Participation of paediatric patients in primary dental care before and after a dental general anaesthetic.

PURPOSE: The aim of this retrospective study is to determine children's attendance and experience of preventative interventions and operative treatment (restorations and extractions) with their primary care dentist (PCD) in the 12 months before and after their caries management under dental general anaesthetic (DGA). METHODS: A record of all children who had an elective DGA in 2016 across two hospital sites was retrospectively obtained (n = 1308). A representative sample of 300 was randomly selected encompassing 114 dental practices. An online questionnaire to the children's PCDs collated quantitative and qualitative data regarding participation in the pre- and post-DGA period. RESULTS: Data was collated and analysed for 80 children (mean age: 6 years 10 months [SD = 2.49; range: 2 years 1 month - 14 years 3 months]; equal sex distribution) with 43 responding PCDs. Attendance for examination declined significantly from 85% (n = 68) pre-DGA to 57.5% (n = 46) post-DGA (p ≤ 0.001). Attendance at emergency appointments pre-DGA was high (33.75% [n = 27]); a significant reduction post-DGA was recorded (p ≤ 0.001). Over one third of children (37.5% [n = 30]) did not receive any form of preventative intervention over 24 months. A non-significant reduction in the provision of operative treatment was observed post-DGA (p = 0.06 [fill, primary]; p = 0.78 [fill, permanent]; p = 0.66 [ext, primary]). No statistical difference between age and treatment experience was found. Qualitative analysis revealed challenges in providing care included behavioural difficulties and poor attendance. CONCLUSION: Improvements are required in strategies employed to support high caries risk children pre- and post-DGA to facilitate a higher incidence of attendance and preventative intervention with PCDs.

Displaced intracapsular neck of femur fractures: Outcome of 810 hydroxyapetite coated (HAC) uncemented hemiarthroplasties.

A Cochrane review influenced new NICE guidelines, which recommended surgeons: Offer cemented implants to patients undergoing surgery with arthroplasty. However our trust routinely uses HAC uncemented stem (Taperloc®, Biomet) hemiarthroplasties. A review of a consecutive series of uncemented HAC stem hemiarthroplasties including measures such as intro-operative complications, mortality and revision surgery. Prospectively collected data between January 2008 and June 2014 was used, with medical record and radiographic reviews performed. 810 consecutive Taperloc uncemented hemiarthroplasty with monopolar heads were performed in 763 patients, with a minimum 12 month follow-up (12-90) follow-up. Mean age 83yrs; 71% female. Meantime to operation was 28.5h. 30day mortality: 4.4% (33/763). One year mortality was 11.2% (89/763). 2.5% (20/810) were admitted on a separate admission with the periprosthetic fracture. 0.6% (5/810) were revised to total hip replacement for subsidence and associated pain. Only 1% (8/810) had intraoperative calcar fractures, all of which were treated with intraoperative cabling with no evidence of clinically relevant subsidence or medium term complications requiring revision surgery within a year. To the author's knowledge this is largest outcome series for modern design uncemented hemiarthroplasty. Our study shows comparable data to cemented hemiarthroplasty but no deaths in the first 2days post-op. Our series also demonstrates a well below average mortality figures which are clearly multifactorial but believe uncemented prosthesis play a role. We believe that uncemented proven stem design hemiarthroplasty remains a safe and good surgical option for displaced intracapsular fractures.

Ilizarov management of Schatzker IV to VI fractures of the tibial plateau: 105 fractures at a mean follow-up of 7.8 years.

This study aimed to determine the long-term functional, clinical and radiological outcomes in patients with Schatzker IV to VI fractures of the tibial plateau treated with an Ilizarov frame. Clinical, functional and radiological assessment was carried out at a minimum of one year post-operatively. A cohort of 105 patients (62 men, 43 women) with a mean age of 49 years (15 to 87) and a mean follow-up of 7.8 years (1 to 19) were reviewed. There were 18 type IV, 10 type V and 77 type VI fractures. All fractures united with a mean time to union of 20.1 weeks (10.6 to 42.3). No patient developed a deep infection. The median range of movement (ROM) of the knee was 110(°) and the median Iowa score was 85. Our study demonstrates good long-term functional outcome with no deep infection; spanning the knee had no detrimental effect on the ROM or functional outcome. High-energy fractures of the tibial plateau may be treated effectively with a fine wire Ilizarov fixator.

Sectioning of a double tooth aided by cone-beam computed tomography.

BACKGROUND: Double teeth present challenges for their clinical management. Recent advances in imaging, particularly cone-beam computed tomography (CBCT), have aided clinicians in accurate diagnosis and management. Data from CBCT imaging can be used for three-dimensional reconstruction to further aid pre-surgical planning. CASE REPORT: A 14-year-old Caucasian male presented with an aesthetically unacceptable double tooth in the 22 region. Clinical and radiographic examination and assessment included CBCT imaging and three-dimensional reconstruction. TREATMENT: Based on this information, together with a comprehensive assessment of the patient's motivation, a treatment plan consisting of extra-alveolar sectioning, re-implantation, endodontic therapy and composite resin restoration was carried out. FOLLOW-UP: The patient failed to return for follow-up at 6 months post-treatment. However, he did return at 12 months, where clinical and radiographic examination was undertaken. At this point the tooth was clinically sound and bony infill was seen radiographically. CONCLUSION: The information gained from the pre-surgical imaging with CBCT was useful in planning treatment in this case. However, this had to be combined with a careful assessment of the patient's motivation to ensure that the course of treatment embarked upon was likely to be successful whilst addressing the patient's concerns.

A pilot improvement project in hospital-based oral healthcare: improving caries risk assessment documentation.

OBJECTIVE: To evaluate the impact of a continuous improvement project to improve completion of a caries risk assessment (CRA) and to assess its impact on delivery of dental caries prevention. DESIGN: Single centre clinical improvement project. SETTING: A paediatric dental department within a UK dental hospital over the course of 2008-2009.Subjects (materials) and methods Continuous monitoring of documentation of a CRA was instigated and results fed back to clinicians. Tools were developed to structure the process of CRA. After six months of intervention, a comparison of preventive care to a pre-intervention sample was undertaken. MAIN OUTCOME MEASURES: The main outcome measure was completion of a CRA. Comparison was also made with pre-intervention data on levels of preventive care received. RESULTS: Over the 12 month project the mean rate of CRA completion improved from 30% over the first 6 months to 73% in the second 6 months. Compared to the pre-intervention sample, all items of the caries prevention package had improved, with delivery of toothpaste strength advice (16% vs 60%, p = 0.001) and diet advice (32% vs 70%, p = 0.004) improving significantly. CONCLUSION: By targeting and improving CRA completion the quality of preventive care delivered has also significantly improved.