An international survey in postgraduate training in Oral Medicine.

OBJECTIVES: The aim of this preliminary study was to investigate postgraduate Oral Medicine training worldwide and to begin to identify minimum requirements and/or core content for an International Oral Medicine curriculum. MATERIALS AND METHODS: Countries where there was believed to be postgraduate training in Oral Medicine were identified by the working group. Standardized emails were sent inviting participants to complete an online survey regarding the scope of postgraduate training in Oral Medicine in their respective countries. RESULTS: We received 69 total responses from 37 countries. Of these, 22 countries self-identified as having postgraduate Oral Medicine as a distinct field of study, and they served as the study group. While there is currently considerable variation among Oral Medicine postgraduate training parameters, there is considerable congruency in clinical content of the Oral Medicine syllabi. For example, all of the training programs responded that they did evaluate competence in diagnosis and management of oral mucosal disease. CONCLUSIONS: This preliminary study provides the first evidence regarding international Oral Medicine postgraduate training, from which recommendations for an international core curriculum could be initiated. It is through such an initiative that a universal clinical core syllabus in postgraduate Oral Medicine training may be more feasible.

Experience of workplace bullying behaviours in postgraduate hospital dentists: questionnaire survey.

OBJECTIVES: To determine the prevalence of bullying and experience of bullying behaviours among postgraduate hospital dentists. DESIGN: Questionnaire survey. SETTING: The study was conducted among a sample of dentally qualified trainees within the UK's Hospital Dental Service. SUBJECTS AND METHODS: Two hundred and twenty-seven postgraduate hospital dentists were sent an anonymous questionnaire by the dental deans of participating deaneries. MAIN OUTCOME MEASURES: Prevalence of bullying and prevalence of experience of bullying behaviours; differences in experience of bullying and bullying behaviours by gender and ethnic group. RESULTS: One hundred and thirty-six hospital dentists returned the questionnaire, a response rate of 60%. Thirty-four (25%) identified themselves as victims of bullying, and 63 (47%) had witnessed their colleagues being bullied. Irrespective of whether or not they labelled themselves as victims of bullying, in the previous year 82 (60%) dentists had experienced one or more of the bullying behaviours included in the checklist. Overall, there was no statistically significant difference in experience of bullying behaviours by gender or ethnic group though non-white participants were significantly more likely than white participants to have experienced four of the bullying behaviours. CONCLUSIONS: Rates of bullying and experience of bullying behaviours among postgraduate hospital dentists were consistent with those reported in other NHS settings.

Nicotine replacement lozenges: abuse-related hyperkeratosis of the lateral border of the tongue. A case report.

A case of a white patch on the right lateral border of the tongue, found to be hyperkeratosis induced by long-term habitual placement of nicotine replacement lozenges (NiQuitin CQ) in the right lingual sulcus, is presented. The lesion became less evident once the patient varied the intraoral location and reduced his consumption of these tablets.

The management of fistulizing oral Crohn's disease with infliximab.

A 20-year-old female patient with oral Crohn's disease developed a fistula in her neck from a focus of intra-oral infection. Despite repeated courses of antimicrobial therapy over a period of several months, the fistula failed to resolve. However, following administration of infliximab, a monoclonal antitumour necrosis factor-alpha antibody, the fistula resolved spontaneously without the need for any further treatment.

Ligneous alveolar gingivitis in the absence of plasminogen deficiency.

A case of localized, longstanding, asymptomatic ligneous gingivitis affecting the crest of the edentulous lower left posterior alveolar ridge (ligneous alveolar gingivitis) of a middle-aged Caucasian woman is presented. This patient did not have any associated ophthalmic lesions (ligneous conjunctivitis) and did not have a plasminogen deficiency.

Oral medicine--update for the dental practitioner oral cancer.

This series provides an overview of current thinking in the more relevant areas of oral medicine for primary care practitioners, written by the authors while they were holding the Presidencies of the European Association for Oral Medicine and the British Society for Oral Medicine, respectively. A book containing additional material will be published. The series gives the detail necessary to assist the primary dental clinical team caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of illustrations of uncommon or rare disorders, or discussion of disorders affecting the hard tissues. Approaching the subject mainly by the symptomatic approach--as it largely relates to the presenting complaint--was considered to be a more helpful approach for GDPs rather than taking a diagnostic category approach. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.

Oral medicine--update for the dental practitioner orofacial pain.

This series provides an overview of current thinking in the more relevant areas of oral medicine for primary care practitioners, written by the authors while they were holding the Presidencies of the European Association for Oral Medicine and the British Society for Oral Medicine, respectively. A book containing additional material will be published. The series gives the detail necessary to assist the primary dental clinical team caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of illustrations of uncommon or rare disorders, or discussion of disorders affecting the hard tissues. Approaching the subject mainly by the symptomatic approach--as it largely relates to the presenting complaint--was considered to be a more helpful approach for GDPs rather than taking a diagnostic category approach. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.

Oral medicine -- update for the dental practitioner. Disorders of orofacial sensation and movement.

This series provides an overview of current thinking in the more relevant areas of oral medicine for primary care practitioners, written by the authors while they were holding the Presidencies of the European Association for Oral Medicine and the British Society for Oral Medicine, respectively. A book containing additional material will be published. The series gives the detail necessary to assist the primary dental clinical team caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of illustrations of uncommon or rare disorders, or discussion of disorders affecting the hard tissues. Approaching the subject mainly by the symptomatic approach -- as it largely relates to the presenting complaint -- was considered to be a more helpful approach for GDPs rather than taking a diagnostic category approach. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.

Oral Medicine--update for the dental practitioner: oral white patches.

This series provides an overview of current thinking in the more relevant areas of oral medicine for primary care practitioners, written by the authors while they were holding the Presidencies of the European Association for Oral Medicine and the British Society for Oral Medicine, respectively. A book containing additional material will be published. The series gives the detail necessary to assist the primary dental clinical team caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of illustrations of uncommon or rare disorders, or discussion of disorders affecting the hard tissues. Approaching the subject mainly by the symptomatic approach--as it largely relates to the presenting complaint--was considered to be a more helpful approach for GDPs rather than taking a diagnostic category approach. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.

Oral medicine--update for the dental practitioner: red and pigmented lesions.

This series provides an overview of current thinking in the more relevant areas of oral medicine for primary care practitioners, written by the authors while they were holding the Presidencies of the European Association for Oral Medicine and the British Society for Oral Medicine, respectively. A book containing additional material will be published. The series gives the detail necessary to assist the primary dental clinical team caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of illustrations of uncommon or rare disorders, or discussion of disorders affecting the hard tissues. Approaching the subject mainly by the symptomatic approach--as it largely relates to the presenting complaint--was considered to be a more helpful approach for GDPs rather than taking a diagnostic category approach. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.

Oral medicine--update for the dental practitioner: oral malodour.

This series provides an overview of current thinking in the more relevant areas of oral medicine for primary care practitioners, written by the authors while they were holding the Presidencies of the European Association for Oral Medicine and the British Society for Oral Medicine, respectively. A book containing additional material will be published. The series gives the detail necessary to assist the primary dental clinical team caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of illustrations of uncommon or rare disorders, or discussion of disorders affecting the hard tissues. Approaching the subject mainly by the symptomatic approach--as it largely relates to the presenting complaint--was considered to be a more helpful approach for GDPs rather than taking a diagnostic category approach. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.

Oral medicine -- update for the dental practitioner: dry mouth and disorders of salivation.

This series provides an overview of current thinking in the more relevant areas of oral medicine for primary care practitioners, written by the authors while they were holding the Presidencies of the European Association for Oral Medicine and the British Society for Oral Medicine, respectively. A book containing additional material will be published. The series gives the detail necessary to assist the primary dental clinical team caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of illustrations of uncommon or rare disorders, or discussion of disorders affecting the hard tissues. Approaching the subject mainly by the symptomatic approach -- as it largely relates to the presenting complaint -- was considered to be a more helpful approach for GDPs rather than taking a diagnostic category approach. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.

Oral medicine--update for the dental practitioner. Mouth ulcers of more serious connotation.

This series provides an overview of current thinking in the more relevant areas of oral medicine for primary care practitioners, written by the authors while they were holding the Presidencies of the European Association for Oral Medicine and the British Society for Oral Medicine, respectively. A book containing additional material will be published. The series gives the detail necessary to assist the primary dental clinical team caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of illustrations of uncommon or rare disorders, or discussion of disorders affecting the hard tissues. Approaching the subject mainly by the symptomatic approach--as it largely relates to the presenting complaint--was considered to be a more helpful approach for GDPs rather than taking a diagnostic category approach. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.

Oral medicine--update for the dental practitioner. Aphthous and other common ulcers.

This series provides an overview of current thinking in the more relevant areas of oral medicine for primary care practitioners, written by the authors while they were holding the Presidencies of the European Association for Oral Medicine and the British Society for Oral Medicine, respectively. A book containing additional material will be published. The series gives the detail necessary to assist the primary dental clinical team caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of illustrations of uncommon or rare disorders, or discussion of disorders affecting the hard tissues. Approaching the subject mainly by the symptomatic approach--as it largely relates to the presenting complaint--was considered to be a more helpful approach for GDPs rather than taking a diagnostic category approach. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.

Oral medicine--update for the dental practitioner lumps and swellings.

This series provides an overview of current thinking in the more relevant areas of oral medicine for primary care practitioners, written by the authors while they were holding the Presidencies of the European Association for Oral Medicine and the British Society for Oral Medicine, respectively. A book containing additional material will be published. The series gives the detail necessary to assist the primary dental clinical team caring for patients with oral complaints that may be seen in general dental practice. Space precludes inclusion of illustrations of uncommon or rare disorders, or discussion of disorders affecting the hard tissues. Approaching the subject mainly by the symptomatic approach--as it largely relates to the presenting complaint--was considered to be a more helpful approach for GDPs rather than taking a diagnostic category approach. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.

A novel mutation in the keratin 13 gene causing oral white sponge nevus.

White sponge nevus (WSN) is an autosomal-dominantly inherited form of mucosal leukokeratosis. Defects in keratins, proteins that form the stress-bearing cytoskeleton in epithelia, have been shown to cause several epithelial fragility disorders. Recently, mutations in the genes encoding mucosal-specific keratins K4 and K13 were shown to be the underlying cause of WSN. We have studied a large Scottish family with 19 persons affected by WSN in four generations. The K4 locus was excluded by genetic linkage analysis; however, genetic linkage consistent with a K13 defect was obtained. Subsequently, a heterozygous missense mutation 335A>G was detected in exon 1 of the KRT13 gene, predicting the amino acid change N112S in the 1A domain of the K13 polypeptide. The mutation was confirmed in affected family members and was excluded from 50 unaffected people by restriction enzyme analysis. These results confirm that mucosal keratin defects are the cause of WSN.

Bannayan-Riley-Ruvalcaba syndrome: report of a family.

Bannayan-Riley-Ruvalcaba (BRR) syndrome is a rare inherited condition. We describe the protean orofacial manifestations of this syndrome in one family and consider their management. The dental surgeon should be aware of this entity, its orofacial connotations and the possible association with Cowden's syndrome.

Aspects of cell proliferation in oral epithelial dysplastic lesions.

There is a need for objective methods of assessment of oral epithelial precancerous lesions and reliable markers for the prediction of malignant change in these lesions. Cell proliferation was examined in 20 dysplastic lesions from the tongue and floor of mouth using bromodeoxyuridine (BrdU) and Ki-67, and a histological compartment analysis was performed. Half of a fresh biopsy from each case was incubated in BrdU for 15 min, the other half was routinely processed and used for Ki-67 analysis. Sections from each block were immunohisto chemically stained with antibodies against BrdU and Ki-67. Dysplasia was graded according to the method of Smith & Pindborg. The BrdU labelling index (LI) and the growth fraction (GF), assessed by the use of Ki-67, was quantified and expressed as units per millimetre basement membrane length (BL) and per 100 total nucleated cells (TNC). The mean LI/TNC was 10.87 (SD 3.65) and the mean LI/BL was 51.55 (SD 20.75). The mean GF/TNC was 26.66 (SD 17.78) and GF/BL was 157.07 (SD 125.84). The mean epithelial thickness was 229.09 microm (SD 104.73). The LI/BL correlated with the atypia score and with the GF/BL. The progenitor compartment sizes also correlated with the atypia scores. The BrdU labelling index provides a further objective measurement of oral epithelial dysplasia and the progenitor compartments were large, implying that basal cell hyperplasia is a significant component of the dysplasia.

Allergy to a common component of resin-bonding systems: a case report.

Allergies to materials routinely used in dentistry are becoming more prevalent. The hydrophilic resin 2-hydroxyethyl methacrylate is a common constituent of systems designed to bond resin-based restorative materials to dentine. It has been considered to have a high sensitizing potential, although dental patient-related allergies to the resin appear to be rare. This report presents details of a patient who has such an allergy, which, it is suspected, manifested as an intra-oral lichenoid reaction to the closely approximating anterior restorations.