Do e-cigarettes have a part to play in peri-implant diseases?

DESIGN: Systematic review. DATA SOURCES: The following databases were searched for publications up to May 2022: Medline, EMBASE, Scopus, Web of Science, LILACS, Cochrane and Open Grey. Additionally, four journals were hand searched. STUDY SELECTION: Clear inclusion and exclusion criteria were provided. A focused question was outlined using PICO format. A full search protocol was supplied, and all study designs were considered. DATA EXTRACTION AND SYNTHESIS: Two reviewers screened 97 articles after de-duplication. Fourteen full-text articles were assessed. Data were collected using a spreadsheet. RESULTS: Four cross-sectional studies were included in the systematic review, all reporting on male participants. Meta-analysis was performed highlighting worse outcomes in electronic cigarette (e- cigarette) user group regarding increased bone loss, probing depth, plaque index and bleeding on probing, as well as increased levels of inflammatory cytokines, when compared to never-smokers. CONCLUSIONS: From the limited number of studies available, e-cigarettes appear to have a negative impact on dental implant outcomes in male patients.

Evolution - removing paper and digitising the hospital.

Purpose: A transition from paper to Electronic Health Records has numerous benefits, including better communication and information exchange and decreased errors by medical staff. However, if managed poorly, it can result in frustration, causing errors in patient care and reduced patient-clinician interaction. Furthermore, a drop in staff morale and clinician burnout due to familiarising themselves with the technology has been mentioned in previous studies. Therefore, the aim of this project is to monitor the change in morale of staff of the Oral and Maxillofacial Department in a hospital which underwent the change in October 2020. Objectives: To observe staff morale during transition from paper to Electronic Health Records; to encourage feedback. Methods: After carrying out a Patient & Public Involvement consultation and receiving local research and development approval, a questionnaire was distributed to all members of the maxillofacial outpatients department on a regular basis. Results: On average, around 25 members responded to the questionnaire during each collection. There was a noticeable divergence in responses week on week according to job role and age, but minimal difference is noted from gender point of view after the first week. The study emphasised the position that not all members were happy with the new system but only a small minority would want to return to paper notes. Conclusion: Staff members adapt to change at different rates, which are multifactorial in nature. A change of this scale should be monitored closely to allow for a smoother transition and ensure staff burnout is minimised.

Artificial intelligence - can it be used to outsmart oral cancer?

Data Sources Electronic search on PubMed, Cochrane, Scopus, Embase, Google Scholar, Saudi Digital Library and Web of Science, and hand searching carried out for studies published January 2000-March 2021. Language was restricted to English.Study selection Original research studies involving artificial intelligence technology for oral cancer diagnosis and prognosis prediction were considered. The studies had to provide quantitative data of their evaluation analysis. The exclusion criteria were reported. No limit was set on study design.Data extraction and synthesis The initial search yielded 628 articles. Following deduplication, 340 full-text articles were screened. QUADAS-2 tool was used to assess the quality of the included studies regarding diagnostic accuracy.Results A total of 16 studies were included with various study designs: 14 cross-sectional, one cohort and one retrospective study. Six studies reviewed the diagnosis aspect. All studies indicate an overall positive trend of artificial intelligence technology.Conclusions Artificial intelligence appears to have good accuracy in oral cancer diagnosis and its prediction.

How strong is the link between periodontitis and stroke?

Data sources PubMed, Scopus, Web of Science, The Cochrane Library, LILACS, OpenGrey and Google Scholar. No language restriction applied; studies conducted until September 2018.Study selection Observational studies in humans exposed and not exposed to periodontitis, in which the primary outcome was the risk of cerebrovascular accident, including haemorrhagic and ischaemic attacks (transient ischaemic attack and ischaemic stroke).Data extraction and synthesis Three examiners conducted a literature search. Duplicates, opinion articles, technical articles, guides and animal studies were excluded. Quality assessment was carried out followed by assessment of risk of bias. The extracted data were analysed using RevMan software. The meta-analysis looked for odds ratio (OR) in case-control studies and risk ratio (RR) in cohort studies as well as their 95% confidence intervals.Results Ten studies were included, all showing low risk of bias. The number of patients ranged from 80 to 15,792 with follow-up duration from 0 to 15 years. The studies showed variable heterogeneity. For stroke in case-control studies (seven studies), the overall heterogeneity was considerable (I2 = 77%). For ischaemic stroke in case-control studies (five studies), the overall heterogeneity was considerable (I2 = 72%), but after an outlying study was removed (I2 = 78%), it reduced significantly (I2 = 4%). For stroke in cohort studies (three studies), null heterogeneity was observed (I2 = 0%). The meta-analysis informed the three main outcomes: 1) individuals with periodontitis were twice as likely to suffer stroke (OR 2.31 [1.39, 3.84], p = 0.001, I2 = 77%); 2) individuals with periodontitis were twice as likely to suffer ischaemic stroke (OR 2.72 [2.00, 3.71], p <0.00001, I2 = 4%); and 3) individuals with periodontitis had a higher risk of experiencing stroke (RR 1.88 [1.55, 2.28], p <0.00001). Overall, the authors found that stroke events were associated with periodontitis.Conclusions The meta-analysis suggests an association between risk of stroke and periodontal disease. However, there is a need for prospective studies to ascertain the relationship between periodontal disease severity and stroke severity; whether there is an impact of periodontal treatment and to review whether periodontal disease impacts on stroke survival.

Postoperative delirium in patients with head and neck oral cancer in the West of Scotland.

Our aims were to determine the prevalence and association of postoperative delirium (POD) in head and neck (H&N) cancer patients undergoing free flap reconstruction at the oral and maxillofacial surgery (OMFS) unit, Queen Elizabeth University Hospital (QEUH) Glasgow, and to assess whether these determinants can be modified to optimise patient care and reduce the occurrence of POD. Delirium remains an important problem in the postoperative care of patients undergoing major H&N surgery, and early detection and management improve overall outcomes. The patient database containing details of the preoperative physical status (including alcohol misuse, chronic comorbidity, and physiological status) of 1006 patients who underwent major H&N surgery with free-flap repair at the QEUH from 2009-2019, was analysed. Factors associated with delirium were studied, identifying univariate associations as well as multivariate models to determine independent risk factors. The incidence of POD was 7.5% (75/1006; 53 male:22 female; mean (SD) age 65.41 (13.16) years). POD was strongly associated with pre-existing medical comorbidities, excess alcohol, smoking, a prolonged surgical operating time (more than 700 minutes), tracheostomy, blood transfusion, and bony free flaps. Those with POD were at an increased risk of postoperative wound and lung complications, and were more likely to require a hospital stay of more than 21 days. Presurgical assessment should identify risk factors to optimise the diagnosis and treatment of POD, and will enhance patient care by reducing further medical and surgical complications, and overall hospital stay.