'Sustainability in the NHS': a novel method for teaching sustainable dentistry and quality improvement to dental core trainees.

The practice of dentistry contributes to 3% of the carbon footprint of the NHS. As awareness and concern about climate change increases, all dental care professionals must play their part in reducing the environmental impact of the care they provide. This paper aims to describe a novel method of teaching, both the theory and practical application of sustainable dentistry, by integrating sustainable quality improvement methods into the existing management and leadership requirements of dental core training.

Responsible waste management: using resources efficiently (Part 2).

This chapter aims to describe the types of waste produced in dental practice, the costs associated with disposal of this waste, and the impact that the disposal method has on the environment and on human health. It discusses the waste hierarchy and explores how dental surgeries can reduce their waste generation through simple changes in practice. The chapter continues by highlighting the benefits of performing a waste audit, with examples of how correct segregation of the waste produced in practice is both cost-effective and reduces the environmental impact of its disposal. Finally, we discuss some of the barriers and enablers of changing waste disposal behaviours in the dental practice and identify how the environmentally minded practitioner can encourage pro-environmental behaviour in their dental team.

Responsible waste management: using resources efficiently (Part 1).

This chapter aims to describe the types of waste produced in dental practice, the costs associated with disposal of this waste, and the impact that the disposal method has on the environment and on human health. It discusses the waste hierarchy and explores how dental surgeries can reduce their waste generation through simple changes in practice. The chapter continues by highlighting the benefits of performing a waste audit, with examples of how correct segregation of the waste produced in practice is both cost-effective and reduces the environmental impact of its disposal. Finally, we discuss some of the barriers and enablers of changing waste disposal behaviours in the dental practice and identify how the environmentally minded practitioner can encourage pro-environmental behaviour in their dental team.

A review of HTM 01-05 through an environmentally sustainable lens.

Patients deserve to be treated in a safe and clean environment with consistent standards of care every time they receive treatment. It is essential that the risk of person-to-person transmission of infections be minimised, yet it is also essential that planetary harm (and therefore public harm) is minimised with respect to resource consumption, air pollution, environmental degradation etc.In 2013, the Department of Health introduced the Health Technical Memorandum (HTM) 01-05 providing dental practices with advice on patient safety when decontaminating reusable instruments in primary care. This paper provides a commentary on HTM 01-05 and similar decontamination guidance. We believe all decontamination documents needs to reflect the so-called 'triple bottom line' - the finance, social cost and impact on the planet.The authors provide an environmental commentary on a number of items mentioned in decontamination documents, including autoclaves (including the use of helix tests), disposable paper towels, undertaking hand hygiene, using a log book, plastic bag use, the use of personal protective equipment, remote decontamination units, single use instruments, single use wipes, disinfection chemicals (for example, sodium hypochlorite) thermal disinfection and wrapping of instruments.It is hoped, in the spirit of the ever-increasing numbers of papers published to highlight how healthcare (and dentistry) could become more sustainable, that these critiques will be taken in the spirit of providing a beginning of further discussion from an environmental perspective.

Dental extractions in primary care for patients at risk of MRONJ.

Aims This study aims to understand the experiences of general dental practitioners (GDPs) performing dental extractions for patients at risk of developing medication-related osteonecrosis of the jaw (MRONJ) and to identify the key features of the patients who are referred to secondary care for their extractions.Materials and methods A mixed-method study consisting of quantitative analysis of anonymised electronic referrals and thematic analysis of in-depth telephone interviews with GDPs.Results In total, 122 electronic referrals for patients at risk of MRONJ were identified. The majority of the referrals contained insufficient information to categorise the patient's risk of developing MRONJ. In-depth telephone interviews with six GDPs were analysed and the themes identified were consequences, difficult decisions, patient awareness and bridging the gap.Conclusion Our results show that fewer than half of the referrals to secondary care investigated in this study showed a clear indication for secondary care involvement and the quality of the patient information provided was often insufficient to determine the patients' risk of developing MRONJ. Improved local guidance for the management of these patients and a dedicated pathway for their post-operative complications may encourage GDPs to perform more of these dental extractions in practice.

The Impact of Periodontal Disease on Hospital Admission and Mortality During COVID-19 Pandemic.

Introduction: COVID-19 has had a huge impact on society and healthcare and it has been suggested that people with periodontal disease are at risk of having worse outcomes from the disease. The aim of this study was to quantify the impact of periodontal disease on hospital admission and mortality during the COVID-19 pandemic. Materials and Methods: The study extracted UK Biobank participants who had taken a COVID-19 test between March and June 2020 (n = 13,253), of which 1,616 were COVID-19 positive (12%) and 11,637 were COVID-19 negative (88%). Self-reported oral health indicators of painful or bleeding gums and loose teeth were used as surrogates for periodontal disease, participants who did not report any of the aforementioned indicators were used as controls. Multivariable logistic regressions were used to obtain crude and adjusted odds ratios of COVID-19 infection, subsequent hospital admission and mortality adjusted for demographics, BMI, biomarkers, lifestyle and co-morbidities. Results: Painful gums, bleeding gums and loose teeth were reported in 2.7, 11.2 and 3.3% of participants with COVID-19 infection, respectively. Risk of COVID-19 infection in participants with painful or bleeding gums and loose teeth compared to controls was not increased (odds ratio [OR]: 1.10, 95% CI: 0.72-1.69; OR: 1.15, 95% CI: 0.84-1.59). COVID-19 positive participants with painful or bleeding gums had a higher risk of mortality (OR: 1.71, 95% CI: 1.05-2.72) but not hospital admission (OR: 0.90, 95% CI: 0.59-1.37). Participants with loose teeth did not show higher risk of hospital admission or mortality compared to the control group (OR = 1.55, 95% CI: 0.87-2.77; OR: 1.85; 95% CI: 0.92-2.72). Conclusion: There was insufficient evidence to link periodontal disease with an increased risk of COVID-19 infection. However, amongst the COVID-19 positive, there was significantly higher mortality for participants with periodontal disease. Utilization of linked dental and hospital patient records would improve the understanding of the impact of periodontal disease on COVID-19 related outcomes.

An orthodontic bracket embedded in the medial pterygoid surface: a case report.

There is a potential risk that orthodontic brackets can become dislodged into the aerodigestive tract. This case illustrates the management of an orthodontic bracket, which became embedded in the deep tissues of the oropharynx. We aim to highlight the potential risk misplaced dental instruments and materials pose, including that they may become embedded in the soft tissues of the throat and suggest that that this possibility should be considered when they cannot be localized.

An orthodontic bracket embedded in the medial pterygoid surface: a case report.

There is a potential risk that orthodontic brackets can become dislodged into the aerodigestive tract. This case illustrates the management of an orthodontic bracket, which became embedded in the deep tissues of the oropharynx. We aim to highlight the potential risk misplaced dental instruments and materials pose, including that they may become embedded in the soft tissues of the throat and suggest that that this possibility should be considered when they cannot be localized.