Objective: The purpose of this paper is to provide a theoretical rationale for the implementation of the Four Component Instructional Design Model for Complex Learning (4C/ID-model) at the University of Pretoria with the aim of systematically developing the clinical reasoning of undergraduate dental students in a classroom setting. Methods:Recent literature provides a rationale for the use of the 4C/ID-model to teach clinical reasoning in terms of four strategic teaching and learning needs: (i) the need for authenticity in the learning process; (ii) the need to manage cognitive load during the learning process; (iii) the need for repeated practise; as well as a need for (iv) valid assessment, feedback and reflection. 2Results and discussion: The literature review indicated that the 4C/ID-model makes provision for teaching and learning in an authentic context and proposes systematically structured methods that could be practically applied to manage cognitive load during repetitive exercises. The model also makes provision for cognitive feedback following assessment in order to eliminate misconceptions about content and to develop the cognitive strategies of the learner. Conclusion:On the basis of the literature review above it is recommended that the 4C/IDmodel be considered as a basis for classroom teaching and learning to develop competence in clinical reasoning in undergraduate dental students, even at pre-clinical level. The model may also have an application in medical education.

Introduction:Ludwig's angina (LA) still presents regularly at our tertiary academic hospital. Various etiologies and comorbid diseases are documented worldwide, but the South African population has not been studied.Aim:To establish whether LA cases presenting to the department are different from international reports regarding etiology and comorbidities.Settings and Design:Retrospective analysis of patients presenting with LA to a tertiary hospital.Materials and Methods:93 patients were included over a 5-year period. Archived files were analyzed for data including age, gender, comorbid diseases, etiology, airway management, and season on admission.Statistical Analysis:Descriptive statistics with the inclusion of frequency distributions.Results:93 patients were included; 65 (69.9%) male and 28 (30.1%) female; age - minimum 20 years, maximum 75 years, mean 40.366. Etiology: 68 (73.1%) odontogenic, 13 (14%) nonodontogenic, and 12 (12.9%) unknown cause. Comorbid diseases: 21 (22.6%) diabetes mellitus (DM), 19 (20.4%) hypertension, and 18 (19.4%) human immunodeficiency virus (HIV). Airway management: 61 (65.6%) tracheostomy and 32 (34.4%) nonsurgical. Complications: 11 (11.8%) deaths, 8 (8.60%) descending mediastinitis, and 7 (7.53%) necrotizing fasciitis. Seasonal occurrence: 30 (32.3%) spring, 24 (25.8%) winter, 22 (23.7%) summer, and 17 (18.3%) autumn.Conclusion:A 2.32:1 ratio male: female presentation mirrors previous statistics. DM patients had increased risks of complications, which resulted in multiple deaths. HIV patients showed increased risks for complications with more intense, longer hospital stays, but lower percentages of deaths compared to patients with DM and complications who died. There was no statistically significant finding regarding seasonal tendency.

The scaffolded case-based learning appears to contribute to accurate clinical decisions when compared to lecture-based teaching. It is suggested that the development of integrated reasoning competencies starts as early as possible in a dental curriculum, perhaps even in the preclinical year of study. Treatment-planning should receive particular attention.

The aim of this study was to determine the prevalence of MB2 canals in permanent maxillary molars utilising CBCT; in patients attending a university hospital. A total of 200 patient scans, (100 female and 100 male patients), were enrolled in the study. In total, 800 teeth were analysed, and teeth with additional canals in their MB roots (MB2) were identified. First maxillary molar teeth exhibited the highest prevalence of MB2 canals, 92% and 87%, for teeth 16 and 26, respectively. Second maxillary molar teeth showed a lower prevalence of MB2 canals, 69% and 65%, for the 17 and 27, respectively. There were no associations of significance between the prevalence of MB2 canals and patient age or gender. Root morphology and anatomy of permanent maxillary first and second molar teeth was found to be highly variable. The prevalence of additional canals in the MB roots is a frequent finding which has previously been underreported.

The study findings support the implementation of an integrated primary oral health care strategy in order to address the underlying socio-economic determinants of ECC in South Africa.