Publications by authors named "Shenuka Singh"

25 Publications

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Research-Related Stakeholders' Perspectives on Sociocultural Considerations in Biobanking Practice in South Africa.

Biopreserv Biobank 2022 Jun 27. Epub 2022 Jun 27.

Department of Medicine, Centre for Medical Ethics and Law, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa.

Biobanking practice continues to proliferate in South Africa, yet little is known about how stakeholders engage with social, cultural, and religious considerations in this area of research. This study was undertaken to establish the perspectives of South African stakeholders (researchers, biobankers, clinicians, and research committee members) on sociocultural considerations in biobanking research. This in-depth exploratory study used semistructured face-to-face or Skype interviews with 25 purposively selected stakeholders involved in the biobanking-related practice. The study sample comprised biobankers, clinicians, researchers, postgraduate students in biobanking research, and research ethics committee members in South Africa. The interview focused on social and cultural challenges facing the biobanking practice in the country. Further probes included stakeholder perspectives on ownership and custodianship of stored biosamples. Thematic analysis was used to analyze the collected data. Several themes arose from the data analysis. These included respondents' perceptions of poor understanding of biobanking among research participants and communities; inconsistency in defining ownership and custodianship of biosamples; variability in respondents' understanding of cultural, religious, and social implications of biobanking; the notion of distrust; and building trust in biobanking. There were also inconsistencies in respondents' recognition of social, cultural, and/or religious influences on participant decision-making in biobanking research. Respondents highlighted that a general climate of distrust existed in the biobanking practice in South Africa. There is a need for greater stakeholder awareness of sociocultural considerations in biobanking practice in South Africa. One possible way to achieve this could be through the availability of training programs aimed at improving stakeholder understanding of the sociocultural context for biobanking practice in addition to greater efforts at community engagement with respect to all biobanking activities and research.
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http://dx.doi.org/10.1089/bio.2021.0149DOI Listing
June 2022

Public healthcare practitioners' knowledge, attitudes and practices related to oral antibiotic prescriptions for dental use in Pietermaritzburg, KwaZulu-Natal.

Health SA 2022 29;27:1832. Epub 2022 Apr 29.

Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.

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 ( = 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 ( = 72, 81.8%) indicated awareness of an antibiotic stewardship programme in their respective institutions. However, a significant number ( = 42; 47.7%) of participants were unsure of whether this programme was active. Most participants ( = 80, 90.9%) indicated the need for improving oral antibiotic prescription for dental conditions. Participants indicated prescription of antibiotics for orofacial swellings ( = 52; 59.0%) and dental pain related to irreversible pulpitis ( = 29; 32.9%), reversible pulpitis ( = 33; 37.5%) and dental fillings ( = 15; 17.0%). Antibiotics were also prescribed for pericoronitis ( = 58; 65.9%), periodontitis ( = 57; 64.7%) and impacted teeth ( = 21; 23.8%). All dental practitioners ( = 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.
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http://dx.doi.org/10.4102/hsag.v27i0.1832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9082215PMC
April 2022

Self-Directed Learning During the COVID-19 Pandemic: Perspectives of South African Final-Year Health Professions Students.

Adv Med Educ Pract 2022 6;13:1-10. Epub 2022 Jan 6.

Discipline of Dentistry, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.

Purpose: Self-directed learning (SDL) has been advocated for effective training of final-year health professions students. COVID-19 challenges conventional teaching, learning, and assessment in the clinical environment. This study aimed to identify and explore enablers and barriers to SDL among final-year health professions students training during the COVID-19 pandemic.

Methods: Adopting the SWOT (strengths, weaknesses, opportunities and threats) framework, this study explored the clinical learning and training experiences of final-year health professions students during the pandemic. A survey was conducted via online platforms. Data from 155 respondents were thematically analyzed.

Results: Personal attributes such as reflection, self-determination, motivation, resilience, and positive learning behaviors and skills were identified as SDL enablers. Collaborative learning networks and online learning platforms facilitate learning needs and goals. Fear and anxiety, untrusted learning sites, uncertainty about graduation, financial issues and challenges in the learning environments were the major themes related to barriers to SDL.

Conclusion: The importance of SDL as a skill for uncertain times warrants further investigation in the training of future healthcare professionals. Inclusive planning and engagement with final-year health professions students to address identified stressors, as well as the creation of shared platforms where students are part of the decision-making processes for clinical learning and training are recommended. Responsive curricula that optimize unpredictable disruptions in clinical training are needed to equip students to diagnose their own learning needs and implement appropriate learning strategies.
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http://dx.doi.org/10.2147/AMEP.S339840DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8747628PMC
January 2022

Online Training as a Means to Improve the Understanding of Ethical, Legal, and Social Aspects of Biobanking Research: Stakeholder Perspectives from South Africa.

Biopreserv Biobank 2022 Jun 20;20(3):283-290. Epub 2021 Dec 20.

Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill. North Carolina, USA.

The proliferation of biobanking activities demand a review of current training opportunities for service providers and researchers, specifically related to the ethical, legal, and social issues (ELSI) of biobanking research. Such information could be useful for planning and developing an educational course. However, it is equally important to explore the platform for offering such a course. This study explored stakeholder perspectives on training needs in biobanking research and the use of an online training platform for such educational purposes. An exploratory study design using qualitative data was used. The study sample comprised selected stakeholders ( = 25) including biobankers, clinicians, researchers, postgraduate students, and research ethics committee members. Semi-structured in-person or Skype interviews were conducted and all ethical considerations were upheld. The interview focused on participants' perspectives on the accessibility and applicability of current available courses, and advantages and disadvantages of online biobanking courses. Data were analyzed using thematic analysis. The following themes arose from data analysis: inadequate availability of online courses, and advantages and disadvantages of online courses and opportunities for a successful training course. There was general consensus regarding the limited availability of context-specific training opportunities on the ELSI of biobanking. The majority of participants were previously self-taught and therefore relied on existing literature and collaborations with international biobanking groups for ongoing learning. Some respondents indicated that the costs of such available training courses were exorbitant. Some respondents also felt that available courses were not tailored to the specific needs of a diverse audience in biobanking. Apart from access, respondents reported possible challenges with internet connectivity and availability of data. Respondents expressed a need for affordable and focused online educational opportunities in biobanking, but highlighted that these courses need to be contextualized and integrated into other learning activities.
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http://dx.doi.org/10.1089/bio.2021.0088DOI Listing
June 2022

Stakeholder perspectives on the ethico-legal dimensions of biobanking in South Africa.

BMC Med Ethics 2021 07 1;22(1):84. Epub 2021 Jul 1.

Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.

Background: Biobanking provides exciting opportunities for research on stored biospecimens. However, these opportunities to advance medical science are fraught with challenges including ethical and legal dilemmas. This study was undertaken to establish perspectives of South African stakeholders on the ethico-legal dimensions of biobanking.

Methods: An in-depth exploratory study was conducted with 25 purposively selected biobankers, clinicians, researchers, postgraduate students in biobanking research, and research ethics committee (REC) members in South Africa. Potential study participants were recruited through known hubs for biobanking in the country, online searches and the snowball sampling technique. A semi-structured face-to-face or Skype interview was arranged. Data was analysed using thematic analysis.

Results: The emergent themes included: inconsistency in understanding consent models, disconnect between biobank researchers and biosample donors, inadequate processes to support re-consenting minors, inconsistent governance processes for biobanking research; challenges with sample and data sharing, and suboptimal strategies for benefit sharing and return of results. Biobanking practice in general appeared to be inconsistent and fragmented. While the need for consent in research is explicitly outlined in legislative documents, some respondents were unclear on the type of consent model to apply in biosample collection. They also reported inconsistencies in research participants' understanding of consent. Furthermore, these respondents' own understanding of consent and consent models were dependent on where they were positioned in biobanking practice (roles occupied). Respondents were unsure about the process to follow to re-consent child participants once the age of majority (≥ 18 years) was reached. It was not surprising that consent was identified as one of the major ethical challenges in biobanking practice. In certain settings, some respondents reported suboptimal governance processes for sample collection. Participants were generally unsure about how to operationalise benefit sharing and how to approach the idea of returning results to research participants and biobank donors.

Conclusion: The study findings indicated inconsistencies in stakeholder understanding of ethico-legal considerations related to biobanking in South Africa. A need for ongoing ethics capacity development among stakeholders was identified. Improving understanding of the ethics of biobanking could be facilitated by acknowledging the disconnect created by biosamples in the relationship between biobank researchers and donors.
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http://dx.doi.org/10.1186/s12910-021-00645-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8247071PMC
July 2021

Challenges to biobanking in LMICs during COVID-19: time to reconceptualise research ethics guidance for pandemics and public health emergencies?

J Med Ethics 2022 Jul 12;48(7):466-471. Epub 2021 May 12.

Faculty of Medicine and Health Sciences, Centre for Medical Ethics and Law, University of Stellenbosch, Stellenbosch, Western Cape, South Africa.

Biobanking can promote valuable health research that may lead to significant societal benefits. However, collecting, storing and sharing human samples and data for research purposes present numerous ethical challenges. These challenges are exacerbated when the biobanking efforts aim to facilitate research on public health emergencies and include the sharing of samples and data between low/middle-income countries (LMICs) and high-income countries (HICs). In this article, we explore ethical challenges for COVID-19 biobanking, offering examples from two past infectious disease outbreaks in LMICs where biobanking activities contributed to the perpetuation of global inequities. We focus on how the ethical imperative to promote the common good during public health emergencies can conflict with protecting the interests of biobank participants. We discuss how conducting biobank research under a waiver of informed consent during public health emergencies is ethically permissible, provided guidance is in place to prevent biopiracy and exploitation of vulnerable communities. We also highlight the need for biobank collaborations between LMICs and HICs to promote capacity building and benefit sharing. Finally, we offer guidance to promote the ethical oversight of biobanks and biobank research during the COVID-19 pandemic or other future public health emergencies.
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http://dx.doi.org/10.1136/medethics-2020-106858DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117471PMC
July 2022

Public Oral Health Care During COVID-19: Time for Reflection and Action.

Authors:
Shenuka Singh

Front Med (Lausanne) 2021 17;8:610450. Epub 2021 Mar 17.

Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal (UKZN), Durban, South Africa.

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http://dx.doi.org/10.3389/fmed.2021.610450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010001PMC
March 2021

Evaluating the Abrasivity of a Nanosized Eggshell-Titanium Dioxide on Tooth Enamel Using Atomic Force Microscopy.

Eur J Dent 2020 Oct 10;14(4):598-604. Epub 2020 Aug 10.

Public Management and Economics, Durban University of Technology (DUT), Durban, South Africa.

Objectives:  This study aimed to evaluate nanosized eggshell-titanium dioxide ([email protected]) abrasiveness in comparison with calcium carbonate and hydrated silica-containing toothpaste.

Material And Methods:  Thirty-five bovine tooth enamels were prepared, and specimens randomly assigned to a sample group of five ( = 7), namely, Colgate regular, Colgate pro-relief, Sensodyne rapid relief, Sensodyne repair, and [email protected] Half of the enamel surface was brushed with each respective sample group, while the other half was covered with a tap.

Statistical Analysis:  The mean roughness value (Ra) of the brushed and covered halves were measured using an atomic force microscope (AFM). To assess the surface morphology and changes, a scanning electron microscope (SEM) was performed. Using pair sample test and ANOVA, the Ra for the entire specimens were analyzed. A Bonferroni correction was used to identify the mean differences among the five groups (α=.05).

Results:  The findings from this analysis show that all the tested toothpaste abraded the enamel significantly ( < 0.05). The abrasive value contained in toothpaste comprising calcium carbonate was lower than the silica toothpaste hydrated.

Conclusion:  Overall, Colgate regular had the lowest toothpaste abrasivity, followed by [email protected], while Sensodyne rapid relief had the most enamel wear. The prominent feature of this study suggests that [email protected] is suitable for oral use, as its abrasivity is comparable with calcium carbonate-containing toothpaste.
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http://dx.doi.org/10.1055/s-0040-1714172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535973PMC
October 2020

A Dental Communication Board as an Oral Care Tool for Children with Autism Spectrum Disorder.

J Autism Dev Disord 2020 Nov;50(11):3831-3843

School of Health Sciences, Department of Dentistry, University of KwaZulu-Natal, Westville Campus, Durban, South Africa.

Children with autism spectrum disorder (ASD) sometimes display an inability for information sharing through functional verbal communication. This may interfere with professional oral care. These children tend to process visual information more efficiently than auditory information. Picture schedules can briefly suffice as visual cues serving a vital function in helping children with ASD to function in a particular setting such as an oral care environment. A visual communication implement such as a dental communication board was developed in this study to allow for a facilitated communication process between the patient with ASD and the oral care professional. This study entailed two main phases, namely the selection of symbols for the construction of a dental communication board and the small scale testing of the board in a clinical setting. This study incorporated a combination of a quantitative non-experimental descriptive survey combined with a concurrent mixed method survey design which retrieved data for both close-ended and open-ended questions from the same respondent. A quantitative survey questionnaire at a structured dental seminar presentation was employed for the first phase, and a combination of a quantitative and qualitative questionnaire was employed for the second phase of this study. Documented responses were collated and analyzed using frequency and thematic analysis. The most frequently selected symbols were retrieved after a frequency analysis and displayed on a color coded background to distinguish the various categories on the dental communication board. The thematic analysis resulted in the emergence of three main themes, namely the strengths of the board; weakness of the board and suggestions. This study anticipates the incorporation of a dental communication board as a visual mode using graphic symbols to augment expressive and receptive language in an oral care environment to facilitate professional oral care for children with ASD.
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http://dx.doi.org/10.1007/s10803-020-04436-0DOI Listing
November 2020

A conceptual framework to guide public oral health planning in Limpopo province.

Health SA 2019 23;24:1109. Epub 2019 Sep 23.

Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.

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.
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http://dx.doi.org/10.4102/hsag.v24i0.1109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917385PMC
September 2019

Evaluation of the Occluding Characteristics of Nanosized Eggshell/Titanium Dioxide with or without Saliva.

Eur J Dent 2019 Oct 31;13(4):547-555. Epub 2019 Dec 31.

Department of Chiropractic and Somatology, Durban University of Technology (DUT), Durban, South Africa.

Objectives:  The study reports on the effectiveness of a ball-milled nanosized titanium dioxide composite ([email protected]) for DH management in comparison with commercial desensitizing paste with and without saliva.

Materials And Methods:   Forty-nine dentine specimens were prepared from extracted bovine anterior teeth. Twenty-one of the specimens were brushed with three desensitizing toothpaste for 7 days, namely: Group 1; [email protected], Group 2; Colgate Pro-relief; and Group 3; Sensodyne repair ( = 7). Twenty-four specimens were brushed with the toothpaste for 7 days and stored in artificial saliva (control) after brushing. Each specimen was subsequently posttreated in citric acid solution to test its stability in acidic condition. Field scanning electron microscope was used to evaluate the effectiveness of the dentine tubules occlusion. The biocompatibility of the composite was tested using BHK21 cell line.

Statistical Analysis:  One-way analysis of variance was used to analyze the percentage occluded area ratio values for all specimens (α = 0.05). Independent -test was further used to evaluate the occlusion differences with saliva and without saliva.

Results And Conclusions:  The number of dentine tubules decreased significantly after 7 days of brushing. Overall, the occlusion observe for [email protected] were significantly better than for Colgate Pro-relief and Sensodyne repair ( < 0.05). BHK21 assay suggested that composite had no significant effect on the BHK21 cell line. This study demonstrated that the composite effectively occluded open dentine tubules within 7 days of brushing.
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http://dx.doi.org/10.1055/s-0039-1697726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938434PMC
October 2019

The Application of the Logistic Equation Model to Predict the Remineralization Characteristics of Desensitizing Paste.

Int J Dent 2019 3;2019:7528154. Epub 2019 Oct 3.

Institute of Systems Science, Durban University of Technology, Durban 4000, South Africa.

Objectives: A mathematical model making using of the Verhulst logistic equation was developed to predict the remineralization behaviors of desensitizing paste.

Methods: The input parameter used for the model was obtained experimentally by brushing twenty-one simulated dentin specimens for seven days with three sample groups, namely, [email protected], Colgate Pro-relief, and Sensodyne repair ( = 7). A field emission scanning electron microscope (FESEM) and ImageJ software were used to observe and measure the % occluded ratio of the dentin surface. The model fittings for the three sample groups were carried out using the built-in MATLAB least-squares fitting routine fmincon in the optimization toolbox.

Results: The results suggest that the experimental parameter were in agreement with the model. It was found that the logistic equation model can make a future prediction of the remineralization pattern for [email protected] and Colgate Pro-relief. It was, however, found that the trajectory for the Sensodyne repair was a bit complex, thus making the prediction difficult.

Conclusions: Overall, the salient feature of this study suggests that the logistic equation could be used to predict the remineralization behavior of desensitizing paste in the management of sensitive tooth.
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http://dx.doi.org/10.1155/2019/7528154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794972PMC
October 2019

Remineralization Potential of a Modified Eggshell-Titanium Composite-Scanning Electron Microscope Study.

Eur J Dent 2019 May 15;13(2):187-192. Epub 2019 Sep 15.

Microscopy and Discipline of Dentistry, University of KwaZulu-Natal. Westville. Durban. South Africa.

Objectives:  This article reports the remineralization potential of a modified eggshell-titanium dioxide (EB-TiO) composite in the management of DH.

Materials And Methods:  The prepared composite was further characterized using different techniques such as Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), transmission electron microscopy (TEM), and field scanning electron microscopy (FSEM) to establish the modification. Forty freshly extracted bovine anterior teeth were used to evaluate the dentin tubule remineralization potential of EB-TiO. Each tooth was sectioned mesiodistally to obtain dentin blocks. The dentin blocks were subsequently agitated in 4% wt. citric acid for 2 minutes to simulate sensitive tooth. Each dentin block was randomly assigned to five groups, namely Group 1: untreated, Group 2: EB alone, Group 3: EB-TiO treated, and Group 4: Colgate Sensitive, and Group 5: Sensodyne treated ( = 8) that were then subjected to remineralization protocol.

Results:  Both the XRD and FTIR images confirm the surface medication of EB-TiO. The TEM revealed a nonhomogeneous structure with an average particle size of 65 nm. FSEM further was used to observe the remineralization capabilities of the samples. The FSEM image of the dentin specimens treated with EB-TiO shows complete remineralization of the dentin tubules, which remain intact postacidic exposure.

Conclusions:  This study confirmed that EB-TiO composite effectively remineralizes dentin tubules. More so, the composite could be a cheaper and more efficient therapy material in the management of DH.
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http://dx.doi.org/10.1055/s-0039-1695662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777159PMC
May 2019

Corrigendum to "An In Situ Evaluation of the Protective Effect of Nano Eggshell/Titanium Dioxide against Erosive Acids".

Int J Dent 2019 10;2019:7209168. Epub 2019 Mar 10.

Public Management and Economics, Durban University of Technology (DUT), Durban, South Africa.

[This corrects the article DOI: 10.1155/2018/4216415.].
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http://dx.doi.org/10.1155/2019/7209168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431510PMC
March 2019

A novel application of nano eggshell/titanium dioxide composite on occluding dentine tubules: an in vitro study.

Braz Oral Res 2019 Mar 18;33:e016. Epub 2019 Mar 18.

Durban University of Technology - DUT Marketing, Durban, South Africa.

To synthesize Nano eggshell-titanium-dioxide ([email protected]) biocomposite and to evaluate its effectiveness in occluding opened dentine tubules. [email protected] 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: [email protected]; 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 [email protected] 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 [email protected] was successfully modified through ball-milling. The TEM revealed the presence of both spherical and irregular particle shape powders. The SEM result showed that [email protected] could effectively occlude open dentine tubules. Equally, the result demonstrated that [email protected] exhibited the highest acid resistant stability post-treatment. NIH 3T3 assay identified that [email protected] had little effect on the NIH 3T3 cell line even at the highest concentration of 100µg/ml. This study suggests that the application of [email protected] effectively occluded dentine tubules and the occlusion showed a high acid resistant stability.
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http://dx.doi.org/10.1590/1807-3107bor-2019.vol33.0016DOI Listing
March 2019

Evaluating the buffering and acid-resistant properties of eggshell-titanium dioxide composite against erosive acids.

J Appl Biomater Funct Mater 2019 Jan-Mar;17(1):2280800018809914

3 Discipline of Dentistry, University of KwaZulu-Natal (UKZN), Durban, South Africa.

Objective:: This paper reports on the buffering and acid-resistant properties of a modified eggshell-titanium composite against citric acid attack.

Materials And Methods:: Eggshell-titanium EB-TiO was prepared by ball-milling eggshell powder and titanium dioxide. Fourier Transform Infrared Spectroscopy (FTIR), X-ray Diffraction (XRD), and Transmission Electron Microscopy (TEM) were used to characterize EB-TiO. The buffering property against citric acid at pH values of 2, 4, and 5 was measured using a pH meter. Five brands of toothpaste (Colgate, Colgate Sensitive, Aquafresh, Oralwise, and Sensodyne) were used to assess the acid-resistant properties of EB-TiO. Enamel models were simulated by dissolving each brand of toothpaste with eggshell (control) and EB-TiO. The samples were exposed to citric acid of pH 2. The average slope (kPa/s) was measured using a pressure sensor. An analysis of variance was used to analyze the kPa/s values (α =.05).

Results:: The FTIR and XRD analyses suggest the surface modification of EB-TiO. The TEM image revealed spherical-shaped particles in EB-TiO. The pH test results showed that the buffering properties of eggshell and EB-TiO were comparable. Significant differences were observed in the acid resistance properties of the samples exposed to citric acids ( P < .05). The Colgate toothpaste infused with eggshell powder had the highest mean kPa/s values, whereas Sensodyne infused with EB-TiO had the lowest kPa/s values.

Conclusion:: The salient features of this study indicate that modification of eggshell with titanium dioxide does not affect its carbonate buffering properties. Connecting the kPa/s values to acid-resistant properties, EB-TiO effectively reduces erosive attacks when added to toothpaste.
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http://dx.doi.org/10.1177/2280800018809914DOI Listing
June 2019

An In Situ Evaluation of the Protective Effect of Nano Eggshell/Titanium Dioxide against Erosive Acids.

Int J Dent 2018 2;2018:4216415. Epub 2018 Dec 2.

Dental Sciences, Durban University of Technology (DUT), Durban, South Africa.

Objectives: Enamel erosion caused by high consumption of acidic drinks poses a significant public health concern. This study was aimed to determine the protective effect of eggshell-titanium dioxide composite ([email protected]) against erosive acids on tooth enamel.

Methods: Twenty prepared bovine tooth enamel specimens were randomly assigned to 5 sample groups (=4): (1) unexposed tooth enamel; (2) exposed tooth enamel + HCI; (3) exposed tooth enamel + HCI + Colgate toothpaste; (4) exposed tooth enamel + HCI + Sensodyne toothpaste; and (5) exposed tooth enamel + HCI + [email protected] The mean roughness value ( ) of the exposed and unexposed tooth was measured with atomic force microscope (AFM). Scanning electron microscope (SEM) and Raman spectroscopy techniques were used to evaluate the surface morphology and changes. ANOVA was used to analyze the mean square roughness ( ) values for all specimens. Bonferonni correction was used to identify the mean differences among the 5 groups (=0.05). The values measured for the unexposed and exposed specimens in HCI alone were statistically significant ( < 0.05).

Results: No significant differences were found for the unexposed and exposed specimens in HCI + toothpaste and [email protected] The tooth enamel specimens exposed to HCI + Sensodyne had the highest values, while specimens exposed to HCI + [email protected] had the lowest values.

Conclusions: This study confirms that the investigated toothpaste provides protection against acidic substances. The study results further suggests that [email protected] could be used to provide enhanced protection for tooth enamel.
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http://dx.doi.org/10.1155/2018/4216415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304922PMC
December 2018

The Oral health status of children with autism Spectrum disorder in KwaZulu-Nata, South Africa.

BMC Oral Health 2018 10 12;18(1):165. Epub 2018 Oct 12.

School of Health Sciences, Discipline of Dentistry, University of KwaZulu-Natal, Westville Campus, South Africa.

Background: Echoing the sentiments of the Sixty-seventh World Health Assembly of May 2014, mandating the all-inclusive and synchronized efforts for the management of autism spectrum disorder (ASD), the aim of this current study was to investigate the oral health status of children with ASD aged between 7 to 14 years in KwaZulu-Natal, South Africa.

Methods: An investigative cross-sectional quantitative design employing non-probability purposeful sampling was conducted on 149 children with ASD attending special needs schools in KwaZulu-Natal. An intra-oral examination to investigate decayed, missing and filled teeth (DMFT/dmft), gingival index (GI), and plaque index (PI), attrition and soft tissue trauma using the World Oral Health Survey Form for Children, (2013) was implemented during data collection.

Results: Average DMFT/dmft scores of 3, 42 and 0, 97 were recorded respectively. Molars dominated the decayed component of the DMFT/dmft with an average caries prevalence of (51, 7% and 40, 8%) respectively. These results displayed zero fillings indicative of unmet treatment needs. The gingival index revealed mild gingival inflammation, (46, 3%) and the plaque index demonstrated visible plaque at (43, 6%).Attrition scores revealed mild loss of dental enamel (47%). The most prevalent soft tissue trauma recorded was lip biting (37, 25%).

Conclusion: Restorative or preventative treatment measures were not evident in this study. Unmet dental needs are therefore an important concern in this population. Health care planners should develop preventive programs targeted at high risk groups such as this study population.
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http://dx.doi.org/10.1186/s12903-018-0632-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186069PMC
October 2018

The effect of colloidal silica and diamond suspensions on the surface roughness of automatically finished heat-polymerized acrylic resin.

J Prosthet Dent 2018 Sep;120(3):485.e1-485.e5

Senior Lecturer, Dentistry, University of KwaZulu-Natal (UKZN), Durban, South Africa.

Statement Of Problem: On an acrylic resin denture base, a smooth and highly polished surface is important to maintain oral health and prevent bacterial colonization. It is unclear how best to obtain such a surface.

Purpose: The purpose of this in vitro study was to examine the effect of both colloidal silica and diamond suspension abrasives on the roughness values of polymethyl methacrylate (PMMA) denture base material.

Material And Methods: Thirty PMMA specimens were fabricated and divided into 3 groups (n=10). Each was automatically polished using a diamond suspension, a colloidal silica suspension, and pumice. The mean roughness value (R) after polishing was recorded using a profilometer. An optical electron microscope was further used to evaluate the smoothness of the polished surface. ANOVA was used to analyze the roughness average (R) values for all polished specimens. A multicomparison test with Bonferroni correction was used to identify the mean differences among the 3 abrasive materials (α=.05).

Results: The R values measured for the colloidal silica suspension and pumice were statistically different (P<.001). Equally, statistical differences were observed between the diamond suspension and pumice abrasives (P<.05). No significant differences were found between the diamond and colloidal silica suspensions (P>.05). The PMMA specimens polished using pumice had the highest R values, whereas specimens polished using the colloidal silica suspension had the lowest R values.

Conclusions: The colloidal silica produced the lowest R values and was the most effective polishing material for denture base resins.
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http://dx.doi.org/10.1016/j.prosdent.2018.05.015DOI Listing
September 2018

Epidemiological profile of patients utilising public oral health services in Limpopo province, South Africa.

Afr J Prim Health Care Fam Med 2017 Jul 12;9(1):e1-e5. Epub 2017 Jul 12.

Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal, South Africa; Teaching and Learning, College of Health Sciences, University of KwaZulu-Natal.

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.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566226PMC
http://dx.doi.org/10.4102/phcfm.v9i1.1206DOI Listing
July 2017

"It's all about trust": reflections of researchers on the complexity and controversy surrounding biobanking in South Africa.

BMC Med Ethics 2016 10 10;17(1):57. Epub 2016 Oct 10.

Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.

Background: Biobanks are precariously situated at the intersection of science, genetics, genomics, society, ethics, the law and politics. This multi-disciplinarity has given rise to a new discourse in health research involving diverse stakeholders. Each stakeholder is embedded in a unique context and articulates his/her biobanking activities differently. To researchers, biobanks carry enormous transformative potential in terms of advancing scientific discovery and knowledge. However, in the context of power asymmetries in Africa and a distrust in science born out of historical exploitation, researchers must balance the scientific imperative of collecting, storing and sharing high quality biological samples with obligations to donors/participants, communities, international collaborators, regulatory and ethics authorities. To date, researcher perspectives on biobanking in South Africa have not been explored and documented.

Methods: In-depth qualitative interviews were conducted with a purposive sample of 21 researchers - 8 in the Western Cape, 3 in Gauteng and 10 in Kwa-Zulu Natal. Interviews lasted approximately 40-60 min and were audiotaped with consent. Thematic analysis of the transcribed interviews was conducted by the co-authors.

Results: Researchers articulated serious concerns over standardised regulatory approaches that failed to consider the heterogeneity of biobanks. Given that biobanks differ considerably, guidelines and RECs need to stratify risk accordingly and governance processes and structures must be flexible. While RECs were regarded as an important component of the governance structure researchers expressed concern about their expertise in biobanking. Operational management of biobanks was regarded as an ethical imperative and a pre-requisite to building trust during consent processes. While broad general consent was preferred, tiered consent was thought to be more consistent with respect for autonomy and building trust. Material Transfer Agreements (MTAs) were often lacking when biosamples were exported and this was perceived to impact negatively on trust. On the other hand, researchers believed that authentic community engagement would help to build trust.

Conclusion: Building trust will best be achieved via a system of governance structures and processes that precede the establishment of a biobank and monitor progress from the point of sample collection through to future use, including export. Such governance structures must be robust and must include comprehensive national legislation, policy and contextualised guidelines. Currently such governance infrastructure appears to be lacking in many African countries including South Africa. Capacity development of all stakeholders including REC members will enhance expeditious and efficient review of biobanking protocols which in turn will reinforce trust in the researcher-donor relationship. Science translation and community engagement in biobanking is integral to the success of biobanking in South Africa.
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http://dx.doi.org/10.1186/s12910-016-0140-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5057490PMC
October 2016

Informed consent in community-based oral health research.

Authors:
Shenuka Singh

J Forensic Odontostomatol 2014 Nov 30;32 Suppl 1:15-21. Epub 2014 Nov 30.

Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal, South Africa.

The ethical principle of respect for persons presents multiple dimensions to stimulate debate around issues related to informed consent for participation, data management, confidentiality and privacy. The informed consent process is built on a continuum involving a comprehensive explanation of the proposed study; and the declaration of consent (the right to withdraw from at anytime from the study without any negative consequences). All research involving human participants carry a certain level of risk (physical or informational) and it is not possible for the researcher to know all the consequences of participation before a study commences. This presentation will focus around the key issues of information, consent' and competence in relation to community-based oral health research and outlines some of debates in the informed consent process.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734818PMC
November 2014

Evidence in oral health promotion-implications for oral health planning.

Authors:
Shenuka Singh

Am J Public Health 2012 Sep 19;102(9):e15-8. Epub 2012 Jul 19.

School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.

I have explored the debates on evidence-based oral health promotion and examined the practicality of promoting oral health care within a whole system (social, cultural, and environmental) approach. The use of evidence-based decision-making in health services and planning is a viable mechanism to identify optimal health benefits; however, barriers to the effective adoption of evidence-based health practice, including barriers that apply to oral health promotion, have been identified. Evidence-based oral health promotion highlights the importance of examining health promotion activities within a defined social context-a departure from the focus on improving study designs and research methods. Thus, the basis for evidence in health activities is grounded in social and organizational systems. This could contribute to sustainable health efforts.
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http://dx.doi.org/10.2105/AJPH.2012.300893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482055PMC
September 2012

Primary health services at district level in South Africa: a critique of the primary health care approach.

BMC Fam Pract 2012 Jul 2;13:67. Epub 2012 Jul 2.

School of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000, South Africa.

Background: The rhetoric of primary health care philosophy in the district health system is widely cited as a fundamental component of the health transformation process in post-apartheid South Africa. Despite South Africa's progress and attempts at implementing primary health care, various factors still limit its success.

Discussion: Inconsistencies and poor understanding of primary care and primary health care raises unrealistic expectations in service delivery and health outcomes, and blame is apportioned when expectations are not met. It is important for all health practitioners to consider the contextual influences on health and ill-health and to recognise the role of the underlying determinants of ill-health, namely, social, economic and environmental influences. The primary health care approach provides a strong framework for this delivery but it is not widely applied.There is a need for renewed political and policy commitments toward quality primary health care delivery, re-orientation of health care workers, integration of primary health care activities into other community-based development, improved management skills and effective coordination at all levels of the health system. There should also be optimal capacity building, and skills development in problem-solving, communication, networking and community participation.

Summary: A well-functioning district health system is required for the re-engineering of primary health care. This strategy requires a strong leadership, a strengthening of the current district heath system and a greater emphasis on health promotion, prevention, and community participation and empowerment.
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http://dx.doi.org/10.1186/1471-2296-13-67DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3403923PMC
July 2012

Policy analysis of oral health promotion in South Africa.

Glob Health Promot 2010 Mar;17(1):16-24

School of Dentistry, University of Kwazulu-Natal, South Africa.

This article reports an analysis of oral health promotion in South African health policy. The central aim of this research was to determine the form and coherence of oral health promotion elements within health policies of post-apartheid South Africa. The study set out to test the hypothesis that oral health promotion elements are fully integrated into health policy and programmatic efforts. A conceptual framework was developed to systematically analyse oral health promotion policy and subsequent decision-making across the country at national and provincial levels. The information was drawn from policy documents, protocols and programme plans, complemented by interviews. The results indicate distinct contradictions between the policy formulation process and its impact on health system decision-making. South African health policy was found to be strong on the rhetoric of equity, health promotion, integration and several other features of the Primary Health Care Approach, but showed little evidence of translating this into action. The development and implementation of oral health promotion appears to be dominated by the influence of dental professionals that perpetuate a curative focus on service delivery. There is an urgent need to re-examine the process and content of oral health policy-making in South Africa. The conceptual framework developed for this study could facilitate further research in this area.
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http://dx.doi.org/10.1177/1757975909356631DOI Listing
March 2010
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