Management of auto-immune blistering disease in an older patient with severe intellectual disability.

Management of chronic oral mucosal diseases might be challenging in older individuals with intellectual disability because of associated comorbidities, variable clinical presentations, and various barriers imposed by the intellectual disability. This report describes the presentation and management of pemphigus vulgaris in an older female with severe intellectual disability.

Validity and internal consistency of four scales in patients with TMD: PHQ8, GAD7, PHQ15 and JFLS20.

OBJECTIVES: The aim of this cross-sectional study was to explore the structural validity and internal consistency reliability of General Anxiety Disorder-7, Patient Health Questionnaire-8, 15 and Jaw Functional Limitation Scale-20 in patients with chronic pain of temporomandibular disorders. MATERIALS AND METHODS: Validity and reliability were assessed in 129 patients diagnosed according to the diagnostic criteria for temporomandibular disorders. Structural validity was explored using factor analysis, and internal consistency by calculating Cronbach α. RESULTS: Confirmatory factor analysis revealed a suitable 2-factor model for Patient Health Questionnaire-8, with Cronbach α of 0.89, and 0.86. One and 2-factor models were suitable for General Anxiety Disorder-7, with overall Cronbach α of 0.93 for the 1-factor model, and 0.91 and 0.84 for both factors in a 2-factor model. A 4-factor solution was appropriate for Patient Health Questionnaire-15, with Cronbach α of 0.72, 0.57, 0.71 and 0.73 for each factor separately. Exploratory factor analysis was conducted to explore the factor structure of Jaw Functional Limitation Scale 20, and a 3-factor solution was appropriate. CONCLUSIONS: This study provides positive evidence of structural validity and internal consistency of these questionnaires in patients with pain of temporomandibular disorders. However, additional testing is required to explore further psychometric properties.

The development and cognitive testing of a patient-reported experience measure for patients with chronic pain of temporomandibular disorders.

INTRODUCTION: The importance of the patients' clinical experience has been reinforced several times over the last decade by healthcare organisations and policy makers. Routine gathering of experience data can help in enhancing patient-centred care and provide guidance to quality improvement schemes. Patient-reported experience measures can help to that end. The aim of this study was to develop a patient-reported experience measure to evaluate the experience of patients with temporomandibular disorders while receiving healthcare. METHODS: Input from several sources was utilised to develop the tool; previous literature, patients with temporomandibular disorders, and experts in the field. A qualitative study was conducted following the COnsensus-based Standards for the selection of health Measurement Instruments guidance to generate the items of the questionnaire, which subsequently underwent cognitive testing. RESULTS: Seventeen patients took part in the qualitative study, in addition to six healthcare professionals. The preliminary questionnaire consisted of 28 questions with six response options. CONCLUSIONS: This patient-reported experience measure is a brief tool to evaluate the clinical experience of patients with temporomandibular disorders. Patients' involvement ensured face and content validity of the questionnaire, in addition to the relevance, comprehensibility and comprehensiveness of the items.

Patient-Reported Outcome Measures Used in Temporomandibular Disorders: A Review of the Literature.

AIMS: To identify the range of patient-reported outcome measures (PROMs) used in TMD studies, summarize the available evidence for their psychometric properties, and provide guidance for the selection of such measures. METHODS: A comprehensive search was conducted to retrieve articles published between 2009 and 2018 containing a patient-reported measure of the effects of TMDs. Three databases were searched: MEDLINE, Embase, and Web of Science. RESULTS: A total of 517 articles containing at least one PROM were included in the review, and 57 additional studies were also located describing the psychometric properties of some tools in a TMD population. A total of 106 PROMs were identified and fell into the following categories: PROMs describing the severity of symptoms; PROMs describing psychologic status; and PROMs describing quality of life and general health. The most commonly used PROM was the visual analog scale. However, a wide range of verbal descriptors was employed. The Oral Health Impact Profile-14 and Beck Depression Inventory were the most commonly used PROMs describing the effect of TMDs on quality of life and psychologic status, respectively. Additionally, the Oral Health Impact Profile (various versions) and the Research Diagnostic Criteria Axis ll questionnaires were the instruments most repeatedly tested in a TMD population, and these instruments have undergone cross-cultural validation in several languages. CONCLUSION: A wide range of PROMs have been used to describe the impact of TMDs on patients. Such variability may limit the ability of researchers and clinicians to evaluate the efficacy of different treatments and make meaningful comparisons.

A Meta-Synthesis of the Experience of Chronic Temporomandibular Disorder Patients Within Health Care Services

Aims: To systematically review the qualitative evidence related to experiences of patients with temporomandibular disorders (TMD) and to explore their journeys within health care services. Methods: A systematic search of the following databases was conducted: MEDLINE, Embase, PsycINFO, Web of Science, CINAHL Complete, and the Cochrane database. Thematic synthesis was used to analyze and synthesize the data from qualitative studies that explored the journeys of TMD patients within health care services. The Critical Appraisal Skills Programme (CASP) tool was used to critically appraise the quality of the included studies. Results: The search strategies yielded 4,563 articles across all databases, and 18 articles were eventually included. Six themes were derived: care-seeking attitudes; expectations and health care experience; the patient-clinician interaction; diagnosis as a stepping stone for improvement; management; and social support. Conclusion: The journey within health care services may play a valuable role in the ability to cope with chronic TMDs. Receiving a diagnosis, being listened to, and being believed are among the most important elements making for a positive clinical experience.

Healthcare priorities in patients with chronic facial pain of temporomandibular disorders.

OBJECTIVES: To explore the experiences of patients with temporomandibular disorders (TMDs) with the National Health Service and to discover their healthcare priorities when seeking treatment. METHODS: Semi-structured interviews were used. They were directed using a topic guide covering subjects such as initial visits in primary care, referrals to secondary care, and the effect on symptoms. The discussions were audiotaped and transcribed verbatim. Thematic analysis was utilised to analyse the data. RESULTS: In total, 15 participants took part in three focus groups. Six themes were identified: "access to appropriate care", "organised and coordinated care", "receiving a diagnosis and enough information", "interaction with the clinical staff", "treatment strategies and having an 'action plan'" and "support and social networks". CONCLUSIONS: The participants gave accounts of the difficulties encountered in healthcare in general terms and specific to TMD. Most notable was the struggle to access appropriate care, receive a diagnosis and be understood. Our findings suggest that delays in delivering appointments with people of expertise may have caused the worsening of symptoms. However, when a pleasant experience was encountered, access to care was fast, the clinician was understanding and communication with the clinical team was good. These provided positive experiences and were appreciated by the patients.

Women in Maxillofacial Surgery and Otolaryngology; Career Obstacles and Success Factors.

ABSTRACT: Little is known on career factors and expectations for female oral and maxillofacial surgeons (OMFS) in developing countries. The study aimed to explore career perceptions of females in 2 related surgical specialties: oral and maxillofacial surgery and otolaryngology (ENT) with a focus on career obstacles and success factors. A structured questionnaire was distributed to female surgeons working in Jordan in the 2 surgical specialties. Questions addressed socio-professional characteristics and career-promoting and hindering factors. All surgeons registered in both specialties were invited. A total of 56 surgeons participated in the survey. Age range was 29 to 55 years (mean = 38.55 ±â€Š5.799). Significantly more OMFS surgeons were single (P = 0.000) younger (P = 0.003), and had fewer years of experience (P = 0.01) than ENT surgeons. Significantly more ENT surgeons perceived the "hard working" attribute and "better communication skills" as career-promoting factors (P = 0.04, P = 0.015, respectively). Further, significantly more ENT surgeons believed that females in the surgical profession help in changing the traditional surgical stereotype linked with the male gender (93.8% ENT in contrast to 75% OMFS, P = 0.047), and expressed a preference for female mentors (48% ENT in contrast to 0% OMFS, P = 0.000). The results of this study indicate that female OMFS surgeons have different socio-professional characteristics and perceptions to their peers in ENT surgery, and this mainly manifested in professional experience, marital status, and important career perceptions. They seem to lack confidence in female participation and promotion of the surgical career, and they show preference for having exclusively male mentors.

Sanjad-Sakati Syndrome: Oral Health Care.

OBJECTIVES: The aim of this report is to describe the orofacial manifestations and dental management of a girl with Sanjad-Sakati syndrome. CLINICAL PRESENTATION AND INTERVENTION: The facial features included microcephaly, thin lips, beaked nose, low set ears, and a retrognathic mandible. An oral examination revealed oligodontia/hypodontia, small dental arches, a high arched palate, and a deep overbite and increased overjet. Oral rehabilitation involved full coverage prosthetic crowns on the upper central incisors, stainless steel crowns on the lower molars, and removable partial prostheses to replace missing teeth. CONCLUSION: Recognition of orofacial features might help in the diagnosis of Sanjad-Sakati syndrome. Dental management of affected patients might be complicated by intellectual, neurological, and endocrine abnormalities.

YouTube as a source for parents' education on early childhood caries.

BACKGROUND: Patients can and do search the Internet for information on various health-related topics. YouTube™ is one popular website they may consult. AIM: To examine the quality of information offered by YouTube™ for patients seeking information on early childhood caries (ECC). DESIGN: YouTube™ was searched for videos on ECC. The usefulness of selected videos in providing adequate information about ECC was evaluated using a 13-point usefulness score. The guidelines of the American Academy of Pediatric Dentistry were used for benchmarking. RESULTS: Most videos were uploaded by healthcare professionals (60%, n = 18). Videos had generally low usefulness scores (mean: 5.1 ± 2.9; range: 1-11). An average YouTube™ video on ECC was viewed two times/day (range: 0.07-34.4 views/day). Less useful videos ranked early on the viewing list, and viewer's interactions with videos were not affected significantly by their usefulness. CONCLUSION: YouTube™ should not be used as a trusted site for educating patients on ECC.