Human Disease/Clinical Medical Sciences in Dentistry: Current state and future directions of undergraduate teaching in the UK and Ireland.

In March 2017, a group of teachers of human disease/clinical medical science (HD/CMSD) representing the majority of schools from around the UK and Republic of Ireland met to discuss the current state of teaching of human disease and also to discuss how the delivery of this theme might evolve to inform improved healthcare. This study outlines how the original teaching in medicine and surgery to dental undergraduate students has developed into the theme of HD/CMSD reflecting changing needs as well as guidance from the regulators, and how different dental schools have developed their approaches to reach their current state. Each school was also asked to share a strengths, weakness, opportunities and threats (SWOT) analysis of their programme and to outline how they thought their HD/CMSD programme may develop. The school representatives who coordinate the delivery and assessment of HD/CMSD in the undergraduate curriculum have extensive insight in this area and are well-placed to shape the HD/CMSD development for the future.

Aspects of training in clinical medical sciences in dentistry (human disease): recent graduates' perspectives from a UK dental school.

Teaching the management of medical emergencies is an important part of most courses in Clinical Medical Sciences in Dentistry (Human Disease). The aim of this study was to examine which medical emergencies graduates from the School of Dental Sciences at Newcastle University had experienced 1 year after qualification and their perceptions of their ability to assess a patient's fitness for treatment or to manage a medical emergency. The study instrument was a computer readable questionnaire. Very few emergencies had been experienced in general practice at this stage of their career, but all respondents either strongly agreed or agreed that their training had adequately equipped them to assess a patient's medical history and deal with medical emergencies. There were, however, aspects of the course that upon reflection that clearly needed to be addressed, including the use of different teachers for aspects of the medical emergency teaching.

Clinical medical sciences for undergraduate dental students in the United Kingdom and Ireland - a curriculum.

The technical aspects of dentistry need to be practised with insight into the spectrum of human diseases and illnesses and how these impact upon individuals and society. Application of this insight is critical to decision-making related to the planning and delivery of safe and appropriate patient-centred healthcare tailored to the needs of the individual. Provision for the necessary training is included in undergraduate programmes, but in the United Kingdom and Ireland there is considerable variation between centres without common outcomes. In 2009 representatives from 17 undergraduate dental schools in the United Kingdom and Ireland agreed to move towards a common, shared approach to meet their own immediate needs and that might also be of value to others in keeping with the Bologna Process. To provide a clear identity the term 'Clinical Medical Sciences in Dentistry' was agreed in preference to other names such as 'Human Disease' or 'Medicine and Surgery'. The group was challenged to define consensus outcomes. Contemporary dental education documents informed, but did not drive the process. The consensus curriculum for undergraduate Clinical Medical Sciences in Dentistry teaching agreed by the participating centres is reported. Many of the issues are generic and it includes elements that are likely to be applicable to others. This document will act as a focus for a more unified approach to the outcomes required by graduates of the participating centres and act as a catalyst for future developments that ultimately aim to enhance the quality of patient care.

Oral health and dental morbidity in long-term allogeneic blood and marrow transplant survivors in Australia.

BACKGROUND: Oral and dental disease is a major cause of long-term morbidity following allogeneic blood and marrow transplantation (Allo-BMT). This study aimed to describe the extent and range of oral and dental complications in BMT recipients and to identify gaps in service provision provided to this high-risk group. METHODS: Participants were Allo-BMT recipients, aged >18 years, and received transplants between 2000 and 2012 in NSW. They completed seven surveys, the purpose-designed Sydney Post-BMT Study survey and six other validated instruments. RESULTS: Of 441 respondents, many reported dry mouth (45.1%), dental caries (36.7%), mouth ulcers (35.3%), oral GVHD (35.1%), gingivitis (16.2%), tooth abscess (6.1%) and oral cancer (1.5%). Regular dental visits were reported by 66.2% of survivors. Middle-high income, older age and geographic location showed a positive association with regular dental visits. Of those who did not visit the dentist regularly, 37% stated they did not feel it necessary, 36% reported cost and 20% stated it was not advised by the treating team. CONCLUSION: Despite oral complications commonly occurring after Allo-BMT, many survivors receive inadequate dental care. These results emphasize the need for improved oral health education, the importance of regular dental checks and improvement in the delivery of dental health services for BMT survivors.

Observations on the exploration and external neurolysis of injured inferior alveolar nerves.

The inferior alveolar nerve is sometimes injured during mandibular surgery, resulting in altered sensibility. Incomplete recovery may be the result of nerve entrapment by scar tissue. Twelve patients underwent external neurolysis of the inferior alveolar nerve following prolonged sensory impairment secondary to mandibular surgery. The mean time to external neurolysis was 14 months (range 12-24 months). Five patients demonstrated improvement in sensibility, two patients returning to normal sensation. No patient had a worsening of symptoms. The results demonstrate that external neurolysis can be a useful step during surgical exploration in carefully selected patients.

Lymphocyte infusion for delayed extramedullary relapse of acute leukemia following bone marrow transplantation.

We report a case of extramedullary relapse of acute myelogenous leukemia twelve years after allogeneic bone marrow transplantation. Due to the localized nature of the relapse, we were able to eliminate a majority of the tumor burden, utilizing local irradiation. Destined with eventual systemic leukemia relapse, further therapy utilizing donor lymphocytes was given at a time of minimal disease burden. The patient remains in a state of complete remission.

Sweet tooth reconsidered: taste responsiveness in human obesity.

Taste responses of normal-weight, obese, and formerly obese individuals for sucrose and fat containing stimuli were examined using a mathematical modelling technique known as the Response Surface Method. The subjects accurately rated intensities of sweetness, fatness, and creaminess of 20 different mixtures of milk, cream, and sugar, and no mixture phenomena or inter-group differences were observed. In contrast, hedonic taste responses varied across subject groups, and were affected differentially by the sucrose and lipid content of the stimuli. Normal-weight subjects optimally preferred stimuli containing 20% lipid and less than 10% sucrose. Obese subjects preferred high-fat stimuli (greater than 34% lipid) that contained less than 5% sucrose, while formerly obese subjects showed enhanced responsiveness to both sugar and fat. Hedonic responsiveness as measured by the optimal sugar/fat ratio was negatively correlated with the degree of overweight (body mass index: weight/height). We hypothesize that sensory preferences for dietary sugars and fats aren determined by body-weight status and may affect the patterns of food consumption.

Patients' views of oral day surgery.

Day case surgery is an expanding area of health care and is an invaluable method of treating patients in many aspects of oral surgical practice. Two questionnaires were used to sample the opinions of 200 patients who had undergone care in a 3-month period. A total of 80% of patients rated their overall experience of oral day surgery as excellent or good. Less disruption to routine was the most common perceived advantage of oral day surgery (35% of patients). Providing patients are carefully selected, much of oral surgery previously undertaken on an in-patient basis may now be carried out as a day case.

General medicine and surgery for dental practitioners. Part 5: liver disease.

The liver has a number of important functions. It metabolises drugs and endogenous substances and contributes to their excretion by the body. Plasma proteins are synthesised in the liver which also acts as a storage organ for glycogen and vitamin B12. The liver is also important in the production of clotting factors for normal haemostatic function.

General medicine and surgery for dental practitioners Part 9: haematology and patients with bleeding problems.

Disorders of the blood can affect the management of dental patients. Particular oral signs may be produced. In addition healing may be affected and the choice of anaesthesia for operative procedures will be influenced. Similarly, patients who have problems with haemostasis are a concern. Surgical procedures are obvious problems. However, restorative dentistry is not trouble-free as patients with bleeding problems may present difficulties regarding the choice of local anaesthesia, as regional block techniques may be contraindicated in some patients.

General medicine and surgery for dental practitioners. Part 8: Musculoskeletal system.

Disorders of the musculoskeletal system may impact on dental management in diverse ways. Diseases of the bones may have a direct influence on treatment and joint disorders can also cause difficulties. Cervical spine involvement may lead to poor neck extension causing difficulties in providing dental treatment under local anaesthesia or allowing the provision of a safe general anaesthetic. Muscular disorders may mitigate against safe general anaesthesia. As with all medical disorders a thorough history can help to prevent many of the possible problems which may occur secondary to musculoskeletal diseases.

Primary care clinicians' knowledge of oral cancer: a study of dentists and doctors in the North East of England.

OBJECTIVE: To compare the knowledge of oral cancer and related issues of general dental and general medical practitioners (GDPs and GMPs). DESIGN: A questionnaire was sent to 420 primary care clinicians, half to dentists and half to doctors. Responses to the questionnaire were analysed using odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The response rate was 68.1% for GDPs and 71.9% for GMPs. Dental practitioners were significantly more likely to have diagnosed cases of oral cancer than medical practitioners (OR = 2.68, 95% CI 1.6,4.4). Important differences arose between the groups in terms of risk factor knowledge and clinical examination. CONCLUSION: This study demonstrates that whilst the knowledge level of both groups is generally good, there are some discrepancies. These relate mainly to risk factor knowledge and clinical examination techniques.

Blood pressure measuring equipment in the dental surgery: use or ornament?

OBJECTIVE: To survey the attitudes, knowledge and practice of general dental practitioners (GDPs) with regard to hypertension in dental patients and to assess opinion with regard to the concept of screening. SETTING: General dental practice. SUBJECTS AND METHODS: GDPs via a postal survey. To achieve an acceptable level of accuracy, at least 196 responses were required. RESULTS: Out of 300 questionnaires, 207 were returned (69% response rate). Most practitioners (98%) had received training in the measurement of blood pressure. Only 4.8% measured blood pressure routinely and this figure rose to 9.2% in patients with a known history of hypertension. Only 27.1% felt that the involvement of dentists in screening for hypertension was a good idea but 85.3% thought that education of practitioners about hypertension would be valuable. CONCLUSION: Most GDPs thought that education of practitioners about hypertension was a good idea. They did not, however, want to be involved with screening of patients for hypertension.

General medicine and surgery for dental practitioners. Part 3: gastrointestinal system.

Diseases of the gastrointestinal (GI) system can be relevant to the dental surgeon for several reasons. The mouth may display signs of the disease itself, for example the cobblestone mucosa, facial or labial swelling of Crohn's disease, or the osteomata of Gardner's syndrome. These are well covered elsewhere and not discussed further here. The sequelae of GI disease, for example gastric reflux producing dental erosion, iron deficiency anaemia and treatment such as corticosteroid therapy may all have a bearing on management and choice of anaesthesia.

General medicine and surgery for dental practitioners. Part 7: renal disorders.

Patients with kidney disorders are increasingly encountered in dental practice due to improvements in medical care leading to prolonged life expectancy. In order to provide appropriate and safe dental care for these patients it is important to have a working knowledge of renal disorders and related problems.

A comparison of broad and narrow retractors for lingual nerve protection during lower third molar surgery.

The incidence of altered lingual nerve sensation following lower third molar removal was examined in 150 cases where a broad retractor was used to retract the lingual flap and compared with 150 cases where a more conventional Howarth's periosteal elevator was employed. This study supports the view that a broad retractor employed to protect the lingual nerve during lower third molar surgery produces significantly less altered lingual nerve sensation at 1 month than a Howarth's periosteal elevator used for the same purpose.

General medicine and surgery for dental practitioners: part 3. Management of specific medical emergencies in dental practice.

In this paper, the actions needed to manage specific medical emergencies are discussed. Each emergency requires a correct diagnosis to be made for effective and safe management. Contemporary management in dental practice avoids the intravenous route when drugs are required to treat the emergency.

General medicine and surgery for dental practitioners: part 1. History taking and examination of the clothed patient.

All dental practitioners must be proficient at taking a medical history, examining a clothed patient and recognising relevant clinical signs. The general examination of a patient should take into account findings from the history. This paper does not attempt to address the detailed oral and dental examination carried out by dental practitioners but focuses on the holistic patient assessment - essential for safe patient management.

General medicine and surgery for dental practitioners: part 2. Medical emergencies in dental practice: the drug box, equipment and basic principles of management.

Dental practitioners need knowledge of the diagnosis and management of medical emergencies. This paper deals with the general aspects of emergency treatment including basic management principles which are applicable to all emergencies. The next paper in this series, part 3, deals with more specific aspects of medical emergency management.

General medicine and surgery for dental practitioners: part 4. Infections and infection control.

Infection control and knowledge of common infectious agents is a cornerstone of safe dental practice. This paper summarises the measures that need to be taken to control cross infection and discusses some of the infectious agents of concern to dental practitioners.