A Systematic Review and Meta-Analysis of the Role of Sugar-Free Chewing Gum in Dental Caries.

OBJECTIVE: To determine the difference in level of dental caries in adults and children who chew sugar-free gum (SFG), compared with those who do not chew SFG or use alternatives such as lozenges, candies, rinses, tablets, and other nonchewing controls. METHODS: Systematic review of published literature. RESULTS: Twelve studies of interventions of SFG for dental caries outcomes were included. SFGs were found to significantly reduce caries increment, giving a preventative fraction (PF) of 28% (95% CI, 7% to 48%). Including the 8 trials that used xylitol gum only as the basis of the intervention, the PF was 33% (95% CI, 4% to 61%). No adverse effects were recorded. There was a high level of heterogeneity among the trials included. CONCLUSION: The findings of this review provide tentative evidence that chewing SFG reduces caries increment in comparison to nonchewing controls. However, there is a considerable degree of variability in the effect and the trials included were generally of moderate quality. There is a need for future research to explore the acceptability and feasibility of the use of SFG as a public health intervention (PROSPERO 2018 CRD42018094676). KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by clinicians when deciding how best to implement dental caries prevention regimes for their patients. With consideration of cost and patient preference, this information could help to develop national policy directives on caries prevention and dictate the direction of future clinical research.

Pilot study to train dentists to communicate about oral cancer: the impact on dentists' self-reported behaviour, confidence and beliefs.

OBJECTIVES: To evaluate the effect of a brief, focused training session on the use of an oral cancer communication guide on dentists' intentions, self-efficacy and beliefs with regards to communicating about oral cancer with patients. DESIGN: Pre-post intervention study. SETTING: The training session took place in a lecture theatre at King's College London. SUBJECTS AND METHODS: Dentists working in various settings were trained on the use of the oral cancer communication guide via a structured session that included an update on oral cancer, modelling the use of the guide in practice, and role playing. Dentists (n = 39) completed questionnaires pre-training, immediately post-training (n = 31) and after 2 weeks (n = 23). Questionnaires assessed current practice, self-efficacy and barriers to discussing oral cancer. RESULTS: A significantly higher proportion of dentists reported that they informed patients that they were being screened for oral cancer post-training (44%) than pre-training (16%). Significantly fewer perceived barriers and higher self-efficacy to discuss oral cancer were also reported. CONCLUSION: Training dentists in the use of the guide showed positive impact by reducing perceived barriers and increasing self-efficacy.

Why don't dentists talk to patients about oral cancer?

OBJECTIVES: Up to half of oral cancer patients are diagnosed with advanced lesions. One route to early diagnosis could involve dentists raising awareness of oral cancer through discussions with patients, emphasising prompt help-seeking. This study explores opinions and practices of dentists regarding discussing oral cancer with patients including views on barriers and facilitators. DESIGN: Qualitative in-depth interviews.Setting Dentists working in general dental practices in the United Kingdom were interviewed in 2013. SUBJECTS AND METHODS: In-depth interviews with dentists (n = 16) were conducted. Interviews were audio-recorded and transcribed. Data was analysed using framework analysis. RESULTS: Dentists recognised the importance of raising awareness but identified several barriers to discussions including system factors (for example, time constraints and a lack of financial incentive), patient factors (for example, fear of invoking undue anxiety) and dentist factors (for example, a lack of sufficient knowledge, training and self-confidence). Facilitators included developing practice standards and good dentist-patient relationships. CONCLUSION: Identified barriers may hold back efforts to raise awareness of oral cancer and could be targeted in future initiatives to encourage early detection.

Spontaneous Appendicocutaneous Fistula: A Case Report

Ruptured appendicitis is not a common cause of spontaneous enterocutaneous fistula. A case of ruptured retrocaecal appendicitis presenting as an enterocutaneous fistula in a Nigerian woman is presented. The literature on this disorder is also reviewed

Ectopic pregnancy in a rural practice.

A 13 year retrospective review of 117 cases of rupture ectopic pregnancy presenting in a rural practice in Oyo State, Nigeria was conducted to determine the clinical pattern and management modalities in this common gynaecological emergency. It showed that the incidence was low due to a low incidence of pelvic inflammatory disease at laparatomy. Autotransfusion and application of appropriate technology in health care delivery played a dominant role in the management of the patients. The mortality rate of 5.9% is still high. Identified contributory factors such as ignorance and inadequate social infrastructure need government intervention to reduce the death rate.

Seminal fluid changes after testicular torsion.

A study was undertaken to determine the changes in the seminal fluid of adult patients presenting with unilateral testicular torsion. There was beneficial effect from excising an infarcted torsive testis and a deleterious effect from retaining it.