Mandibular cortical indices on cone-beam computed tomography images in osteoporotic women on treatment with oral bisphosphonates.

OBJECTIVE: To evaluate the mandibular cortical indices in osteoporotic women receiving oral bisphosphonates (oBPs). MATERIAL AND METHODS: The study group included 46 Caucasian women aged over 55 years on treatment with oBPs for postmenopausal osteoporosis. Information recorded included age, weight, height, type of oBP, duration of treatment, comorbid conditions and coadjuvant medication. Forty-six age-matched Caucasian women with no known diagnosis of osteoporosis were selected as the control group. All participants underwent cone-beam computed tomography, and the mandibular cortical width (MCW) and the height from the inferior mandibular border to the mental foramen (MBMF) were measured. RESULTS: The MBMF was similar in the participants with osteoporosis and in controls. MCW was significantly greater in the participants with osteoporosis than in the controls (p < 0.001). CONCLUSION: Mandibular cortical width should not be used to predict the risk of bisphosphonate-associated osteonecrosis of the jaws.

Pseudoepitheliomatous hyperplasia after diode laser oral surgery. An experimental study.

BACKGROUND: to examine the process of epithelial reparation in a surgical wound caused by diode laser. MATERIAL AND METHODS: An experimental study with 27 Sprage-Dawley rats was undertaken. The animals were randomly allocated to two experimental groups, whose individuals underwent glossectomy by means of a diode laser at different wattages, and a control group treated using a number 15 scalpel blade. The animals were slaughtered at the 2nd, 7th, and 14th day after glossectomy. The specimens were independently studied by two pathologists (blinded for the specimens' group). RESULTS: at the 7th day, re-epithelisation was slightly faster for the control group (conventional scalpel) (p=0.011). At the 14th day, complete re-epithelization was observed for all groups. The experimental groups displayed a pseudoepitheliomatous hyperplasia. CONCLUSIONS: it is concluded that, considering the limitations of this kind of experimental studies, early re-epithelisation occurs slightly faster when a conventional scalpel is used for incision, although re-epithelisation is completed in two weeks no matter the instrument used. In addition, pseudoepitheliomatous hyperplasia is a potential event after oral mucosa surgery with diode laser. Knowledge about this phenomenon (not previously described) may prevent diagnostic mistakes and inadequate treatment approaches, particularly when dealing with potentially malignant oral lesions.

Minor salivary gland biopsy in Sjögren's syndrome: a review and introduction of a new tool to ease the procedure.

OBJECTIVES: To review the existing techniques for minor salivary gland biopsy (MSGB) in the lip and to suggest a new approach to ease the procedure and reduce post-operative complications. STUDY DESIGN: A comprehensive literature review and a descriptive study of a new surgical technique. RESULTS: Diverse incisions have been suggested for MSGB with different designs (ellipse, circular, linear), different directions (parallel, oblique, vertical) and a wide range of lengths (from 1 mm up to 3 cm), but no comparative studies supporting the advantages of a particular type of incision over the others could be retrieved. A variety of features of the existing techniques for MSGB are linked to undesired events and surgical complications which could be minimized by modifying certain aspects of these procedures. The technique described, together with the use of the S forceps, represents a significant improvement over the already described chalazion forceps because it allows for a better access and positioning of the lower lip, improves the ergonomic conditions of the assistant, and facilitates the identification of lip areas with more superficial gland lobules. CONCLUSION: The suggested approach for lip MSGB includes a specifically designed instrument whose performance during lip biopsy may contribute to minimize post-operative complications.

Mouth Breathing and Its Impact on Atypical Swallowing: A Systematic Review and Meta-Analysis.

The aim of this systematic review is the assessment of the effect of mouth breathing on the prevalence of tongue thrust. The review was performed according to the PRISMA 2020 checklist guidelines, and the protocol was registered with PROSPERO (CRD42022339527). The inclusion criteria were the following: studies of clinical trials and cross-sectional and longitudinal descriptive studies that evaluate the appearance of tongue thrust in patients with mouth breathing; healthy subjects of any age, race or sex; and studies with a minimum sample group of five cases. The exclusion criteria were the following: studies with syndromic patients, articles from case reports, and letters to the editor and/or publisher. Searches were performed in electronic databases such as The National Library of Medicine (MEDLINE via PUBMED), the Cochrane Central Register of Controlled Trials, Web of Science and Scopus, including studies published until November 2023, without a language filter. The methodological quality of the included case-control studies was assessed using the Newcastle-Ottawa Scale (NOS), and the Joanna Briggs Institute (JBI) tool was used for descriptive cross-sectional studies and cross-sectional prevalence studies. A meta-analysis was conducted on studies that provided data on patients' classification according to mouth breathing (yes/no) as well as atypical swallowing (yes/no) using Review Manager 5.4. From 424 records, 12 articles were selected, and 4 were eligible for meta-analysis. It was shown that there is no consensus on the diagnostic methods used for mouth breathing and tongue thrust. The pooled risk ratio of atypical swallowing was significantly higher in the patients with mouth breathing (RR: 3.70; 95% CI: 2.06 to 6.66). These studies have several limitations, such as the heterogeneity among the individual studies in relation to the diagnostic tools and criteria for the assessment of mouth breathing and atypical swallowing. Considering the results, this systematic review shows that patients with mouth breathing presented higher risk ratios for atypical swallowing.

Effect of early vs. delayed extubation on functional outcome among patients with acute ischemic stroke treated with endovascular thrombectomy under general anesthesia: the prospective, randomized controlled EDESTROKE trial study protocol.

BACKGROUND: Recent meta-analyses and randomized studies have shown that among patients with acute ischemic stroke undergoing endovascular thrombectomy, general anesthesia with mechanical ventilation is associated with better functional status compared to local anesthesia and sedation, and they recommend its use. But once the procedure is completed, when is the optimal moment for extubation? Currently, there are no guidelines recommending the optimal moment for extubation. Prolonged mechanical ventilation time could potentially be linked to increased complications such as pneumonia or disturbances in cerebral blood flow due to the vasodilatation produced by most anesthetic drugs. However, premature extubation in a patient who has suffered a stroke could led to complications such as agitation, disorientation, abolished reflexes, sudden fluctuations in blood pressure, alterations in cerebral blood flow, respiratory distress, bronchial aspiration, and the need for reintubation. We therefore designed a randomized study hypothesizing that early compared with delayed extubation is associated with a better functional outcome 3 months after endovascular thrombectomy treatment under general anesthesia for acute ischemic stroke. METHODS: This investigator-initiated, single-center, prospective, parallel, evaluated blinded, superiority, randomized controlled trial will include 178 patients with a proximal occlusion of the anterior circulation treated with successful endovascular thrombectomy (TICI 2b-3) under general anesthesia. Patients will be randomly allocated to receive early (< 6 h) or delayed (6-12 h) extubation after the procedure. The primary outcome measure is functional independence (mRS of 0-2) at 90 days, measured with the modified Rankin Score (mRS), ranging from 0 (no symptoms) to 6 (death). DISCUSSION: This will be the first trial to compare the effect of mechanical ventilation duration (early vs delayed extubation) after satisfactory endovascular thrombectomy for acute ischemic stroke under general anesthesia. TRIAL REGISTRATION: The study protocol was approved April 11, 2023, by the by the Santiago-Lugo Research Ethics Committee (CEI-SL), number 2023/127, and was registered into the clinicaltrials.gov clinical trials registry with No. NCT05847309. Informed consent is required. Participant recruitment begins on April 18, 2023. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.

Simulation for training in sinus floor elevation: new surgical bench model.

OBJECTIVES: to describe a bench model (workshop of abilities) for sinus floor elevation (SFE) training that simulates the surgical environment and to assess its effectiveness in terms of trainees' perception. STUDY DESIGN: thirty-six randomly selected postgraduate students entered this cross-sectional pilot study and asked to fill in an anonymous, self-applied, 12-item questionnaire about a SFE workshop that included a study guide containing the workshop' s details, supervised practice on a simulated surgical environment, and assessment by means of specific check-lists. RESULTS: Thirtiy-six fresh sheep heads were prepared to allow access to the buccal vestible. Using the facial tuber, third premolar and a 3D-CT study as landmarks for trepanation, the sinus membrane was lifted, the space filled with ceramic material and closed with a resorbable membrane. The participants agreed on their ability to perform SFE in a simulated situation (median score= 4.5; range 2-5) and felt capable to teach the technique to other clinicians or to undertake the procedure for a patient under supervision of an expert surgeon (median= 4; range 1-5 ). There were no differences on their perceived ability to undertake the technique on a model or on a real patient under supervision of an expert surgeon (p=0.36). CONCLUSIONS: Clinical abilities workshops for SFE teaching are an essential educational tool but supervised clinical practice should always precede autonomous SFE on real patients. Simulation procedures (workshop of abilities) are perceived by the partakers as useful for the surgical practice. However, more studies are needed to validate the procedure and to address cognitive and communication skills, that are clearly integral parts of surgical performance.

Criteria for the prescription of oral bisphosphonates for the treatment of osteoporosis in a series of women referred for tooth extraction.

OBJECTIVE: To evaluate the criteria for the prescription of oral bisphosphonates (OB) in a series of women with osteoporosis referred for tooth extraction. STUDY DESIGN: The study included 38 postmenopausal women on treatment with OBs. The following variables were analysed: age, weight, height, type of OB and duration of treatment, bone densitometry and risk factors for osteoporosis. In addition, the osteoporosis self-assessment tool (OST) was administered and collagen type I C-telopeptide (CTX) levels were measured. RESULTS: Bone densitometry had only been performed in six patients (15.7%) before starting OB treatment. Based on the results of the OST, nine (23.6%) of the participants presented a low risk of osteoporosis. CTX levels were measured in 23 patients: 11 (47.8%) presented values below 150 pg/ml. CONCLUSION: Although all patients in the present series were on treatment with OBs, a large percentage did not satisfy the criteria for the initiation of treatment for postmenopausal osteoporosis.

The use of clinical guidelines for referral of patients with lesions suspicious for oral cancer may ease early diagnosis and improve education of healthcare professionals.

UNLABELLED: Early diagnosis and referral of oral cancer is essential. Successful implementation of clinical guidelines must include current practitioners and students. OBJECTIVE: To evaluate the diagnostic accuracy of students at oral cancer screening and to assess the effectiveness of clinical referral guidelines. STUDY DESIGN: Fifth year dental students were randomly allocated to either control (n=19) or experimental groups (n = 18). Both received the customary training in oral diagnosis. The experimental group underwent a 2 hour workshop where the guidelines for the referral of suspicious lesions were discussed. Three months later, a set of 51 clinical cases including benign, malignant, and precancerous conditions/lesions were used to assess the screening ability of each subject. RESULTS: All 37 students entered the study. Sensitivity (control group) ranged from 16.7% to 66.7%; the experimental group scored from 16.7% to 83.3%. Fifty percent of the experimental students reached sensitivity values ≥ 62.5% (p = 0.01). Diagnostic specificity (control group) spanned from 80% to 93.3% (median = 50%); amongst experimental group it ranged from 82.2% to 97.8% (median = 92.8%); (p = 0.003). Concordance -control group- was X = 82.5 (SD = 3.2), and X = 88.2 (SD = 4.3) for the experimental, (p > 0.001). Cohen's kappa test was poor (K < 0.40) for the controls and moderate for the experimental group. The experimental group referred more oral cancers urgently (p = 0.002) and left less unreferred cancers (0.04). This group also referred more precancerous lesions/conditions urgently (p = 0.02). CONCLUSIONS: The implementation of a clinical referral guideline at undergraduate level has proved valuable, under experimental conditions, to significantly increase diagnostic abilities of the examiners and thus to improve screening for oral cancer.

Knowledge of oral cancer and preventive attitudes of Spanish dentists. Primary effects of a pilot educational intervention.

OBJECTIVE: To assess the knowledge and preventive attitudes that Spanish dentists have towards oral cancer, before and after an educational intervention. METHODS: A quasi-experimental study based on a nationwide intervention. All Spanish dentists were offered an on-site course on oral cancer. An individual questionnaire was administered before and after attending the course. The main outcome measures were systematic examination of the oral cavity, promotion of healthy habits and knowledge of clinical aspects. RESULTS: 440 GDPs entered the study. Age: 40.7+/-10.7, range 21-74. Professional experience: 13.9+/-8.9 years, range 0-45. Of those who participated in the study, 53.1% had never attended a course on oral cancer, 72.4% stated that they perform a systematic examination of the oral mucosa, 88.2% provided systematic counselling on tobacco cessation, and 54.7% reported that they did the same for alcohol. In addition, 32.3% advised patients to eat fruits and vegetables high in antioxidants. Professional experience was significantly associated with oral mucosa systematic examination (t= 2.9; p=0.003), advice on alcohol consumption (t=5.0; p=0.000), and on fruit and vegetable intake (t=5.1; p<0.001). None of these practices were specifically associated with knowledge on oral cancer. All areas of knowledge examined showed statistically significant improvement after the educational intervention. CONCLUSIONS: The intervention appears to have improved the GDP s knowledge, confirming the importance of this national campaign.

Study of factors influencing preoperative detection of alveolar antral artery by CBCT in sinus floor elevation.

This study aimed at assessing the prevalence of alveolar antral artery (AAA) detection by CBCT, its related variables, and at describing explanatory models useful in surgical planning, by retrospective evaluation of CBCT explorations. The modelling of the probability for detecting AAA was undertaken using logistic generalized additive models (GAM). The capacity for discriminating detection/no detection was assessed by receiver operating characteristic curves. A total of 466 sinuses were studied. Univariate models showed detection probability was linked to sinus width and thickness of the lateral bony wall, together with the shape and height of the osseous crest. AAA detection probability increased steadily until the thickness of the bony wall reached 6 mm. Multivariate models resulted good discriminators for AAA detection, particularly for females, showing an area under the curve (AUC) of 0.85. Models considering patients altogether, and those including only males offered slightly lower values (AUC = 0.79). The probability of AAA detection by CBCT was influenced by gender (higher in males and for narrow sinuses) and increases with the thickness of the sinus lateral bony wall and the height of the residual alveolar ridge. Besides, and particularly for women, the thickness of the ridge at the basal level seems to improve the explanatory model for AAA detection.

CASDES: A Computer-Aided System to Support Dry Eye Diagnosis Based on Tear Film Maps.

Dry eye syndrome is recognized as a growing health problem, and one of the most frequent reasons for seeking eye care. Its etiology and management challenge clinicians and researchers alike, and several clinical tests can be used to diagnose it. One of the most frequently used tests is the evaluation of the interference patterns of the tear film lipid layer. Based on this clinical test, this paper presents CASDES, a computer-aided system to support the diagnosis of dry eye syndrome. Furthermore, CASDES is also useful to support the diagnosis of other eye diseases, such as meibomian gland dysfunction, since it provides a tear film map with highly useful information for eye practitioners. Experiments demonstrate the robustness of this novel tool, which outperforms the previous attempts to create tear film maps and provides reliable results in comparison with the clinicians' annotations. Note that the processing time is noticeably reduced with the proposed method, which will help to promote its clinical use in the diagnosis and treatment of dry eye.

A methodology for improving tear film lipid layer classification.

Dry eye is a symptomatic disease which affects a wide range of population and has a negative impact on their daily activities. Its diagnosis can be achieved by analyzing the interference patterns of the tear film lipid layer and by classifying them into one of the Guillon categories. The manual process done by experts is not only affected by subjective factors but is also very time consuming. In this paper we propose a general methodology to the automatic classification of tear film lipid layer, using color and texture information to characterize the image and feature selection methods to reduce the processing time. The adequacy of the proposed methodology was demonstrated since it achieves classification rates over 97% while maintaining robustness and provides unbiased results. Also, it can be applied in real time, and so allows important time savings for the experts.

Lamb ex vivo model for training in maxillary sinus floor elevation surgery: a comparative study with human standards.

BACKGROUND: Many models have been suggested for surgical training in sinus floor elevation (SFE), but information on key features that provide feedback to the trainee is scarce. The aim of this study is to compare the thickness of the lateral wall of the maxillary sinus (TLWMS) and the thickness of the Schneiderian membrane (TSM) between an animal model and the human standard. METHODS: The observational study used 20 fresh lamb heads. Cone-beam computed tomography (CT) was performed for recording the following: TLWMS, sinus lateral floor width, distance from the lateral border of the anteroposterior bone crest to the sinus wall, and height of lateral maxillary sinus. Thirty human radiologic exploration cone-beam CTs were used for comparisons. The sinus membrane thickness was measured at three points per section and compared to those of 10 formalin-preserved human membranes. RESULTS: TLWMS in the animal model scored 2.25 ± 0.3 mm and was thicker than that of humans with subsinusal edentulism (Xi - Xj = 0.3; 95% confidence interval = 0.1 to 0.4), although this difference was not considered clinically relevant. The average thickness of the sinus membrane was 485.5 ± 137.1 µm with no significant differences between sides (P = 0.12) or between the thickness of human and lamb Schneiderian membranes. CONCLUSIONS: The model based on lambs is potentially useful for training in SFE techniques because of the similarities in the TLWMS and particularly the TSM. Additional studies are needed to validate this model within a teaching environment.

Distance of the alveolar antral artery from the alveolar crest. Related factors and surgical considerations in sinus floor elevation

BACKGROUND: In a variable proportion of maxillary sinuses alveolar antral artery is located close to the residual ridge, increasing the chances for haemorrhagic complications during sinus floor elevation procedures. MATERIAL AND METHODS: Retrospective observational study of CBCT explorations performed for implant-treatment planning. The upper first molar area was selected for this study. The relative uncertainty (standard deviation of the measurement divided by its mean and expressed as a percentage from 0% to 100%) was chosen for determining the observational errors. For modeling the chances of AAA detection, the generalized additive models (GAM) approach was chosen. RESULTS: A total of 240 maxillary sinuses were studied (46.25% males) whose median median age was 58 years old (IQR: 52-66). Univariate models showed that the chances for an AAA-alvelar crest distance ≤15mm increase in wider sinuses with lower, subsinusally edentulous crests. When distance is considered as a continuous variable, the best mutivariate model showed an explained deviance of 67% and included AAA diameter, distance AAA-sinus floor, sinus width, and shape, height and width of the residual ridge. Thinner AAAs are found closer to the crest (within the ≤15mm safe distance). CONCLUSIONS: Bearing in mind the inclusion criteria and the limitations of this investigation, it is concluded that there is a high proportion of maxillary sinuses where AAA describes a course close to the alveolar crest (≤15mm), which was classically considered a safe distance for SFE. This position is related to the presence of atrophic crests (depressed ridge form) and wide maxillary sinuses where the distance of the vessel to the floor of the sinus is small. This information may permit a better surgical planning of SFE procedures

Pseudoepitheliomatous hyperplasia after diode laser oral surgery. An experimental study

BACKGROUND: to examine the process of epithelial reparation in a surgical wound caused by diode laser. MATERIAL AND METHODS: An experimental study with 27 Sprage-Dawley rats was undertaken. The animals were randomly allocated to two experimental groups, whose individuals underwent glossectomy by means of a diode laser at different wattages, and a control group treated using a number 15 scalpel blade. The animals were slaughtered at the 2nd, 7th, and 14th day after glossectomy. The specimens were independently studied by two pathologists (blinded for the specimens' group). RESULTS: at the 7th day, re-epithelisation was slightly faster for the control group (conventional scalpel) (p = 0.011). At the 14th day, complete re-epithelization was observed for all groups. The experimental groups displayed a pseudoepitheliomatous hyperplasia. CONCLUSIONS: it is concluded that, considering the limitations of this kind of experimental studies, early re-epithelisation occurs slightly faster when a conventional scalpel is used for incision, although re-epithelisation is completed in two weeks no matter the instrument used. In addition, pseudoepitheliomatous hyperplasia is a potential event after oral mucosa surgery with diode laser. Knowledge about this phenomenon (not previously described) may prevent diagnostic mistakes and inadequate treatment approaches, particularly when dealing with potentially malignant oral lesions

Minor salivary gland biopsy in Sjögren’s syndrome: A review and introduction of a new tool to ease the procedure

OBJECTIVES: To review the existing techniques for minor salivary gland biopsy (MSGB) in the lip and to suggest a new approach to ease the procedure and reduce post-operative complications. Study DESIGN: A comprehensive literature review and a descriptive study of a new surgical technique. RESULTS: Diverse incisions have been suggested for MSGB with different designs (ellipse, circular, linear), different directions (parallel, oblique, vertical) and a wide range of lengths (from 1 mm up to 3 cm), but no comparative studies supporting the advantages of a particular type of incision over the others could be retrieved. A variety of features of the existing techniques for MSGB are linked to undesired events and surgical complications which could be minimized by modifying certain aspects of these procedures. The technique described, together with the use of the S forceps, represents a significant improvement over the already described chalazion forceps because it allows for a better access and positioning of the lower lip, improves the ergonomic conditions of the assistant, and facilitates the identification of lip areas with more superficial gland lobules. CONCLUSIONS: The suggested approach for lip MSGB includes a specifically designed instrument whose performance during lip biopsy may contribute to minimize post-operative complications

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Secuencia TRAP. Diagnóstico diferencial con gemelo muerto / Twin reverse arterial perfusion (TRAP) sequence. Differential diagnosis with intrauterine demise of one twin

La secuencia TRAP (twin reverse arterial perfusion) está presente en el 1% de las gestaciones gemelares monocoriales. Presentamos un caso de secuencia TRAP poco convencional en el que el gemelo acardias está bien formado, identificándose en él estructuras craneales y cardiacas. El diagnóstico diferencial entre fenómeno TRAP y gemelo muerto intraútero se hizo a partir de otros signos ecográficos de sospecha, como la presencia de una arteria umbilical única, un higroma dorsal y el cordón corto. El diagnóstico de certeza se consiguió mediante Doppler, que demostró la presencia de la anastomosis arterio-arterial y el flujo reverso en el gemelo «muerto». Consideramos que la existencia de un fenómeno TRAP debe tenerse en cuenta ante el diagnóstico ecográfico de gestación monocorial con muerte de uno de los gemelos. El pronóstico y manejo de la gestación va a diferir en ambos casos. La presencia de estructuras craneales y corazón no excluye el diagnóstico de TRAP (AU)

TRAP sequence occurs in 1% of monochorionic twin pregnancies. We present an atypical case of TRAP sequence in which the acardiac twin was properly formed and the cranial and cardiac structures could be identified. The differential diagnosis between TRAP phenomenon and intrauterine death of one twin was performed on the basis of other suspicious ultrasound signs, such as the presence of a single umbilical artery, a dorsal hygroma, and a short cord. The definitive diagnosis was established by Doppler, which showed an arterio-arterial anastomosis and reverse flow in the dead twin. We believe that the presence of a TRAP phenomenon should be taken into account in cases of ultrasound diagnosis of a monochorionic pregnancy with intrauterine demise of one twin. The finding of cranial structures and heart does not exclude a diagnosis of TRAP (AU)

Criteria for the prescription of oral bisphosphonates for the treatment of osteoporosis in a series of women referred for tooth extraction

Objective: To evaluate the criteria for the prescription of oral bisphosphonates (OB) in a series of women with osteoporosis referred for tooth extraction. Study design: The study included 38 postmenopausal women on treatment with OBs. The following variables were analysed: age, weight, height, type of OB and duration of treatment, bone densitometry and risk factors for osteoporosis. In addition, the osteoporosis self-assessment tool (OST) was administered and collagen type I Ctelopeptide (CTX) levels were measured.Results: Bone densitometry had only been performed in six patients (15.7%) before starting OB treatment. Based on the results of the OST, nine (23.6%) of the participants presented a low risk of osteoporosis. CTX levels were measured in 23 patients: 11 (47.8%) presented values below 150 pg/ml.Conclusion: Although all patients in the present series were on treatment with OBs, a large percentage did not satisfy the criteria for the initiation of treatment for postmenopausal osteoporosis (AU)

Simulation for training in sinus floor elevation: New surgical bench model

Objectives: to describe a bench model (workshop of abilities) for sinus floor elevation (SFE) training that simulates the surgical environment and to assess its effectiveness in terms of trainees’ perception.Study design: thirty-six randomly selected postgraduate students entered this cross-sectional pilot study and asked to fill in an anonymous, self-applied, 12-item questionnaire about a SFE workshop that included a study guide containing the workshop’s details, supervised practice on a simulated surgical environment, and assessment by means of specific check-lists. Results: Thirtiy-six fresh sheep heads were prepared to allow access to the buccal vestible. Using the facial tuber, third premolar and a 3D-CT study as landmarks for trepanation, the sinus membrane was lifted, the space filled with ceramic material and closed with a resorbable membrane. The participants agreed on their ability to perform SFE in a simulated situation (median score= 4.5; range 2-5) and felt capable to teach the technique to other clinicians or to undertake the procedure for a patient under supervision of an expert surgeon (median= 4; range 1-5 ). There were no differences on their perceived ability to undertake the technique on a model or on a real patient under supervision of an expert surgeon (p=0.36). Conclusions: Clinical abilities workshops for SFE teaching are an essential educational tool but supervised clinical practice should always precede autonomous SFE on real patients. Simulation procedures (workshop of abilities) are perceived by the partakers as useful for the surgical practice. However, more studies are needed to validate the procedure and to address cognitive and communication skills, that are clearly integral parts of surgical performance (AU)

The use of clinical guidelines for referral of patients with lesions suspicious for oral cancer may ease early diagnosis and improve education of healthcare professionals

Early diagnosis and referral of oral cancer is essential. Successful implementation of clinical guidelines mustinclude current practitioners and students.Objective: To evaluate the diagnostic accuracy of students at oral cancer screening and to assess the effectiveness of clinical referral guidelines.Study Design: Fifth year dental students were randomly allocated to either control (n=19) or experimental groups(n=18). Both received the customary training in oral diagnosis. The experimental group underwent a 2 hourworkshop where the guidelines for the referral of suspicious lesions were discussed. Three months later, a set of 51 clinical cases including benign, malignant, and precancerous conditions/lesions were used to assess the screeningability of each subject.Results: All 37 students entered the study. Sensitivity (control group) ranged from 16.7% to 66.7%; the experimental group scored from 16.7% to 83.3%. Fifty percent of the experimental students reached sensitivity values ¡Ý62.5%(p=0.01). Diagnostic specificity (control group) spanned from 80% to 93.3% (median=50%); amongst experimental group it ranged from 82.2% to 97.8% (median=92.8%); (p=0.003). Concordance -control group- was X=82.5(SD=3.2), and X=88.2 (SD=4.3) for the experimental, (p>0.001). Cohen¡¯s kappa test was poor (K<0.40) for the controls and moderate for the experimental group. The experimental group referred more oral cancers urgently(p=0.002) and left less unreferred cancers (0.04). This group also referred more precancerous lesions/conditionsurgently (p=0.02).Conclusions: The implementation of a clinical referral guideline at undergraduate level has proved valuable,under experimental conditions, to significantly increase diagnostic abilities of the examiners and thus to improvescreening for oral cancer (AU)