Oral potentially malignant disorders - An assessment of knowledge and attitude to future education in undergraduate dental students.

INTRODUCTION: The aim of this study was to assess the knowledge and clinical experience of oral potentially malignant disorders (OPMDs) in undergraduate dental students in six European countries (Croatia, France, Italy, Portugal, Spain and United Kingdom) and assess student's attitude and preference to future education on the topic. A secondary aim was to identify gaps in student's knowledge and clinical practice. The study was a part of the Erasmus+ project "Oral Potentially Malignant Disorders: Healthcare Professionals Training" (Grant No: 2020-1-UK01-KA202-078917). MATERIALS AND METHODS: An online questionnaire was distributed to all final-year students in six partner universities. This consisted of four parts assessing: (1) knowledge on OPMDs, (2) clinical experience with this group of patients, (3) self-rated competence in the management of OPMDs and (4) preferences with regard to future education. RESULTS: Two hundred and sixty final-year dental students from six partner universities responded to the questionnaire. Response rates varied from 12% to 92% between partner universities. Significant differences in clinical experience and knowledge were found between students. Students with more clinical exposure to OPMDs rated their knowledge and competence in the management of OPMDs higher than students with less clinical experience. The majority of students were interested in future education on OPMDs, preferably via short educational videos. CONCLUSION: The majority of students have received theoretical knowledge of OPMDs during their undergraduate studies, however, not all had clinical exposure to this group of patients. Students were open to further education on OPMDs. Important deficiencies in knowledge were identified that need to be addressed and it is anticipated that the e-learning platform and e-book that are in development by partner institutions will help to improve overall knowledge of OPMDs.

Patient experience of virtual consultations in Oral Medicine during the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic resulted in a rapid shift to the use of virtual consultations in both primary and secondary care. The aim of this study was to assess patient experience of virtual consultations (telephone and video) in the Oral Medicine department during the first wave of the COVID-19 pandemic. METHODS: A validated survey was developed with the Patient Experience Team in Guy's and St Thomas' NHS Foundation Trust. A combination of previously validated questions and newly validated psychometric questions were used to design the patient feedback questionnaire. The survey was administered to all patients following their virtual (telephone or video) consultation. Data were synthesised and electronically analysed. Qualitative data were thematically analysed. RESULTS: A total of 115 surveys were completed. Over 82% rated their experience as good or very good and 69% preferred a virtual consultation for their next consultation. Thematic analysis of individual comments identified positive themes including convenience and positive/helpful clinical experience. Areas for development identified from thematic analysis included accessibility and clinical limitations in not undertaking a physical examination. CONCLUSION: Overall, the patient experience of virtual consultations in Oral Medicine was positive.

Impact of wait times on spinal cord stimulation therapy outcomes.

OBJECTIVE: Presently, the long-term success rate of spinal cord stimulation (SCS) ranges from 47% to 74%. SCS efficacy is inversely proportional to the passage of time between development of chronic pain syndrome and time of implantation. To improve outcomes, implantation should be performed early. This study identifies sources of delay and offers suggestions for improvement. METHODS: A retrospective analysis of 437 SCS patients examines delays to accessing SCS at various points in the referral stream, from initial diagnosis, family physician, and various specialist treatments, to implantation. Analysis of variance evaluated the effect of age, sex, treating specialty, and their interactions on implantation delay. A multiple linear regression model was developed to assess factors contributing to implantation delay. RESULTS: From time of onset of chronic pain to implantation, patients endured a delay of 65.4 ± 2.04 months. Initial physician contact occurred at a mean of 3.4 ± 0.12 months after development of pain syndrome. Family physicians managed cases for 11.9 ± 0.45 months and various specialists for an additional 39.8 ± 1.22 months. Neurosurgeons were quickest to refer to an implant physician (average wait-time 32.28 ± 2.64 months), while orthopedic surgeons and nonimplanting anesthesiologists took the longest, contributing to wait times of 51.60 ± 5.04 months and 58.08 ± 5.76 months, respectively. Once the decision for implantation was made, the implanting physician required 3.31 ± 0.09 months to organize the procedure. A gradual decline in wait times was observed from 1980 to present. CONCLUSION: To improve SCS success rates, physicians involved in the treatment for chronic pain should refer these cases early to an implant physician once failure of medical management becomes apparent.

Malignant Transformation Rate of Oral Submucous Fibrosis: A Systematic Review and Meta-Analysis.

Oral submucous fibrosis (OSF) is a chronic progressive condition affecting the oral cavity, oropharynx and upper third of the oesophagus. It is a potentially malignant disorder. The authors collated and analysed the existing literature to establish the overall malignant transformation rate (MTR). A retrospective analysis of medical and dental scientific literature using online indexed databases was conducted for the period 1956 to 2021. The quality of the enrolled studies was assessed by the Newcastle-Ottawa Scale (NOS). A meta-analysis using a random effects model of a single proportion was performed along with statistical tests for heterogeneity. The overall proportion of malignancy across all studies was 0.06 (95% CI, 0.02-0.10), indicating an overall 6% risk of malignant transformation across all studies and cohorts. Sub-group analyses revealed strong differences in proportion of malignancy according to ethnicity/cohort; Chinese = 0.02 (95% CI 0.01-0.02), Taiwanese = 0.06 (95% CI, 0.03-0.10), Indian = 0.08 (95% CI, 0.03-0.14) and Pakistani = 0.27 (95% CI 0.25-0.29). Overall, the MTR was 6%; however, wide heterogeneity of the included studies was noted. Geographic variations in MTR were noted but were not statistically significant. Further studies are required to analyse the difference between cohort groups.