AAA: a rock and a hard place.

Introduction This retrospective analysis sought to ascertain the effect of the advice, analgesia and antibiotics (AAA) regimen upon the appropriateness of antibiotic prescribing for those patients attending for emergency dental extraction at the Department of Oral Surgery, King's College Dental Hospital (KCDH), London. This has subsequently been used as a foundation upon which to discuss the potential factors that are likely to have had an effect upon the prescribing patterns of general dental practitioners (GDPs) throughout the United Kingdom (UK) at this time and possible future implications should the UK experience a second mandatory closure of primary care dental settings.Materials and methods Retrospective data collection for patients attending for emergency dental extractions was performed at the Department of Oral Surgery, KCDH. Data were collected between March-June 2020 during KCDH's designation as an urgent dental care hub.Results In total, 1,414 patients attended for emergency dental extraction. Four hundred and seventy-one (33.3%) patients sought advice from their GDP before contacting KCDH's emergency dental triage service. Prior to attending KCDH for emergency dental extraction, 665 (47%) patients were prescribed antibiotics by a primary care health provider.Conclusion Our findings suggest that the AAA regimen may have inadvertently contributed to inappropriate prescription of systemic antibiotics by GDPs.

Guide for commissioning oral surgery: the development of a calibration tool.

Aims In previously published work a calibration tool used within the Department of Oral Surgery, King's College Dental Hospital London, identified a consensus of 68% in classifying levels of complexity of cases as per NHS England's Guide for Commissioning Oral Surgery and Oral Medicine. The authors postulated that the same challenges in triaging patients would be experienced by clinicians working in less supported environments. A pilot survey attempted to ascertain the level of compliance with the commissioning framework on a national scale.Materials and methods Twenty cases treated at the Department of Oral Surgery, King's College Dental Hospital London, were identified for inclusion. Radiographs and case histories were compiled within an online questionnaire and circulated via NHS email links and online e-questionnaire platforms. Results were analysed by a specialty registrar and consultant in oral surgery.Results One hundred and fifty-four responses were received. An average of 66.2% responses received were in agreement with the predetermined answers of the survey.Discussion The results can be interpreted as a consensus of 66.2% nationally, which is similar to previous local results. This study demonstrates shortcomings of the commissioning framework, conflicts between the commissioning framework and the oral surgery training curriculum and ambiguity of modifying factors. Collectively, these may in some cases result in greater inefficiencies of care.

Mandibular division trigeminal nerve injuries following primary endodontic treatment. A case series.

The aim of this study is to report a series of patients with mandibular division trigeminal nerve (V3 ) injuries secondary to endodontic treatment, evaluate presentation characteristics and identify prevention strategies. This article describes a retrospective review of patients referred to a tertiary clinic 2007-2015 with V3 injury following endodontic treatment. The sample included 12 male and 16 female patients with a mean age of 41.5 years. Sixteen cases presented following endodontic treatment of the first and second molar, premolar teeth in eight cases and canine in two cases. Fifteen patients reported immediate post-operative symptoms, in eleven cases there was a 24-48 h asymptomatic period. The average referral delay was 23.1 months. Twenty patients had permanent neuropathy. Four patients experienced resolution of symptoms within 8 weeks. V3 injury following endodontic treatment is rare but can result in permanent neuropathy and functional impairment. This can be avoided through comprehensive pre-operative radiographic examination, identification and referral of high-risk cases.