Does dental rehabilitation under general anaesthetic contribute to the development of temporomandibular disorders in children and adolescents? A scoping review.

BACKGROUND: Temporomandibular disorders (TMDs) have multiple aetiological factors. Although some evidence suggests invasive and lengthy dental procedures may contribute towards TMD development, there is a relative paucity in the literature regarding an association between elements of paediatric dental general anaesthesia (pDGA) and TMDs. This review aims to consider the impact of dental rehabilitation (and its constituent elements) performed under general anaesthesia on the development of TMDs in childhood and adolescence and identify theories and/or gaps in knowledge which may benefit from future research. METHODS: Due to the need to preliminarily examine the nature and extent of the current evidence base, a scoping review approach was chosen. The review was conducted based on the framework provided by the methodological working group of the Joanna Briggs Institute (JBI) for conducting systematic scoping reviews. Electronic databases MEDLINE, Embase, Scopus, Web of Science and Cochrane Library were searched as well as the grey literature using OpenGrey, Nexis, Ethos, Google Scholar and ProQuest, with eligible studies uploaded onto Zotero (Mac Version 5.0.96.2). RESULTS: A total of 810 records were identified. After removing duplicates and those not available in English, 260 were identified for title and abstract screening. Seventy-six records underwent full-text review of which only one met the broad inclusion criteria. The most common reasons for exclusion were no specific relation to general anaesthesia, not specifically relating to dental treatment and only being concerned with TMD management. The included study found that while development of TMDs following dental rehabilitation under GA did occur in children, whether the problems caused by treatment were exacerbated by other elements of the pDGA process remains unknown. CONCLUSION: This review has confirmed a distinct paucity of research in this field. While there is no current tangible scientific evidence that common and routine dental procedures lead to TMD, the literature shows that alterations to any one or a combination of critical factors can contribute to TMD development, which may be collectively exacerbated by iatrogenic macrotrauma during the pDGA process. We have highlighted elements of pre-, peri- and post-operative pDGA, alongside biopsychosocial factors, which may contribute to TMD development in childhood and adolescence and may benefit from future research.

Classifying Children's Behaviour at the Dentist-What about 'Burnout'?

In children and young people, complex and prolonged dental treatment can sometimes be met with resistance despite previously successful treatment appointments. While this has traditionally been referred to as a 'loss of cooperation' or 'non-compliance', these children may actually be experiencing 'burnout', of which many may have the potential to recover and complete their course of treatment. Burnout has been defined as "the extinction of motivation or incentive, especially where one's devotion to a cause or relationship fails to produce the desired results". Traditionally, burnout is experienced by those who deliver services rather than be in receipt of a service; however, the burnout concept proposed in this paper explores it as an alternative perspective to other dentally relevant psychosocial conditions and should be considered when employing appropriate behaviour management techniques and coping strategies for paediatric patients. The intention of this paper is not to establish firm grounds for this new concept in healthcare, but to start a discussion and motivate further theoretical and empirical research. The introduction of the 'burnout triad model' and the importance of communication aims to highlight the tripartite influence of patients, parents and professionals engaged in the central 'care experience' and underlines the belief that early recognition and management of potential signs of burnout may help reduce the likelihood of those involved developing the condition.

The 'five star' fallacy: an analysis of online reviews and testimonials of dental practices in Northern England.

Aims and objectives To develop a greater understanding of how dental practices in the UK utilise and promote patient reviews and testimonials. To compare and contrast the star ratings, levels of engagement and levels of identifiability by comparing those placed by patients on social media, review websites and search engines, to those placed on providers' own websites. To provide recommendations for future advertising guidance.Materials and methods All practices providing dental services in North East England and Cumbria were identified from the Care Quality Commission database. A web-based Google search for the respective dental practice websites, NHS listings, Facebook pages and Google results page listings was performed. The presence or absence of patient testimonials and reviews was recorded, alongside the total number of testimonials/reviews and the number of non-identifiable testimonials/reviews. Data were analysed using Microsoft Excel and SPSS Statistics.Results Of the 401 practice websites, 19.7% (n = 79) contained at least one graded review, while 40.9% (n = 158) of the 386 NHS listings; 87.2% (n = 272) of the 343 Facebook pages; and 94.4% (n = 442) of the 468 Google listings also contained at least one graded review. All of the 1,798 testimonials observed on practice websites were positive in their sentiment. Further, 22 practices utilised video testimonials. Each of the online review locations showed overall mean scores above 4.5 out of 5 stars.Conclusions Dental practice websites, the NHS website, Facebook and Google utilise testimonials and reviews in distinct and diverse ways. Unlike other jurisdictions around the world, the UK does not have guidance in this area. Electronic word of mouth is often replete with bias, and as such, patients need to be encouraged to seek out multiple sources before decision-making. Facebook and Google may be perceived to be more 'trustworthy' sources of information as they appear less curated and less susceptible to manipulation than practice websites, which the public may feel gives greater credence to the information they provide. In order to achieve the highest standards of integrity and honesty, advertising guidance surrounding reviews and testimonials would benefit from future revision.

Mind the 'GAPP': a pre-graduation assessment of preparedness for practice amid a pandemic.

Introduction 'Preparedness for practice' refers to a multifaceted concept, encompassing not only clinical skills, but also broader, non-clinical skills, such as communication and professionalism. Previous graduates have reported feeling less prepared for complex procedures, such as molar endodontics and surgical extractions. Dental students typically utilise their final year to refine their clinical skills, however, the COVID-19 pandemic has meant that newly qualified dentists will have had around six months where they have not performed clinical dentistry before beginning dental foundation training (DFT).Aims This study aimed to explore final year students' self-reported preparedness for practice, identify areas of relative weakness that may influence future training needs and to highlight any perceived impact of the pandemic on final year experience and potential impact on DFT.Materials and methods The current Graduate Assessment of Preparedness for Practice (GAPP) questionnaire was adapted for our specific research aims and piloted and the PreGAPP questionnaire distributed via the social media channels of dental school student societies. Analysis was carried out using IBM Statistical Package for the Social Sciences software using descriptive statistics and the Mann-Whitney U test for two unrelated variables.Results Responses were received from final year students across all 16 UK dental schools. Students reported increased preparedness across domains in which they had the most experience; for example, providing preventative advice and administering local anaesthesia. Male students reported feeling significantly more prepared than female students, mature students significantly more than younger students, and students on four-year courses significantly more than traditional five-year courses. The COVID-19 pandemic was expected to have a major-to-severe impact on undergraduate experience and future DFT prospects.Conclusion Dental graduates in the COVID-19 era may have significantly different training needs to those before them. Complex clinical procedures remain the areas where students feel they are least prepared for practice. The importance of a clinical passport to highlight current experience level to trainers, alongside the creation of a personal development plan at the beginning of DFT, will ensure that targeted and personalised training can be implemented where required.

Dental foundation training in the COVID-19 era - the national recruitment lottery.

National recruitment has radically transformed the selection and allocation of dental graduates to dental foundation training (DFT) schemes across England, Wales and Northern Ireland, with recruitment in Scotland via a separate, independent process. It has been reported as a mostly positive change to the previous deanery-led model, in which nepotism allegedly featured too widely. A candidate's ranking is typically based on performance across two face-to-face assessments and a situational judgement test (SJT). The COVID-19 pandemic, however, has created a recruitment 'lottery' of sorts, in which ranking for 2021 is now solely based on the SJT. Subject matter experts assert that neither preparation nor revision for the SJT is required; yet, following the announcement of the adaptation to DFT recruitment for September 2021, a rapid rise of exorbitantly priced SJT question banks, mock papers, workshops and courses has ensued - a shameless monetisation of the collective angst and increased pressure faced by dental students. Preparation courses present a conceivable risk of SJT 'coaching' and 'faking'. Where medicine leads, dentistry usually follows and future selection to DFT needs to strongly consider the introduction of academic performance measures. SJTs remain one of the most well-accepted, reliable and cost-effective means of selection into healthcare roles, however, only when part of a wider selection process.

Advertising and facial aesthetics in primary care: how compliant are practice websites and social media with published guidance?

Aims and objectives To assess compliance of dental practices across North East England and North Cumbria (NENC) with General Dental Council (GDC) Guidance on advertising and Advertising Standards Agency-Committee of Advertising Practice (ASA-CAP) Regulation 12.12 - prohibition of marketing prescription-only medicines/treatments to the public. To provide checklists for registrants to safeguard their own compliance with GDC guidance and ASA-CAP advertising regulations.Materials and methods All premises providing dental care in NENC were identified from the Care Quality Commission (CQC) database and subsequently checked against the GDC Guidance on advertising and the ASA-CAP code for advertising prescription-only medicines, specifically relating to aesthetic treatments.Results Of the 450 dental practices sampled, 84.7% had a website, 72.7% had a Facebook page and 34% had an Instagram account. Only seven websites (1.8%) were fully compliant with GDC advertising guidance. Of the 450 practices sampled, 148 websites, 51 Facebook pages and 41 Instagram accounts mentioned or offered skin treatments. Only six websites and three Facebook pages were fully compliant. No Instagram accounts were compliant.Conclusions Compliance with the most up-to-date advertising guidelines from the GDC and ASA-CAP is generally poor. A lack of registrant knowledge surrounding the scope of guidance available has most likely resulted in inadvertent non-compliance. Checklists should help improve compliance.

The Six-Year-Old 'Adult'.

Children are not miniature adults, yet when a child celebrates their sixth birthday, little do they know that, with the arrival of their first 'adult' tooth, they are about to gain their first real experience of being a 'grown-up'. The age of six is a key milestone in the mental, physical and emotional wellbeing of children, with most children in the UK having commenced primary school education by their fifth birthday. Six-year-olds are about to enter the most critical period in their dental development, the mixed-dentition phase, where their mouths are in a near continuous state of flux. This pivotal age in their dental development should not be undervalued; the dental decisions we make at this age means childhood lasts a lifetime. Caries is the most prevalent, preventable global disease, and with one in four children suffering from dental caries in the primary dentition by the time they start school, the foundations we lay down at the age of six translate into lifelong benefits for the permanent dentition. In this paper, the aim is to demonstrate that at the age of six we get a second chance to get things right. From caries risk factors and tailoring the five pillars of prevention by educating parents on the developing dentition, to reinforcing the importance of habit-breaking, developmental anomalies of enamel and early orthodontic intervention, this paper describes the importance of the age of six, never before so exclusively expressed in a dental sense.

The blue palate-A case series of imatinib-related oral pigmentation and literature review.

Pigmented oral mucosal lesions are diverse, and differential diagnosis can range from benign conditions such as oral melanotic macule to malignancies such as oral malignant melanoma. Imatinib mesylate is a tyrosine kinase inhibitor used as a first-line medication in the management of oncohematological conditions such as chronic myeloid leukemia and gastrointestinal stromal tumors. Side effects of imatinib therapy are common, and paradoxically imatinib has been associated with both hypo- and hyperpigmented lesions, the underlying mechanism for which is still unclear. Hyperpigmentation associated with imatinib therapy is a potentially underreported phenomenon. This article presents an in-depth, clinicopathological review of the literature surrounding imatinib-related hyperpigmentation, alongside a case series of imatinib-related oral pigmentation with notable practical learning points. A pragmatic flowchart to help clinicians in the diagnosis and management of oral pigmented lesions is provided, as well as advice on the application of the ABCDE criteria to standardize recording of oral pigmented lesions.

Colour fidelity: the camera never lies - or does it?

Digital dental photography has rapidly evolved into one of the most powerful tools in the dental world from documentation of dento-legal information to communication, portfolio creation, advertising and marketing. Human memory has been described as terribly short and decidedly fickle. Photography provides the solution to this, aiming to capture in an image the precise picture seen by the naked human eye. Accurate and true reproduction of colour in an image is one of the most important elements in dental photography. Dental photography can mistakenly be viewed as overly technical and unreasonably complex. We present a simple and innovative, yet incredibly inexpensive, way to faithfully reproduce colour in an image. The importance of file format is explored alongside the risks of image manipulation, teledentistry and the consequences of misleading advertising campaigns.

Dental core training: the trainee perspective.

Dental core training (DCT) is a postgraduate training period, eligible following successful completion of foundation/vocational training, which has multiple entry points and endpoints with a varied duration from one to three years. The introduction of national recruitment in 2017, away from a previous individual deanery-led process, has introduced new variables such as a ranking system for choosing training posts, with the outcome dependent on combined performance at interview and a situational judgement test for which competition is nationally against other applicants. This unique, trainee-led study provides an appreciation and understanding of the motivations and experiences of trainees who pursue DCT, such as the rationale behind location and speciality choice, the perception of national recruitment and the situational judgement test, and the influence of salary variation, alongside trainee perceptions and experiences of the training programme from inside the trainee perspective. Undertaking DCT is not a 'forever decision' and will stand the trainee in good stead in pursuit of speciality training or a return to general practice, with a wide variety of opportunities that can lead to fulfilment and a rewarding career pathway for enthusiastic dentists.

Mandibular third molars: 'naughty' or NICE?

The 20-year anniversary of the implementation of NICE TA1 - Guidance on the Extraction of Wisdom Teeth - arrived in March 2020. Since its implementation, impaction of erupted or partially erupted mandibular third molars and the associated increased caries risk in second molars has been a topic widely debated in both general practice and hospital settings. This has led to significant variation in the management observed. Radiographic examination of carious second molars with an associated impacted third molar is not routine and is commonly a coincidental finding following routine bitewing examination in an otherwise symptom-free, healthy mouth. Caries in mandibular second molars is a clear oversight in NICE guidance, with management decisions influenced by personal philosophy, clinical judgement and experience. NICE guidance is exactly that; guidance, an aid to help our and the patient's decision-making. Consideration should be given to caries risk assessment and the judicious use of radiographs as well as clinical expertise, taking account of patient values on a case-by-case basis when deciding if teeth should be kept or removed.

Nasofrontal dermoid cyst: rare presentation of a philtrum sinus.

Congenital midline nasal lesions are extremely rare, and nasal dermoids are their most common presentation. To the best of our knowledge, only two cases of a philtrum sinus with skull base extension have been reported previously. A 3-year-old boy presented to the maxillofacial department with a discharging upper lip sinus that had been present from birth. No other congenital abnormalities were reported. Initially this sinus was assumed to be blind-ended and excised under general anaesthetic, but the area then failed to heal. Radiological work-up showed a patent dermal sinus that extended from the infranasal region through the nasal septum into the basal aspect of the anterior cranial fossa. The patient was referred for multidisciplinary management. A high index of suspicion of nasofrontal dermoid should be exercised when a patient presents with an upper lip sinus and recurrent discharge, until it is proven otherwise.