Oral Medicine for undergraduate dental students in the United Kingdom and Ireland-A curriculum.

INTRODUCTION: Oral Medicine focuses on care for patients with chronic, recurrent and medically related disorders of the orofacial region that are distinct from diseases of the periodontal and tooth tissues, with an emphasis on non-surgical management. At present, there are no shared outcomes for Oral Medicine to define the standards to be achieved before new graduates become registered dentists engaged with ongoing professional development. CURRICULUM: We present a consensus undergraduate curriculum in Oral Medicine agreed by representatives from 18 Dental Schools in the United Kingdom and Republic of Ireland. The scope of Oral Medicine practice includes conditions involving the oral mucosa, salivary glands, neurological system or musculoskeletal tissues that are not directly attributable to dental (tooth and periodontium) pathology. Account is taken of the priorities for practice and learning opportunities needed to support development of relevance to independent clinical practice. The outcomes triangulate with the requirements set out by the respective regulatory bodies in the UK and Republic of Ireland prior to first registration and are consistent with the framework for European undergraduate dental education and greater harmonisation of dental education. CONCLUSIONS: This curriculum will act as a foundation for an increasingly shared approach between centres with respect to the outcomes to be achieved in Oral Medicine. The curriculum may also be of interest to others, such as those responsible for the training of dental hygienists and dental therapists. It provides a platform for future collective developments with the overarching goal of raising the quality of patient care.

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.

Evolution of 2D tin oxides on the surface of molten tin.

The exfoliation of two dimensional (2D) oxides, established on the surface of specific liquid metals, has recently been introduced. One such liquid metal is molten tin, which forms a variety of surface 2D oxides. However, the development behaviour of these surface tin oxides is still unknown. Here the evolution of stoichiometry and thickness from single-layer SnO to highly oxidised multi-layer SnO2 in ambient oxygen is explored.

Compliance of NHS dental practice websites in Wales before and after the introduction of the GDC document 'Principles of ethical advertising'.

Objectives To evaluate the compliance of NHS dental practice websites in Wales, UK, with the 2012 GDC document Principles of ethical advertising, before its introduction (2011) and again after its introduction (2014).Methods All practices in Wales with an NHS contract and dental practice website were identified. The content of the website was evaluated to determine if it complied with the principles outlined in the 2012 GDC document Principles of Ethical Advertising.Results Twenty-five percent of the 446 practices sampled in 2011 had a website, compared to 44% of the 436 practices sampled in 2014. The principles best complied with were; displaying the name, geographic address, and telephone number of the practice (100% for both years). None of the websites compared the qualifications or skills of its practitioners to others, therefore 100% complied with this principle. Displaying team members' professional qualification and the country from which this is obtained was fairly well represented; 92% and 61% respectively in 2014; an improvement from only 50% and 49% respectively in 2011. Principles worst complied with were displaying the GDC's address (3% 2011; 9% 2014) or link to the GDC website (11% 2011; 7% 2014) and details of the practice complaints procedure (1% 2011; 5% 2014). Overall, no practice complied with all of the compulsory principles.Conclusion In both 2011 and 2014 no practice website was compliant with all the principles outlined in the 2012 GDC document Principles of ethical advertising. Reflecting results from previous studies, this study showed that compliance is slowly improving, yet over 4 years after the introduction of the mandatory principles, it remains that no practice website is 100% compliant.

Benefits of telemonitoring in the care of patients with heart failure.

Telemonitoring involves remotely monitoring patients' vital signs. It is an innovative and promising development in the care of people with heart failure that may reduce hospital admissions and the burden on the NHS, as well as improve patients' quality of life and clinical outcomes. This article describes what telemonitoring is and explores the evidence base for its use. The role of the nurse in telemonitoring is also discussed, with particular reference to dealing with and responding to alerts. The development and implementation of new technology is essential to improve the delivery of healthcare and optimise patient outcomes, and telemonitoring may play an important role in the future of heart failure services.

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.

Estimating sediment and caesium-137 fluxes in the Ribble Estuary through time-series airborne remote sensing.

High spatial and temporal resolution airborne imagery were acquired for the Ribble Estuary, North West England in 1997 and 2003, to assess the application of time-series airborne remote sensing to quantify total suspended sediment and radionuclide fluxes during a flood and ebb tide sequence. Concomitant measurements of suspended particulate matter (SPM) and water column turbidity were obtained during the time-series image acquisition for the flood and ebb tide sequence on the 17th July 2003 to verify the assumption of a vertically well mixed estuary and thus justifying the vertical extrapolation of spatially integrated estimate of surface SPM. The ¹³7Cs activity concentrations were calculated from a relatively stable relationship between SPM and ¹³7Cs for the Ribble Estuary. Total estuary wide budgets of sediment and ¹³7Cs were obtained by combining the image-derived estimates of surface SPM and ¹³7Cs with estimates of water volume from a two-dimensional hydrodynamic model (VERSE) developed for the Ribble Estuary. These indicate that around 10,000 tons of sediment and 2.72 GBq of ¹³7Cs were deposited over the tidal sequence monitored in July 2003. This compared favourably with bed height elevation change estimated from field work. An uncertainty analysis on the total sediment and ¹³7Cs flux yielded a total budget of the order of 40% on the final estimate. The results represent a novel approach to providing a spatially integrated estimate of the total net sediment and radionuclide flux in an intertidal environment over a flood and ebb tide sequence.

Numb chin syndrome: a case series and discussion.

Numb chin syndrome is a sensory neuropathy in the distribution of the mental or inferior alveolar nerve. It may occur in benign disease, both systemic and dental in origin. It is also an under appreciated sign of malignancy. We present six cases from our experience highlighting the varied presentation and briefly review the aetiology, pathogenesis and management of numb chin syndrome and stress its importance with regards to the association with malignant disease.

Lung cancer mortality at a UK tin smelter.

BACKGROUND: An earlier study of mortality among male former employees at a tin smelter in Humberside, UK, had identified excess mortality from lung cancer, which appeared to be associated with occupational exposure. AIMS: The aim of the present study was to investigate the relationship between lung cancer mortality and quantitative measures of exposure. METHODS: Using available records of occupational hygiene measurements, we established exposure matrices for arsenic, cadmium, lead, antimony and polonium-210 ((210)Po), covering the main process areas of the smelter. We established work histories from personnel record cards for the previously defined cohort of 1462 male employees. Three different methods of extrapolation were used to assess exposures prior to 1972, when no measurement results were available. Lung cancer mortality was examined in relation to cumulative inhalation exposure by Poisson regression analysis. RESULTS: No significant associations could be found between lung cancer mortality and simple cumulative exposure to any of the substances studied. When cumulative exposures were weighted according to time since exposure and attained age, significant associations were found between lung cancer mortality and exposures to arsenic, lead and antimony. CONCLUSIONS: The excess of lung cancer mortality in the cohort can most plausibly be explained if arsenic is the principal occupational carcinogen (for which the excess relative risk diminishes with time since exposure and attained age) and if there is a contribution to excess mortality from an enhanced prevalence of smoking within the cohort. The implications of the dose-response for arsenic exposure for risk estimation merit further consideration.

Oral mucosal lesions in a UK HIV/AIDS oral medicine clinic. a nine year, cross-sectional, prospective study.

PURPOSE: To investigate changes in presentation of oral mucosal lesions in patients with HIV/AIDS attending a dedicated oral medicine clinic over a nine year period. MATERIALS AND METHODS: 358 Patients with HIV/AIDS attending a dedicated oral medicine clinic, contained within a genitourinary medicine clinic. Data was collected prospectively for all patients attending the oral medicine clinic, and entered into a database. Lesions were recorded according to the EEC-WHO diagnostic criteria 1991/1993. RESULTS: In 358 patients with 542 lesions, over 54% of the lesions belong within one of the five categories of ulcers, warts, candidiasis, OHL and Kaposi's sarcoma. The major differences in the presentation of the lesions over time were between the ulcers and the warts, but in this series the introduction of HAART did not make a statistical difference. CONCLUSIONS: There has been a large reduction in the presentation of oral ulcers, and there appears to be a relative increase in viral papillomata, and a decrease of other mucosal diseases over the period of study. Many of the warts biopsied showed dysplastic changes, and continued follow-up of these patients will be important to determine whether these patients are at increased risk for developing oral squamous carcinoma. Also, proposals are put forward suggesting a need for alteration of the three groups of HIV/AIDS lesions classification suggested by the EEC-WHO consensus.

Minor recurrent aphthous stomatitis and smoking: an epidemiological study measuring plasma cotinine.

OBJECTIVE: To compare blood cotinine levels between a group of patients with minor recurrent aphthous stomatitis (RAS) and a group representative of the general population, matched for age and gender. SETTING: Although smoking has been implicated as a protective factor in RAS, few studies have compared the prevalence of smoking in RAS patients with population controls. Cotinine is a smoking derivative with a long half-life in the circulation. Measurement of plasma cotinine levels provides an accurate and objective measurement of an individual's cigarette consumption. METHODS: Blood samples were taken from 84 RAS patients and 81 controls. A microplate enzyme immunoassay (EIA) was used to detect plasma cotinine levels. RESULTS: The number of RAS patients [2 (2.4%)] who were smokers (plasma cotinine > 25 microg ml(-1) was significantly lower than in the control group [12 (14.8%); P = 0.00102]. Furthermore, the mean cotinine level amongst smokers in the RAS group was significantly lower than in smokers in the control group (P = 0.0068). CONCLUSION: This study shows that a group of RAS patients is significantly less likely to contain smokers than a matched control population, and among smokers the level of cigarette use was significantly lower in RAS patients than the control population. The perceived negative association between RAS and smoking was supported by this epidemiological study.

Metalloproteinase expression in normal and malignant oral keratinocytes: stimulation of MMP-2 and -9 by scatter factor.

Matrix metalloproteinases (MMPs) are Zn2+ dependent proteases produced by a variety of cell types. They have a fundamental role in tissue remodelling, tumour invasion and metastasis. Scatter factor (SF), secreted by fibroblasts, has a paracrine action on epithelial cells and binds the trans-membrane c-met receptor inducing loss of adhesion, cell motility and invasiveness in vitro. The purpose of this study was to test if SF can regulate the production of MMPs by epithelial cells. Supernatants from oral squamous cell carcinoma-derived cells (H375 and H376), a human keratinocyte line (UP), and primary cultures of oral mucosal keratinocytes, grown in the presence or absence of SF, were analysed using 0.1% gelatin zymography. MMPs were characterised by comparison with human recombinant enzymes and by the use of specific inhibitors. Oral mucosal keratinocytes, UP, and H357 cells expressed MMP-2 and MMP-9, whilst H376 cells only expressed MMP-2. SF increased the expression of MMP-9 in UP and MMP-2 in H376 supernatants. Both MMP-2 and MMP-9 activity were increased in H357 and normal keratinocyte supernatants. This could be blocked using a human recombinant anti-SF antibody. In all epithelial lines tested, c-Met, the cell surface receptor for SF, could be detected. The results indicate that SF stimulates MMP expression in UP, H376, H357, and normal oral mucosal cells and points to a role for SF in the regulation of oral keratinocyte behaviour in wound healing and neoplasia.

The epidemiology of serious adverse drug reactions among the elderly.

Although the incidence and prevalence of serious adverse drug reactions (ADRs) in the elderly cannot be accurately stated, published estimates appear to be unchanged since the earliest reports in the 1960s. Whereas heightened awareness of the problem may weigh in favour of a reduction in ADR frequency, the dramatic increase in the number and availability of therapeutic agents has undoubtedly contributed to the observed high proportion of drug-induced morbidity among acute geriatric hospital admissions. No single drug or drug class is of particular concern since none appears to cause serious morbidity out of proportion with its use. Although numerous studies have sought to identify risk factors for ADRs, the only truly independent predictor is the absolute number of concurrently used medications. However, other studies indicate that there is poor doctor-patient agreement regarding a patient's drug regimen, and interventions that aim to reduce the incidence of ADRs have failed to demonstrate a positive effect. Thus at present the most rational approach would appear to be to establish an accurate knowledge of the patients drug regimens: once this is known one can attempt to rationally minimise the number of medications without compromising therapeutic goals.

The influence of information provided by patients on the accuracy of medication records.

OBJECTIVE: To assess two interventions for improving the accuracy of doctors' information about their patients' medication. DESIGN AND SETTING: A 12-month two-armed (parallel designed) prospective study among elderly patients of four general practitioners (GPs) in two local government areas of Sydney's North Shore. PATIENTS: 206 elderly, ambulant, self-caring patients (69 men, 137 women; median age, 75 year; range, 60-94 years). INTERVENTION: Patients were issued with a medication record card (MRC), filled in by their GPs with what they believed to be the patient's current medications, and were asked to produce it at all subsequent consultations. Patients of two of the GPs were additionally asked to bring their currently used medications to all scheduled appointments. MAIN OUTCOME MEASURE: Accuracy of the MRC, determined by confirmatory home visits and inspection of medications by a pharmacist. RESULTS: The proportion of patients with regimens recorded accurately on their MRCs improved significantly (from 25.9% to 42.0%) only in the group asked to bring their medications to consultations (P = 0.03). Most errors of recording were of omission, with patients taking a median of two medications (range, 0-10) of which their GPs were not aware. CONCLUSION: Requesting that patients bring their medications to consultations, in conjunction with the use of medication record cards, can improve information for doctors about their patients' medications.