Integration of mental health screening in the management of patients with temporomandibular disorders.

Mental health disorders such as depression or anxiety, or both, are more common in patients with temporomandibular disorders (TMD) (16%-40%) than in the general population (16%), and failure to recognise them may be detrimental to the management of TMD. Paper-based screening tools previously reported in this group require assessment by clinicians and subsequent collation of data. We describe our experience of a new system - IMPARTS (Integrating mental and physical: research training and services), which uses validated tools to identify and to monitor the progress of patients who may benefit from psychological intervention. At outpatient clinics, patients used an electronic tablet to complete the General Anxiety Disorder Questionnaire (GAD-7), the Patient Health Questionnaire (PHQ-9), the Inclusion of Oral Health Impact Profile (OHIP-14), and the Brief Pain Inventory (BPI). Data were linked directly to their electronic record to allow the results, with suggestions for treatment, to be reviewed immediately during the consultation. A total of 162 patients were included. Screening showed that referral was required in 28 (17%) with a probable major depressive disorder and 32 (20%) with a general anxiety disorder. Two (1%), who were identified as being at high risk of suicide or self-harm, were referred for immediate psychological assessment. Use of the system can aid the holistic treatment of patients with TMD through appropriate referral. Early identification of mental health problems and concurrent management are most beneficial in those who have had symptoms of TMD for up to two years, and are therefore essential.

Lingual necrosis secondary to mucormycosis.

Mucormycosis is a rare fungal infection with a high mortality that affects immunocompromised patients. This is an unusual case of necrosis of the tongue in a patient with pulmonary mucormycosis, diabetes mellitus, and aplastic anaemia.

Clinical medical sciences for undergraduate dental students in the United Kingdom and Ireland - a curriculum.

The technical aspects of dentistry need to be practised with insight into the spectrum of human diseases and illnesses and how these impact upon individuals and society. Application of this insight is critical to decision-making related to the planning and delivery of safe and appropriate patient-centred healthcare tailored to the needs of the individual. Provision for the necessary training is included in undergraduate programmes, but in the United Kingdom and Ireland there is considerable variation between centres without common outcomes. In 2009 representatives from 17 undergraduate dental schools in the United Kingdom and Ireland agreed to move towards a common, shared approach to meet their own immediate needs and that might also be of value to others in keeping with the Bologna Process. To provide a clear identity the term 'Clinical Medical Sciences in Dentistry' was agreed in preference to other names such as 'Human Disease' or 'Medicine and Surgery'. The group was challenged to define consensus outcomes. Contemporary dental education documents informed, but did not drive the process. The consensus curriculum for undergraduate Clinical Medical Sciences in Dentistry teaching agreed by the participating centres is reported. Many of the issues are generic and it includes elements that are likely to be applicable to others. This document will act as a focus for a more unified approach to the outcomes required by graduates of the participating centres and act as a catalyst for future developments that ultimately aim to enhance the quality of patient care.

Orofacial presentations of sarcoidosis--a case series and review of the literature.

Sarcoidosis is a multi-system disease of unknown aetiology characterised by the presence of non-caseating granulomas, the lungs and lymph nodes being the most affected sites. Orofacial manifestations of the condition are increasingly recognised, with several recent case reports where the initial presentation of the disease is in the region. Here, we report six cases of orofacial sarcoidosis which help to illustrate the wide spectrum of the condition.

Effective management of smoking in an oral dysplasia clinic in London.

BACKGROUND: Precancerous lesions precede the development of oral cancer; of several clinical types the most common is leukoplakia. The risk factors include tobacco and excess alcohol use and diets low in antioxidants. Studies concerning the management of risk factors related to oral precancer are meager. OBJECTIVES: We investigated the effectiveness of smoking cessation at a dysplasia clinic among patients followed up for at least for 12 months. METHODS: Data from case notes relating to 180 patients with white and red patches of oral mucosa (excluding other benign disorders confirmed by biopsy findings) attending a dysplasia clinic at a teaching hospital in London and seen by one consultant between 1993 and 2003 were transcribed. Effect of referring to a smoker's clinic to receive specialist help was evaluated against brief advice given at the dysplasia clinic +/- medications. RESULTS: The mean age at the first visit was 48.5 years (+/-12.5), 65% were male, and 88% were white European. One hundred and sixty-two patients (90%) had used tobacco and 83% were current smokers. Of the smokers 95% had smoked over 10 years, the majority smoking over 10 cigarettes per day. Nine were alcohol misusers including two binge drinkers. One hundred and forty-six were diagnosed with oral leukoplakia, 16 with non-homogeneous types (speckled or nodular). Three patients were diagnosed with an erythroplakia. Nineteen per cent exhibited the presence of dysplasia and one subject had in situ carcinoma. Five patients in the sample quit smoking prior to arrival in the dysplasia clinic. Twenty-seven cases (20%) with oral leukoplakia quit smoking while registered as a patient at the dysplasia clinic: 17 of 100 subjects quit with brief advice +/- medications and 10 of 30 following referral to the smoker's clinic. The difference between the two groups was significant for point prevalence abstinence at the last visit to the clinic (minimum 12 months follow up). Out of a total of 180 precancer cases managed in the dysplasia clinic (mean follow up 4.2 years) three patients subsequently developed invasive carcinoma during follow up. CONCLUSIONS: Smoking cessation needs to be an integral component of management of cases attending a dysplasia clinic and referring to smoker's clinics could help to improve the effectiveness of managing patients with oral precancer to quit smoking.

Behçet's disease: a review.

Behçet's disease (BD) is a multi-system inflammatory disorder dominated clinically by recurrent oral and genital ulceration, uveitis, and erythema nodosum. Behçet's disease runs a chronic course, with unpredictable exacerbations and remissions whose frequency and severity may diminish with time. Behçet's disease typically arises in young adults, although childhood-onset BD has also been reported. The disease can affect both genders and has a worldwide distribution, although it is more prevalent in countries of the ancient Silk Route. The cause of BD remains unknown, although an autoimmune reaction triggered by an infectious agent in a genetically predisposed individual has been suggested. The treatment of BD is symptomatic and empirical, but generally specific to the clinical features of each patient. The majority of affected individuals do not have life-threatening disease, although mortality can be associated with vascular-thrombotic and neurological disease.

An audit of the efficacy of the oral brush biopsy technique in a specialist Oral Medicine unit.

The diagnosis of oral epithelial dysplasia has traditionally been based upon histopathological evaluation of a full thickness biopsy specimen from lesional tissue. It has recently been proposed that cytological examination of "brush biopsy" samples is a non-invasive method of determining the presence of cellular atypia, and hence the likelihood of oral epithelial dysplasia. The present audit determined, retrospectively the sensitivity, specificity and positive and negative predictive values of the oral brush biopsy technique in the diagnosis of potentially malignant disease in a group of 112 patients attending a specialist Oral Medicine unit. The sensitivity of detection of oral epithelial dysplasia or squamous cell carcinoma of the oral brush biopsy system was 71.4% while the specificity was 32%. The positive predictive value of an abnormal brush biopsy result (positive or atypical) was 44.1%, while the negative predictive value was 60%. It is concluded that not all potentially malignant disease is detected with this non-invasive investigative procedure.

Neutrophil chemotaxis on silicone and polyurethane surfaces.

Silicone vascular catheters have a greater risk of infection and produce greater inflammation in vivo and greater complement activation in vitro than other vascular catheter polymer materials. This study investigated whether polymorphonuclear leukocyte (PMNL) chemotaxis under agarose on silicone surfaces is different than on polyurethane (PU). Glass slides were coated with silicone and PU by use of a constant-speed dipping apparatus. Chemotaxis (3 h) in response to (10-7 mL) FMLP, zymosan-activated serum, and fresh serum (100%) was greater on silicone than on PU (P<.05). Polyclonal antibody to C5a blocked >50% of the movement toward serum (P<.05). Serum in the PMNL well significantly decreased chemotaxis toward FMLP on silicone (P<.05) but not on PU. These findings suggest that excessive complement activation by silicone may interfere with chemotaxis, but further work is necessary to determine whether this is relevant to an increased risk of catheter-related infection.

Use of photodynamic therapy for the treatment of squamous cell carcinoma of the soft palate.

A 53-year-old white woman presented with a 5-month history of throat pain. The soft palate was biopsied and histological examination confirmed the diagnosis of infiltrating squamous cell carcinoma. She refused surgery and radiotherapy and was therefore offered photodynamic therapy which she accepted. She was treated with 20 J/cm2 at 100 m W/cm2 over a 3 cm area. She was discharged three days later having made an uncomplicated recovery, though substantial analgesia was required. Healing was complete after 2 months, with no loss of palatal function and at most recent follow-up (16 months) there was no sign of residual disease and she remained well.