INTRODUCTION: Caries and gingival disease are prevalent oral health issues affecting more than 80% of school-going children including those with special needs attending special schools. Schools play a crucial role in promoting oral health, providing education and identifying issues early. These school-based health programmes are essential for addressing these issues and can reach more than 1 billion children worldwide, as well as school staff, families and the community. AIMS AND OBJECTIVES: To determine the current delivery of oral health care programmes in the identified special schools by means of a semi-structured interview with school managers. DESIGN: A descriptive qualitative study design. METHODS: All school managers (principals) who were responsible for the facilitation of the implementation and delivery of oral health services in each of the 22 special schools were invited to participation in the study. Purposive sampling was used to select the managers at the various special schools. Data collection comprised face-to-face, semi-structured interviews to explore the specific provision of oral health-related interventions and programmes (1 interview was conducted per school, n=22). RESULTS: Six emergent themes were present in the study: oral health activities, implementation and evaluation process, implementation challenges, policy content perceptions, dental examinations and oral health prevalence in special schools. Oral hygiene was identified as a priority, with educators and school nurses responsible for school oral health education, supervised teeth brushing programme, pain management, oral examinations in some cases and referral for dental treatments through engaging parents, learners and health workers in oral health promotion, which was supported by the school's health policy with the departmental heads responsible for programme evaluation. However, the implementation of the programmes was impacted by five factors: lack of parental support, lack of professional guidance, lack of resources, lack of support from the oral health department and the Covid-19 pandemic further exacerbated these challenges. CONCLUSION: The study reveals that special schools have preventative and promotive oral health programmes, but they need therapeutic or curative services to address unmet treatment needs. Factors affecting these programmes have led to gaps in implementation processes. Together, these findings point to an urgent need for a review of oral health care programmes in KwaZulu-Natal special schools to ensure proper support and collaboration between key stakeholders to reduce negative effects and improve overall oral health programmes.

SIGNIFICANCE: Effective community engagement for the use of large data sets in health research is faced with challenges similar to those in investigator-driven research. The scope of community engagement has evolved in high-income countries to embrace citizen science by communities and regulators to build trust in data science research. In South Africa and other low- and middle-income countries, with varying levels of literacy and the influence of pre-existing beliefs and past negative experiences with research, advisory committees of diverse stakeholder composition still have a role to play in protecting the rights of researched communities.

SIGNIFICANCE: Data science research involves large volumes of data, often derived from unconventional sources. Given the complex nature of big data research, there is a strong need for the development of ethically appropriate protocols that are sensitive to the complexities of data science and data sources. While reviews of health research by research ethics committees are necessary from an ethical and legal perspective, complementary advisory committees such as ethics advisory committees could be established to advise on ethics challenges more broadly. In this Perspective, we describe a multidisciplinary ethics advisory committee linked to a data science research hub in sub-Saharan Africa.

BACKGROUND: Vulnerable individuals residing at long-term care facilities require special oral health consideration. Examining concepts of oral health and hygiene practices of caregivers becomes essential for understanding the quality of oral health services provided to residents AIM: This study explored the oral health-related knowledge, attitudes and practices (KAP) of caregivers. SETTING: Long-term care facilities in the eThekwini District, KwaZulu-Natal. METHODS: A cross-sectional study was conducted at seven long-term care facilities among 188 caregivers who completed a self-administered questionnaire. Data were collated and analysed using the Statistical Package for the Social Sciences (SPSS) version 24. Inferential techniques included an analysis of variance (ANOVA) test. A p-value ≤ 0.05 was considered to be statistically significant. RESULTS: Participants reported that dentures do not to be cleaned (n = 139; 73.9%). Participants (n = 70; 37.2%) reported that some medications have oral side effects. Most participants (n = 173; 92%) were optimistic about improving their oral health knowledge and skills. Participants (n = 108; 57.4%) only reported flossing when they had food trapped between their teeth. Few participants (n = 30; 16%) reported visiting the dentist every 6 months. CONCLUSION: Participants had a positive attitude to improve their oral health-related knowledge and practices. However, the study showed that there is a need to scale-up oral health education and training activities for caregivers. CONTRIBUTION: It is envisaged that findings of this study will demonstrate the importance of oral health-related knowledge among caregivers in providing better oral health care through improved attitudes and practices.

BACKGROUND: The prevalence and impact of oral disease among long-term institutionalised residents highlight the need for a scale-up of preventive and promotional oral health services that include oral health education and training for caregiving staff. However, opportunities to improve oral healthcare services are met with challenges AIM: This study was undertaken to establish coordinator perspectives on oral health provision SETTING: Seven long-term care facilities in the eThekwini district, South Africa METHODS: An in-depth exploratory study was conducted with 14 purposively selected coordinators (managers and nurses). Semi-structured interviews were conducted and focused on coordinators' experience and perspectives on oral healthcare. Data were analysed using thematic analysis RESULTS: The following themes emerged from the study: A lack of comprehensive oral health care practices, inadequate support from the dental sector, insufficient oral health prioritisation, limited funding for oral health, and challenges associated with coronavirus disease (COVID-19). All respondents reported that no oral health initiatives existed. Plans for oral health training workshops presented with coordination and funding challenges. Oral health screening initiatives have ceased since COVID-19 CONCLUSION: The study findings indicated that prioritisation of oral health services was inadequate. There is a need for continual oral health in-service training for caregivers and support from coordinators in guiding the implementation of oral health training programmes CONTRIBUTION: It is envisaged that the findings of this study will bring about greater coordinator involvement and collaboration with the public and private dental sectors to improve oral healthcare at long-term care facilities

BACKGROUND: There is limited published evidence on health workers' perspectives on trends in oral antibiotic prescription for dental conditions in the public health sector. AIM: This study set to determine healthcare practitioners' knowledge, attitudes and practices related to oral antibiotic prescriptions for dental use. SETTING: This included two public hospitals in Pietermaritzburg. METHODS: This was a cross-sectional study using quantitative data. Purposive sampling was used to select medical and dental practitioners from Institution A and B (n = 122). A self-administered questionnaire was developed using open and close-ended questions. Data were collected and analysed using the Statistical Package for Social Sciences (IBM SPSS version 25R). RESULTS: The response rate for the study was 72.1%. The majority of study participants (n = 72, 81.8%) indicated awareness of an antibiotic stewardship programme in their respective institutions. However, a significant number (n = 42; 47.7%) of participants were unsure of whether this programme was active. Most participants (n = 80, 90.9%) indicated the need for improving oral antibiotic prescription for dental conditions. Participants indicated prescription of antibiotics for orofacial swellings (n = 52; 59.0%) and dental pain related to irreversible pulpitis (n = 29; 32.9%), reversible pulpitis (n = 33; 37.5%) and dental fillings (n = 15; 17.0%). Antibiotics were also prescribed for pericoronitis (n = 58; 65.9%), periodontitis (n = 57; 64.7%) and impacted teeth (n = 21; 23.8%). All dental practitioners (n = 14) supported the need for antibiotic cover for pericoronitis and periodontitis. CONCLUSION: The results indicated inconsistencies in healthcare practitioners' reported knowledge, attitudes and practices related to antibiotic prescription patterns. CONTRIBUTION: This study highlights the need for clear evidence-based guidelines for antibiotic prescription for dental conditions.

BACKGROUND: There is limited understanding of the complexities surrounding public oral health service delivery in South Africa and the resulting impact on oral health outcomes. AIM: This study aimed to identify the strengths and challenges in oral health decision-making within the public health sector and to propose a conceptual framework to guide oral health service delivery in the province. SETTING: This study was performed in the Limpopo province. METHODS: National and provincial health policy documents were reviewed to identify statements on oral health service delivery. A face-to-face, semi-structured interview was conducted with the Limpopo Provincial Manager of Department of Health, Oral Health Services. Data were collected on oral health policies and the organisational structure of public oral health services. A self-administered questionnaire was completed by five district managers of public oral health services to obtain data on the delivery of public oral health services in Limpopo province. RESULTS: The results indicated that oral healthcare was not explicitly mentioned, included or referred to in the examined health policy documents. The interviews indicated that public oral health services do not have a dedicated budget and were not considered a priority. The questionnaire results revealed challenges in infrastructure, human resources and perceived marginalisation from the healthcare services. Participants agreed that there was a need for oral health to be clearly expressed and prioritised in health policy statements. CONCLUSION: This study proposed a framework that incorporated the identified core components that influenced oral health services provision in Limpopo province.

Abstract To synthesize Nano eggshell-titanium-dioxide (EB@TiO2) biocomposite and to evaluate its effectiveness in occluding opened dentine tubules. EB@TiO2 was synthesized and characterized using X-ray diffraction (XRD), and Transmission Electron Microscope (TEM). Sixteen simulated bovine dentine discs were prepared and randomly assigned into four groups according to the following treatment (n = 4): Group 1: No treatment; Group 2: eggshell powder; Group 3: EB@TiO2; Group 4: Sensodyne. These were then agitated in a solution of 1g powder and 40mL water for 3hours. Thereafter, each dentine discs from the respective groups were post-treated for 5 min with 2wt% citric acid to test their acid resistant characteristics. Scanning Electron Microscope (SEM) was used to observe the effectiveness of occluded dentine pre-and post-treatment. The cytotoxicity of the synthesized EB@TiO2 was tested using NIH 3T3 assay. ANOVA was used to evaluate the mean values of the occluded area ratio and the data of MTS assay. This was followed by a multi-comparison test with Bonferroni correction (α = .05). The XRD confirmed that EB@TiO2 was successfully modified through ball-milling. The TEM revealed the presence of both spherical and irregular particle shape powders. The SEM result showed that EB@TiO2 could effectively occlude open dentine tubules. Equally, the result demonstrated that EB@TiO2 exhibited the highest acid resistant stability post-treatment. NIH 3T3 assay identified that EB@TiO2 had little effect on the NIH 3T3 cell line even at the highest concentration of 100µg/ml. This study suggests that the application of EB@TiO2 effectively occluded dentine tubules and the occlusion showed a high acid resistant stability.

BACKGROUND: Despite the impact of oral diseases on the quality of life, there is limited updated evidence on oral health status in Limpopo province. OBJECTIVES: To determine the epidemiological profile of patients utilising public oral health services in Limpopo province. METHOD: This was a descriptive retrospective clinical chart review conducted in five purposively selected district hospitals in Limpopo province. The collected data included the patient's sociodemographic information, reasons for dental consultation, information on the dental or oral diseases and the treatment received. Five hundred clinical files were systematically selected (100 from each district hospital) for the period 01 January 1995 to 31 December 2013. Data were collected using the World Health Organization's indicator age groups, namely 6-year-olds, 12-year-olds, 18-year-olds and 35-44-year-old groups. A data capturing sheet was used to record the collected information. Data were analysed using the statistical software package for social sciences SPSS version 23.0. RESULTS: The majority of patients were in the age group of 6 to 20 years (n = 375, 75%). The majority were male patients (n = 309; 62%). Dental caries was the most common complaint (n = 298, 60%). The second most common main complaint in this age group was retained primary or deciduous teeth (n = 60, 12%) affecting children mainly in the age group of 6 to 12 years. The most common clinical procedure across all five districts was dental extractions (n = 324, 64%). Other clinical interventions included scaling and polishing (n = 33, 12%) and dental restorative care (n = 20, 3%). CONCLUSION: There is an urgent need to reorient oral health service delivery in Limpopo province to focus more on preventive oral health programmes.

The oral health behaviour of children is increasingly seen to be driven and shaped by parental influences. AIM AND OBJECTIVES: The study set out to explore parental understanding of dental caries, self-care practices, and dental sealants as preventive strategies for dental caries. METHODS: This was an explorative and cross-sectional study. The participants were parents/care-givers (n=295) of grade one learners. Twelve schools were selected from the Chatsworth Circuit, KwaZulu-Natal, using a systematic sampling technique. Information was obtained through the use of a self-administered questionnaire and focus group discussions. RESULTS: Seventy-four percent of respondents reported that unhealthy deciduous teeth can lead to problems when permanent teeth develop (p<0.001). Although the majority of respondents understood the role of diet and self-care practices, almost 80% of these respondents did not floss and 70% did not use a mouth rinse. Sixty-five percent were aware of dental sealants and these parents were twice as likely to be willing to have sealant placements performed on their children than those parents who were unaware of the procedure (OR 2.32, p<0.001). CONCLUSION: Parental knowledge and awareness of oral health self-care practices does appear to translate into support for dental sealants as a preventive strategy for dental caries.