health practices. The oral examination was conducted by a calibrated researcher and included caries, periodontal status, dental erosion, trauma, and soft tissue lesions. STATISTICAL ANALYSIS: The data were analyzed using the Statistical Package for Social Sciences (SPSS) software. RESULTS: The mean age was 25.5 (±7.49) years with 91% being male. The majority (84%) of patients were Black, and almost all (87%) had never received oral health education; 55% were not aware that illicit drugs could have an impact on the oral health status and 40% had never had a prior dental consultation. The caries prevalence was 68% with a mean decayed, missing and filled teeth (DMFT) score of 5.3 (±6.18). More than half (58%) required periodontal treatment and there were minimal soft and hard tissue lesions diagnosed. Those who perceived their teeth to be in a poor condition had a significantly higher Decayed, Missing and Filled Teeth (DMFT) score compared with those who perceived their oral health to be good. Just under half (41.9%) of the participants did not need any periodontal intervention, with the other half presenting with plaque retention or calculus and thus needed oral hygiene intervention inclusive of scaling and polishing. There was minimal evidence of pathological oral lesions with only 1.5% presenting with necrotizing periodontal disease (NPD). Overall, there was generalized poor oral hygiene CONCLUSION: Many of the participants had poor oral hygiene knowledge and practices and a relatively high prevalence of caries. It is imperative that oral health promotion and education is incorporated into the medical interventions provided at rehabilitation centers.

Oral Health Status and Practices, and Anthropometric Measurements of Preschool Children: Protocol for a Multi-African Country Survey.

BACKGROUND: Oral diseases are among the most prevalent conditions with significant impact on the growth and development of young children. Data are required to plan effectively for the management of early childhood caries (ECC) and other oral diseases in this age. There are currently very few African countries with updated and nationally representative data on ECC prevalence, and risk indicators and regional data on ECC and other oral diseases are scarce. OBJECTIVE: We aim to determine the oral health status and practices, dietary intake, and anthropometric measurements of preschool children in several African countries. METHODS: A cross-sectional study will be conducted in several African countries using a standardized questionnaire and clinical examination for data collection from healthy preschool children in kindergartens and primary health care facilities. The clinical examination will assess ECC using the decayed, missing due to caries, and filled teeth (dmft) index according to the World Health Organization (WHO) criteria, dental erosion (using the Basic Erosive Wear Examination Index), deciduous molar hypomineralization (using the European Association of Paediatric Dentistry criteria), dental fluorosis (using Dean's Index), oral hygiene status (using the Oral Hygiene Index Simplified), and oral mucosal lesions. Oral hygiene habits and dental visits will be assessed using the WHO child questionnaire, and dietary intake will be assessed using the Food and Agriculture Organization method. Anthropometric measurements will be obtained following the International Society for the Advancement of Kinanthropometry standard protocol, and the children's nutritional status will be assessed following the WHO child growth standards. To train and calibrate examiners, educational resources and electronic forms will be used to reach interexaminer and intraexaminer reliability with κ>0.6. Descriptive analysis will determine the prevalence of clinical conditions by age and sex. Bivariate analysis and multivariable regression will assess associations between the clinical conditions and sociodemographic factors, and oral health behaviors. RESULTS: Data collection will begin after approvals and ethical clearance are obtained. The first stage will include 3 countries, namely Egypt, Nigeria, and South Africa, and collaborators from other African countries will join afterward. CONCLUSIONS: This study will lay down the foundations for using validated tools to collect data on the oral health of young children in Africa, allowing researchers from different countries across Africa to collect standardized data on ECC and other oral conditions. This will facilitate comparisons and analysis of risk factors that might be unique to the African continent. The results will provide baseline data on the prevalence of oral diseases and enable planning to address the treatment needs of young African children and design programs to prevent oral diseases in the African continent. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/33552.

Forecasting for the need of dentists and specialists in South Africa until 2030.

To manage the increasing burden of dental diseases, a robust health system is essential. In order to ensure the oral health system operates at an optimal level going into the future, a forecast of the national shortfall of dentists and dental specialists in South Africa (SA) was undertaken. There is currently a shortage of dentists and specialists in SA and given the huge burden of dental diseases, there is a dire need to increase the number of these health care workers. The aim was to determine the projected shortfall of dentists and specialists in each of the nine provinces in SA. The projected shortfall was calculated based on the SA Disability-Adjusted Life Years (DALYs) for each province. The estimate for the evaluation of the Global Burden of Disease (GBD) for SA was obtained from the Institute of Health Metrics and Evaluation (IHME) Global Burden of Disease website. For each province, age standardized DALYs were calculated with mid-year population estimates obtained from Statistics SA 2018. In order to reduce the existing human resources for health (HRH) inequity among the provinces of SA, three scenarios were created focussing on attaining horizontal equity. The best-case scenario estimates a shortfall of 430, 1252 and 1885 dentists and specialists in 2018, 2024 and 2030 respectively. In an optimistic scenario, the national shortfall was calculated at 733, 1540 and 2158 dentists and specialists for the years 2018, 2024 and 2030 respectively. In an aspirational scenario, shortfalls of 853 (2018), 1655 (2024) and 2267 (2030) dentists and specialists were forecasted. Access to oral health services should be ensured through the optimum supply of trained dentists and specialists and the delivery of appropriate oral health services. Thus, the roadmap provided for upscaling the oral health services recognizes the influence of both demand and supply factors on the pursuit of equity.

Genetic Drivers of Head and Neck Squamous Cell Carcinoma: Aberrant Splicing Events, Mutational Burden, HPV Infection and Future Targets.

Head and neck cancers include cancers that originate from a variety of locations. These include the mouth, nasal cavity, throat, sinuses, and salivary glands. These cancers are the sixth most diagnosed cancers worldwide. Due to the tissues they arise from, they are collectively named head and neck squamous cell carcinomas (HNSCC). The most important risk factors for head and neck cancers are infection with human papillomavirus (HPV), tobacco use and alcohol consumption. The genetic basis behind the development and progression of HNSCC includes aberrant non-coding RNA levels. However, one of the most important differences between healthy tissue and HNSCC tissue is changes in the alternative splicing of genes that play a vital role in processes that can be described as the hallmarks of cancer. These changes in the expression profile of alternately spliced mRNA give rise to various protein isoforms. These protein isoforms, alternate methylation of proteins, and changes in the transcription of non-coding RNAs (ncRNA) can be used as diagnostic or prognostic markers and as targets for the development of new therapeutic agents. This review aims to describe changes in alternative splicing and ncRNA patterns that contribute to the development and progression of HNSCC. It will also review the use of the changes in gene expression as biomarkers or as the basis for the development of new therapies.

A Three-year Audit of Dental Services at Primary Health Care Facilities in Gauteng, South Africa: 2017 to 2019.

AIM: The aim of this study was to determine the types and trends of dental services offered over 3 months (April, May, and June) every year from 2017 till 2019 at all full-time primary oral health care facilities (POHCFs) in Gauteng Province, South Africa. MATERIALS AND METHODS: This was a record-based retrospective study. Data were collected from April, May, and June in 2017, 2018, and 2019, from all full-time POHCFs in Gauteng. The data were obtained from the attendance registers at each facility and included the number of patients and personnel and the type and number of procedures performed. RESULTS: A total of 90 POHCFs were included. The number of clinicians remained stable, whereas the mean number of patients per month increased from 587 (2017) to 654 (2019). This resulted in an increase in the mean monthly patient-to-clinician ratio from 376 (2017) to 428 (2019). On average, 459 extractions, 64 restorations, and 43 fissure sealants were performed monthly per district. Clinicians treated on average 19 patients per day and on average 15 extractions for every restoration. The mean operator-to-dental assistant ratio was 1.3:1. CONCLUSION: Although there were differences in the types of services rendered and the workloads of clinicians across the province, a significant increase was observed in the number of patients over the study period. The most common services rendered were extractions and the extraction-to-restoration ratio was fairly high. Managers need to carry out regular audits to ensure that the facilities are operating optimally.

Human Resources for Oral Health Care in South Africa: A 2018 Update.

To describe the current oral health care needs and the number and category of dental personnel required to provide necessary services in South Africa (SA). This is a review of the current disease burden based on local epidemiological studies and the number of oral health personnel registered with the Health Professions Council of South Africa (HPCSA). In SA, oral health services are rendered by oral hygienists, dental therapists, dentists, and dental specialists. Dental caries remains one of the most prevalent conditions, and much of them are untreated. The majority of oral care providers are employed in the private sector even though the majority of the population access the public sector which only offers a basic package of oral care. The high prevalence of caries could be prevented and treated by the public sector. The infrastructure at primary health care facilities needs to be improved so that dentists performing community service can be more effectively utilized. At present, SA requires more dental therapists and oral hygienists to be trained at the academic training institutions.

Dental Caries, Body Mass Index, and Diet among Learners at Selected Primary Schools in Pretoria, Gauteng Province, South Africa.

AIM: To assess whether the prevalence of dental caries (DC) was associated with the body mass index (BMI), socioeconomic status (SES), and diet of grade six learners in Pretoria, South Africa (SA). MATERIALS AND METHODS: A cross-sectional study was carried out. Learners underwent an oral and anthropometric examination, while the information on dietary intake and SES were collected using a standardized questionnaire. RESULTS: Of a possible 529 learners, 440 (83%) participated of whom 53% were boys. The mean age was 11.8 years, and 50% fell into the "medium" SES category. The prevalence of DC was 43%. The mean decayed, missing and filled teeth (DMFT) score was 1.19 (SD = ±1.79), of which the decayed (D) component was the largest 1.07 (SD = ±1.59). Two-thirds (62%) of learners had a normal BMI, and 26% were underweight. Less than half (47%) reported brushing their teeth twice a day; 71% claimed to drink up to one and a half glasses of sugar-sweetened beverages (SSBs), and 67% reported eating one to three sweets a day. The prevalence of DC was not significantly associated with BMI, diet, or SES, although having no caries was associated with eating less than three sweets a day. CONCLUSION: The mean DMFT score was relatively low with much of the decayed teeth being untreated. Most learners were classified having a normal BMI, despite having bad eating habits. Oral health in this group of learners may be more influenced by healthcare-seeking behavior and access to healthcare services than by diet alone. CLINICAL SIGNIFICANCE: The decayed component was fairly high, which means that there is a huge need for dental treatment, and although prevention and oral health promotion is important, learners with decayed teeth should have access to curative services. How to cite this article: Nkambule NR, Madiba TK, Bhayat A. Dental Caries, Body Mass Index, and Diet among Learners at Selected Primary Schools in Pretoria, Gauteng Province, South Africa. J Contemp Dent Pract 2019;20(11):1241-1248.

Knowledge and Practices Related to Hepatitis B Infection among Dental and Oral Hygiene Students at a University in Pretoria.

AIMS AND OBJECTIVES: The aim of the study was to determine the knowledge and practices of dental and oral hygiene (OH) students related to the transmission and prevention of the hepatitis B virus (HBV). METHODS: A cross-sectional analytical design was used and all dental and OH students registered at a university in Pretoria in 2017 were asked to participate. Students were classified as either clinical (senior students who were treating patients) or nonclinical (junior students who had not yet started treating patients) depending on their year of study. A pretested, self-administered questionnaire consisting of 16 closed-ended and 4 open-ended questions relating to the students' knowledge and practice concerning HBV infection was used. Data were analyzed using SPSS version 23. All data were confidential and anonymity was ensured. RESULTS: A total of 292 (78%) students agreed to participate, and of these, 70% were female. The average age was 21.78 years (±2.7) and almost two-thirds (61%) were classified as clinical students. A significant number of nonclinical students reported that the HBV could be transmitted through saliva (P < 0.01), through shaking hands (P < 0.01) and from sharing a toothbrush (P = 0.02) with an infected person. Clinical students correctly reported that HBV could be spread during the birth process from mother to child (P = 0.03). A significant number of nonclinical students stated that they would use antibiotics to prevent the spread of HBV infection (P < 0.01). The majority of respondents (94%) stated that vaccinations should be taken to prevent infection with HBV and >90% of students reported having completed the vaccination schedule. CONCLUSION: Although both the knowledge on the virus and the modes of transmission were very good, more than half did not know that HBV infection can be transmitted through piercing and more than half of the nonclinical students wrongly reported that antibiotics can be used to prevent infection after exposure. The vast majority were vaccinated against HBV.

The changing demographic profile of dentists and dental specialists in South Africa: 2002-2015.

INTRODUCTION: It is essential to have regular audits of the number of oral health personnel so that planning, delivery of services and training can be addressed. There has not been such an audit in South Africa (SA) for more than 10 years. AIM: To determine the demographic profile of dentists and dental specialists (DS) between 2002 and 2015. METHODS: A retrospective record-based study was used and all dentists and DS registered with the Health Professions Council of South Africa (HPCSA) from 2002 till 2015 were included. Demographic data, including gender, age, race, type of practice and geographical residence were recorded. RESULTS: There were 6,125 dentists and 481 DS registered with the HPCSA in 2015. The younger dentists tended to be Black and Asian women while older dentists were mostly White males. The majority of DS with maxillo-facial surgeons (30%), orthodontists (30%) and prosthodontists (17%). The number of dentists increased at around 2% per annum and the majority of the dentists and DS resided in the most metropolitan provinces of SA. Over the 13-year period, the number of female dentists almost doubled and the number of Coloured, Black and Asian/Indian dentists and DS increased sharply. CONCLUSION: The population to dentist ratio was fairly low, with the majority of dentists and DS residing in the three metropolitan provinces of SA. There has been a relatively sharp increase in the number of Coloured, Black and female dentists, which could be a result of increased admission of previously disadvantaged students to dental schools.

Self-reported Knowledge, Attitude and Consumption of Sugar-sweetened Beverages among Undergraduate Oral Health Students at a University in South Africa.

AIMS AND OBJECTIVES: This study assessed the knowledge, attitude and consumption of sugar-sweetened beverages (SSBs) and its association with body mass index (BMI) among undergraduate oral health students. MATERIALS AND METHODS: A cross-sectional design was used and the study was conducted at a South African dental university. Undergraduate dental and oral hygiene students (n = 344) registered in 2015 were invited to participate. A self-administered questionnaire was used to elicit the necessary information. Data analysis included frequencies and correlations using Chi-square tests. Statistical significance was set at P < 0.05. RESULTS: The response rate was 88% (301) and the mean age was 22.3 years (range: 17-42; standard deviation ±3.2). The majority were female (72%) and 70% of respondents had an acceptable level of knowledge on the types of SSBs and possible health conditions if consumed excessively. Almost half (46%) had a positive attitude toward the consumption of SSBs. Clinical students had a significantly higher level of knowledge compared to nonclinical students (P = 0.03). Participants consumed an average of six teaspoons (±9.5) of sugar from SSBs daily. Those with poor knowledge and attitude consumed significantly more SSBs (P < 0.01) than those with higher levels of knowledge and attitude. Males were significantly more obese and overweight than females (P < 0.01). There was no association between the amount of sugar consumed from SSBs and the BMI. CONCLUSIONS: The knowledge and attitude toward SSBs was acceptable. Although sugar consumption from SSBs was relatively high, there was no significant correlation between the consumption of SSBs and the BMI.

The Effects of the Refugee Crisis on Age Estimation Analysis over the Past 10 Years: A 16-Country Survey.

Dental age estimation (AE) tests are routinely done on living and deceased persons. There is anecdotal evidence suggesting an increase in age estimations due to the refugee crisis. Our aim is to determine the reasons and methods for performing dental AE tests in both living and deceased individuals. Global trends in AE over the past 10 years were also investigated. A database of all forensic laboratories was obtained and an electronic questionnaire was sent to all of them. The questionnaire was self-developed and included questions on the reasons for performing AE tests, the preferred methods used in living and deceased individuals, and the people/organizations who requested these AE tests. The number of tests performed annually varied between 0 and 500 and the majority were on asylum seekers, refugees, and for adoption cases. Most units used multiple techniques to determine the age among the living, but seldom used more than three techniques for the deceased. The majority of tests were requested by coroners and the legal fraternity. There has been an increase in the number of dental AEs carried out and this has been mostly due to asylum seekers and refugees. The most common techniques for the living were variations of Demirjian's technique while country specific techniques were used for the deceased.

The Impact of Hyposalivation on Quality of Life (QoL) and Oral Health in the Aging Population of Al Madinah Al Munawarrah.

Hyposalivation (HS) affects aging individuals by causing pain and discomfort in the oral cavity. The aim here was to determine the impact of hyposalivation and the saliva pH on the quality of life and caries status of geriatrics population. A total of 138 male outpatients attending the Taibah University College of Dentistry (TUCoD) dental clinic were included in the study. The saliva flow, pH, Quality of Life (QoL), and caries status were recorded. The QoL was measured using the Arabic version of the Oral Health Impact Profile-14 (OHIP-14), and the caries status was recorded using the Decayed, Missed, Filled Teeth (DMFT) index. The mean age was 67.5 years and 64% were classified as having hyposalivation. The older respondents tended to have a lower saliva flow and pH compared to their younger counterparts. There was a significant inverse association (p = 0.02) between the caries status and mean saliva flow rate. There was also a significant (p < 0.001) positive correlation between caries and the OHIP-14 scores (Spearman's ρ = 0.293). The prevalence of hyposalivation was relatively high and there was an inverse relationship between the age, the saliva flow, and pH. Those with more caries reported significantly poor QoL.

Erratum to: Duration of Hospital Stay Following Orthognathic Surgery at the Jordan University Hospital.

[This corrects the article DOI: 10.1007/s12663-011-0327-5.].

Comparing dental students' perceptions of their educational environment in Northwestern Saudi Arabia.

OBJECTIVES: To compare the perceptions of dental students over a 5-year period. METHODS: This cohort study was carried at Taibah University, College of Dentistry, Al-Madinah Al-Munawwarah, Saudi Arabia between 2009 and 2014. Data was obtained using the Dundee Ready Education Environment Measure (DREEM), which consists of 50 items, 4 of these were irrelevant to this cohort and were excluded. All students registered in 2009 were included and followed up in 2014. Their responses were compared using the paired student's t-test. RESULTS: Thirty-four students completed the questionnaire in 2009, and 30 of them participated in 2014 (12% drop out rate). The mean domain and total scores decreased over time. The mean scores for 6 items decreased significantly, while 4 of them had a significant increase. The lowest mean score in 2009 regarding support for stressed students increased (p=0.004) in 2014. However, the highest mean score in 2009 related to having a good social life, reduced (p=0.007) in 2014. This could be an indication of the high workload and its impact on their social lives. CONCLUSION: Student's perceptions were relatively low at the beginning, and remained low throughout the study. There were no significant changes in mean domain, and total scores and although scores of some items improved, most decreased over the study period.

Assessment of knowledge of dental staff at a saudi arabian university regarding the prophylaxis for infective endocarditis.

UNLABELLED: The use of prophylactic antibiotics for the prevention of infective endocarditis following dental procedures has long been debated and there is still confusion regarding its efficacy. As a result, the prophylactic treatment varies considerably amongst different countries across the world and amongst different dental practitioners. AIM: To evaluate the knowledge of dental staff regarding the guidelines for the prevention of infective endocarditis. METHODS: This was a cross sectional analytical study which included all staff members. A self administered questionnaire was used and responses were "graded" according to the American Heart Association (AHA) guidelines. RESULTS: The response rate was 87% (N=39) and 97% reported to use the AHA guidelines; 66% reported their knowledge was based on previous training and scientific journals. Of those cardiac conditions and dental procedures which required prophylaxis; 47% and 65% chose the correct option, respectively. Penicillin was prescribed as the drug of choice by the majority of respondents. CONCLUSIONS: Although almost all staff reported the use of the AHA guidelines, many were not following them. The study emphasizes the need for continuous education and evaluation of this critical aspect of dentistry.

Correlating dental caries with oral bacteria and the buffering capacity of saliva in children in Madinah, Saudi Arabia.

INTRODUCTION: Caries is associated with high counts of mutans streptococci (MS), lactobacillus (LB), and a low saliva buffering capacity (BC). No study using odds ratios (OR) has correlated caries and these factors and no similar study has been done in Saudi Arabia before. OBJECTIVES: To determine: The prevalence of caries, the number of colony forming units (CFUs) of MS and LB, the saliva buffering capacity (BC) and the relationship between these factors. MATERIALS AND METHODS: This was an analytical cross sectional study on children from Madinah. Caries was recorded using dmft/DMFT (decayed, missing, filled teeth). The scores for MS and LB and the BC of saliva was calculated using the Caries Risk Test (CRT)(®). RESULTS: A total of 316 students were examined; two-thirds (62%) were female and 25% were caries free. Saliva was collected from 235 participants and the majority had high MS and LB scores (66 and 71%, respectively) while 25% had a low saliva BC. The odds for those who had high LB and MS CFUs, were 9 and 4 times more at risk to developing dental caries and those with a low BC had significantly more caries (P = 0.03). The likelihood for those having severe caries and high counts of LB and MS was 25 (P < 0.01) and 6 (P = 0.042) times greater, respectively, compared to those with no or mild caries. Those with multiple risk factors were more likely to have caries compared to those with single or no risk factors present. CONCLUSIONS: The prevalence of caries was relatively high and many respondents had greater than 10(5) CFUs/ml of MS and LB. Almost all with a low BC had severe caries. There was a strong correlation between high MS, high LB, and low BC and the high prevalence of caries; hence the combination of these factors could be confidently used to predict caries in this population.

Duration of hospital stay following orthognathic surgery at the jordan university hospital.

BACKGROUND: Major oral and maxillofacial surgery procedures have been routinely performed on an inpatient basis in order to manage both, the recovery from anesthesia and any unpredictable morbidity that may be associated with the surgery. The use of inpatient beds is extremely expensive and if the surgical procedures could be done on an outpatient setting, it would reduce the costs and the need for inpatient care. The aim was to determine the length of hospital stay (LHS) and the factors which influence the LHS following orthognathic surgery at the Jordan University Hospital over 5 years (2005-2009). METHODS: This was a retrospective record review of patients who underwent orthognathic surgery at Jordan University Hospital between 2005 and 2009. The variables were recorded on a data capture form which was adapted and developed from previous studies. Descriptive and analytical statistical methods were used to correlate these variables to the LHS. RESULTS: Ninety two patients were included in the study and 74% of them were females. The mean age was 23.7 years and the mean LHS was 4 days. The complexity of the procedure, length of operation time, intensive care unit (ICU) stay and year of operation were significantly correlated with a positive LHS (P < 0.05). CONCLUSION: Patients' hospital stay was directly related to the complexity of the orthognathic procedure, the operation time, time spent in ICU and the year in which the operation was done. There was a significant reduction in the LHS over the progressing years and this could be due to an increase in experience and knowledge of the operators and an improvement in the hospital facilities.

A randomized controlled trail comparing the efficacy of 0.5% centbucridine to 2% lignocaine as local anesthetics in dental extractions.

The development of local anesthesia in dentistry has marked the beginning of a new era in terms of pain control. Lignocaine is the most commonly used local anesthetic (LA) agent even though it has a vasodilative effect and needs to be combined with adrenaline. Centbucridine is a non-ester, non amide group LA and has not been comprehensively studied in the dental setting and the objective was to compare it to Lignocaine. This was a randomized study comparing the onset time, duration, depth and cardiovascular parameters between Centbucridine (0.5%) and Lignocaine (2%). The study was conducted in the dental outpatient department at the Government Dental College in India on patients attending for the extraction of lower molars. A total of 198 patients were included and there were no significant differences between the LAs except those who received Centbucridine reported a significantly longer duration of anesthesia compared to those who received Lignocaine. None of the patients reported any side effects. Centbucridine was well tolerated and its substantial duration of anesthesia could be attributed to its chemical compound. Centbucridine can be used for dental procedures and can confidently be used in patients who cannot tolerate Lignocaine or where adrenaline is contraindicated.

The impact of service-learning on two groups of South African dental students.

Service-learning has become an important component in the education of medical and dental students around the world. Dental students at the University of Witwatersrand, South Africa, provide dental services to rural communities via the Phelophepa train or a Public Oral Health Facility (POHF). The Phelophepa train is a mobile primary health care facility offering dental, pharmacy, nursing, and medical services provided by health professions students. The objective of this study was to determine the impact this experience with service-learning has had on dental students. Final-year dental students in 2008 and 2009 participated in the study by completing a self-administered questionnaire. There was a 100 percent response rate (N=55) on the demographic questions and a 98 percent response rate (N=54) on the opinion questions. Students on the Phelophepa train performed more extractions and examinations than those at the POHFs. Most students (95 percent), both on the train and at the clinics, reported that their clinical skills and efficiency had improved, and 96 percent felt more aware of the communities' needs. Almost all the students (96 percent) reported that the experience had helped them define their personal strengths and weaknesses. Complaints they mentioned included large numbers of patients (87 percent), long working hours (60 percent), and equipment being inadequate (48 percent) or not working (40 percent). This program positively impacted these students and enhanced their personal growth and social responsibility by exposing them to the needs of rural and urban communities in South Africa.