Undergraduate perspectives of the awareness, diagnosis and management of patients with eating disorders.

Introduction Patients with eating disorders (EDs) may present with potentially life-threatening complications due to missed and late diagnoses. Dentists can play a fundamental role in the early identification and signposting of patients with suspected EDs.Aims To investigate the awareness of final-year dental students of the aetiology, diagnosis and management of EDs.Methods An anonymous electronic questionnaire was distributed to final-year dental students at the University of Manchester. Respondents reported their knowledge, confidence and education related to the management of patients with EDs.Results Over 50% of students felt they had an above average awareness of the clinical signs and oral manifestations of EDs. The majority of students lacked confidence in discussing a suspected ED diagnosis with patients (75%) and referring them to appropriate services (71%). Additionally, 58% were not confident in planning treatment for and treating a patient with an ED. In total, 100% of students reported that they would benefit from further teaching related to the management of patients with EDs.Conclusion Participants highlighted the need for further teaching related to the diagnosis and management of patients with EDs. This study supports the development of an educational resource of undergraduate dental students.

Confidence-level of foundation dentists in the North West of England in the placement of preformed metal crowns using the Hall technique.

INTRODUCTION: The Hall technique is a biological caries management approach commonly used within the field of paediatric dentistry. The technique involves the placement of a preformed metal crown (PMC) without local anaesthetic, caries removal or tooth preparation. Despite being widely taught across dental schools in the United Kingdom, evidence from the literature suggests that PMCs are seldom used in general dental practice, even by newly qualified dentists. This study aimed to evaluate the experience and self-reported confidence of Foundation Dentists (FDs) in the North West of England in the placement of preformed metal crowns using the Hall technique. MATERIALS AND METHODS: An anonymous questionnaire was distributed to 117 Foundation Dentists in the North West of England. RESULTS: Forty-six questionnaires were returned, giving a response rate of 39%. The results revealed that 80.4% of FDs felt "somewhat," "quite" or "extremely" confident with the Hall technique at the point of graduation. This increased to 85.3% upon completion of Dental Foundation Training. CONCLUSION: Foundation Dentists' self-reported confidence in the Hall technique was reasonably high both at the point of qualification and upon completing Dental Foundation Training. Nevertheless, many of the Foundation Dentists felt that they would benefit from further postgraduate training on the technique.

An exploratory study investigating the barriers to reporting child dental neglect concerns among general medical practitioners in Greater Manchester.

Introduction Dental neglect presents a global concern and is a shared public challenge for all healthcare professionals, including general medical practitioners (GPs). Previous literature highlights a lack of training among GPs and suggests that barriers are present to reporting concerns of dental neglect.Aims To investigate the current awareness of child dental neglect among GPs in Greater Manchester and to investigate barriers to the reporting of concerns.Methods An anonymous, electronic questionnaire was distributed to GPs in Greater Manchester. Respondents reported their experience and training in child dental neglect and their management of suspected cases. Results were assessed using descriptive analysis.Results In total, 25 GPs completed the questionnaire. It was found 60% received undergraduate child protection training and 96% completed postgraduate training. Only 20% felt adequately trained in the referral of suspected child dental neglect and the majority acknowledged that more training is required. Furthermore, 42% had been suspicious of child dental neglect; however, only 80% recorded their observations. Plus, 32% had suspected child dental neglect and not completed a referral. Common barriers to reporting included lack of knowledge of referral procedures and lack of certainty of diagnosis.Conclusion Barriers to referral of suspected cases of neglect were reported and there is a demand for further training among GPs.

Black staining: an overview for the general dental practitioner.

'Black stain' is a form of extrinsic staining affecting the buccal and palatal surfaces of primary and permanent teeth. It presents as an incomplete line of dark dots formed at the cervical third of the tooth, typically following the gingival margin and not extending to the proximal areas. There is no consensus on its prevalence, though it appears to vary between 2-20%, with an equal male and female distribution. Although the aetiology is not completely understood, its microflora is dominated by chromogenic bacteria, such as actinomyces and prevotella melaninogenica, and there appears to be a low incidence of caries in the presence of the stain. The cause of the dark pigmentation seems to be from iron deposits such as ferric sulphate, present due to a reaction with the products of bacterial metabolism. This paper aims to provide information on the diagnosis, aetiology and treatment considerations for black stain. A patient case report is also explored.

White enamel lesions in children: considering caries, chronological and congenital causes and their consequent care.

White enamel lesions are a common presentation to the general dentist and aesthetic concerns are the most frequent presenting problem. Aetiology may be multifactorial and management of such lesions is heavily dependent on the cause. In the paediatric patient, differentiating white lesions caused by caries, fluorosis and genetic and developmental disorders is key to offering optimal long-term treatment outcomes. Early intervention allows for carefully planned management of less common disorders. Many of these disorders exist along a spectrum, and white lesions offer a useful clue to prompt intervention and referral to the relevant specialists. This article overviews common white lesions of the teeth and outlines the hierarchy of management options available.

An evaluation of sepsis in dentistry.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major health concern and causes substantial morbidity and mortality. It is imperative that the signs of sepsis are identified early in both adult and paediatric patients and appropriately escalated to initiate early treatment and improve prognosis. This paper aims to discuss the change in classification from the previous systemic inflammatory response syndrome (SIRS) criteria to the current definition in adults and also the unchanged definition in children. The hallmark signs of sepsis (both red and amber flags) are discussed in relation to their underlying cellular mechanisms to provide a comprehensive overview for clinicians in primary care, hospital and community settings. The rise of antimicrobial resistance is also an increasing global health concern with resistant bacteria from common infections likely to result in greater patient morbidity and worse outcomes.A literature search identified reported sepsis cases in dentistry through searches in Ovid Medline and Embase from January 1990 to December 2019. Only primary studies were included with no restrictions on languages. Four articles were identified which reported sepsis associated with tooth extractions, dental abscess and submental/submandibular cellulitis. It is well known that locoregional infections of dental origin have the potential to cause sepsis. Therefore, dental healthcare professionals need to be vigilant and understand the specific signs and escalation protocols to ensure patient safety.

Guidelines for the orthodontic management of the traumatised tooth.

Dental trauma is common in the UK, with more than one in ten children having experienced some form of dental trauma. In addition, one in ten patients have been reported to have experienced dental trauma before orthodontic treatment. A recent survey of orthodontists' knowledge and experience of orthodontic management of traumatised teeth has highlighted large inconsistencies in management of traumatised teeth among UK orthodontists, highlighting the need for further information or training on orthodontic management of traumatised teeth.Therefore, the following guidelines have been developed in order to provide an evidence-based approach to treat this cohort of patients. The following guidance is based on the available literature, expert opinion and UK orthodontists' consensus drawn from a recent survey.

Evaluating compliance of dental radiography for paediatric patient assessment in specialised tertiary care units: a United Kingdom multi-centre survey.

Aim The aim of this survey was to determine compliance towards dental radiography selection criteria for paediatric patients undergoing new patient examinations in specialised tertiary care centres in the United Kingdom.Methods Five university-associated dental hospitals were included in this study. Retrospective data was collected reviewing all paediatric patients on the new patient assessment clinics, where dental imaging was requested or the patient had relevant previous imaging. Data was collected from 28 June 2018, continuing retrospectively for a maximum of six months or until 150 patients were reached. Patients referred solely for orthodontic assessment were excluded.Results Seven hundred and fifty patients were included with an average age of eight years - 95.5% of patients had a radiographic justification provided. All patients were grouped into 56 disease categories and a total range of one cross-sectional and nine planar radiographs were prescribed in this cohort. Each radiograph was assessed for compliance to the Faculty of General Dental Practice, European Association of Paediatric Dentistry and national Italian guidelines for dental diagnostic imaging. Additionally, selection criteria for CBCT scans were taken from SEDENTEXCT guidelines. Full panoramic radiographs were the most commonly prescribed at 34.8% (n = 261). However, this demonstrated the lowest compliance rate as per selection criteria at 75.9%. This was due to referrers requesting radiographs primarily for assessing dental development (18.8%; n = 49) and caries assessment (2.7%; n = 7). Other radiograph formats demonstrated varying levels of guideline compliance ranging from 93.5-100%.Conclusion This study identifies common radiograph request errors and can inform paediatric clinicians to improve compliance to guidelines and reduce radiation exposure to young patients.

How is paediatric dentistry taught? A survey to evaluate undergraduate dental teaching in dental schools in the United Kingdom.

INTRODUCTION: The quality assurance of undergraduate dental education in the UK is regulated by the General Dental Council who describe the competencies expected of the newly qualified dentist or "safe beginner." Whilst the literature has explored the level of undergraduate training in a number of dental specialties within the UK, there is a paucity of information on the UK curriculum for undergraduate paediatric dental teaching. AIMS: This study aimed to assess the undergraduate teaching of paediatric dentistry within dental schools in the UK. METHODS: An anonymous questionnaire was distributed to all 16 UK dental schools via email. RESULTS: Twelve questionnaires were completed, giving a response rate of 75%. First exposure to both academic teaching and clinical teaching in paediatric dentistry ranged from years 1-4. Whilst there were broad similarities between units with regard to core components of the curricula, there were notable differences including the teaching of regenerative endodontics (75%) and the use of the titanium trauma splint (58%). Silver diamine fluoride was only used clinically in one unit (8%), and non-vital pulpotomy was taught by two units (16%). There was also considerable heterogeneity in assessment methods between universities. CONCLUSION: The undergraduate paediatric dental curriculum is broadly similar between UK dental schools. However, there are discrepancies in assessment methods and the teaching of new advances.

Silver diamine fluoride - an overview of the literature and current clinical techniques.

Dental caries continues to affect the British population, despite advances in prevention and management options. There are many treatment and preventive treatment strategies to address dental caries. Silver diamine fluoride (SDF) is a colourless alkaline solution containing silver and fluoride, which forms a complex with ammonia and has proven to be effective in management of dental caries. Additional dental benefits of SDF continue to be explored and discussed in the literature. SDF is a relatively new material which can be used to reduce and crystallise dental caries in a simple non-invasive treatment modality without the use of local anaesthetic. It can thus be well tolerated by children as a treatment technique and can be quickly applied to the isolated tooth without the need for extensive excavation. Currently, SDF is classified in the UK as a desensitising agent; however, it may be reclassified as a caries treatment agent at some stage and thus provide an effective non-invasive treatment for children's tooth decay. This would prevent the multiple admissions for dental extraction under general anaesthetic, as a simpler approach can be provided. This article will evaluate and review the literature behind SDF and provide details on its use and clinical application.

Experience of and barriers to reporting child safeguarding concerns among general dental practitioners across Greater Manchester.

Introduction Child abuse and neglect present a significant global concern, therefore, it is imperative that dental professionals can identify children at risk. Previous literature has suggested that general dental practitioners (GDPs) do not feel adequately trained to do so and that there is a gap between the suspicion of abuse and onward referral.Aims To assess the experience of paediatric safeguarding reporting among GDPs in Greater Manchester and investigate the current barriers to reporting safeguarding concerns.Methods An anonymous questionnaire was distributed via email to a sample of general dental practices in Greater Manchester.Results Thirty-six questionnaires were completed, giving a 36% response rate. Fifty-eight percent of respondents had received undergraduate training and 83% had received postgraduate training. Eighty-one percent felt that GDPs require further training and support. Fifty-eight percent of GDPs had been suspicious of at least one case of child abuse or neglect, however, only 28% had completed an onwards referral. Common barriers to reporting included: fear of violence to the child; lack of certainty of diagnosis; and lack of confidence in their suspicions.Conclusion Barriers to the referral of suspected cases of abuse or neglect are still commonly reported. There is a strong demand for further child protection training among GDPs.

Orthodontic management of traumatized teeth: A national survey of UK orthodontists.

BACKGROUND/AIM: There is a lack of research into orthodontic movement and management strategies of traumatized teeth. The aim of this survey was to assess the knowledge of UK-based orthodontists in the orthodontic management of traumatized teeth. MATERIALS/METHODS: A 24-item questionnaire survey was electronically distributed to all members of the British Orthodontic Society. RESULTS: A total of 213 respondents completed the survey with the majority of these being UK registered specialists in orthodontics. Three responses were excluded as one was not based within the UK and two were orthodontic trainees with <1 year of experience, leaving a total of 210 respondents. The majority had orthodontically treated up to three patients with a history of dental trauma in the preceding 3 months. Obtaining a trauma history was done by the majority of respondents. A wide variation in times waited by respondents before orthodontically treating teeth with different types of traumatic injuries was observed. Similarly, the preferred orthodontic management strategies of traumatized teeth differed substantially among respondents. Almost all respondents were interested in further training in the management of dental trauma. CONCLUSIONS: The study showed a wide variation in the orthodontic management of traumatized teeth among UK-based orthodontists. Further training and national guideline establishment are indicated for orthodontic management of traumatized teeth in the UK.

A discoloured anterior tooth: enamel microabrasion.

Objectives The aim of this article is to present an easy to use, conservative method for managing discolouration in enamel in general practice. Materials and methods Microabrasion was used in this case to remove superficial layers of discoloured enamel utilising abrasive acids, which was further improved by using ICON, a newly developed resin infiltrant. Results Significant improvement shown by the presented case suggests that this modality of treatment could be used more frequently. Discussion This simple yet extremely effective treatment can be used by the general dental practitioner despite not having the necessary equipment as readily available alternatives can be used. Conclusion Using minimally invasive options in managing superficial enamel lesions can be effective and prevent the use of invasive procedures in the first instance.

Oral Manifestations of Autoimmune Neutropenia: A Case Report.

Autoimmune neutropenia is a self-limiting condition characterized by the presence of granulocyte-specific autoantibodies. This case report describes a 2-year-old female who presented to the Department of Pediatric Dentistry with a history of oral ulceration, complicated by high temperature, gingival hypertrophy and gingival hemorrhage. These symptoms had precipitated an admission to a district general hospital and diagnosis of viral tonsillitis. The severity of the presentation to the Pediatric Dental Department prompted a review of recent discharge blood investigations, which revealed a neutrophil count of 0.07×109/L(1.0-8.5 ×109/L) indicating severe neutropenia. Urgent referral to Pediatric Hematology resulted in same-day admission and a diagnosis of autoimmune neutropenia was established. The patient was managed with chlorhexidine mouthwash, prophylactic antimicrobial and antifungal medication and granulocyte colony stimulating factor (G-CSF). Neutropenia may present with features exclusive to the oral cavity. Recognition of atypical presentations such as oral ulceration with associated systemic illness may assist in early diagnosis.

Diagnostic Accuracy of Tests for Polyuria in Lithium-Treated Patients.

In lithium-treated patients, polyuria increases the risk of dehydration and lithium toxicity. If detected early, it is reversible. Despite its prevalence and associated morbidity in clinical practice, it remains underrecognized and therefore undertreated. The 24-hour urine collection is limited by its convenience and practicality. This study explores the diagnostic accuracy of alternative tests such as questionnaires on subjective polyuria, polydipsia, nocturia (dichotomous and ordinal responses), early morning urine sample osmolality (EMUO), and fluid intake record (FIR). This is a cross-sectional study of 179 lithium-treated patients attending a general adult and an old age psychiatry service. Participants completed the tests after completing an accurate 24-hour urine collection. The diagnostic accuracy of the individual tests was explored using the appropriate statistical techniques. Seventy-nine participants completed all of the tests. Polydipsia severity, EMUO, and FIR significantly differentiated the participants with polyuria (area under the receiver operating characteristic curve of 0.646, 0.760, and 0.846, respectively). Of the tests investigated, the FIR made the largest significant change in the probability that a patient experiences polyuria (<2000 mL/24 hours; interval likelihood ratio, 0.18 and >3500 mL/24 hours; interval likelihood ratio, 14). Symptomatic questioning, EMUO, and an FIR could be used in clinical practice to inform the prescriber of the probability that a lithium-treated patient is experiencing polyuria.

Risk factors for polyuria in a cross-section of community psychiatric lithium-treated patients.

OBJECTIVES: Polyuria increases the risk of dehydration and lithium toxicity in lithium-treated patients. Risk factors have been inconsistently described and the variance of this adverse effect remains poorly understood. This study aimed to establish independent risk factors for polyuria in a community, secondary-level lithium-treated sample of patients. METHODS: This was a cross-sectional study of the lithium-treated patients attending a general adult and an old age psychiatry service. Participants completed a 24-hour urine collection. Urine volume and the presence of polyuria were the outcomes of interest. The relationship between outcome and the participant's demographic and clinical characteristics was explored with univariable and multivariable analysis. RESULTS: A total of 122 participants were included in the analysis, with 38% being diagnosed with polyuria. Female gender and increased body weight independently predicted the presence of polyuria (standardized regression coefficient 1.01 and 0.94, respectively; p = 0.002 and p = 0.003, respectively). Female gender and increased body weight, lithium dose, and duration of lithium treatment independently predicted higher 24-hour urine volumes (standardized regression coefficients 0.693, p < 0.0005; 0.791, p < 0.0005; 0.276, p = 0.043; 0.181, p = 0.034, respectively). Of three different weight metrics, lean body weight was the most predictive. CONCLUSIONS: Female gender and increased body weight explain part of the variance of this adverse effect. Both risk factors offer fresh insights into the pathophysiology of this potentially reversible and dangerous adverse effect of lithium treatment. Future research should focus on understanding the differences between the genders and between different body compositions in terms of lithium pharmacokinetics and pharmacodynamics.

Transition from child and adolescent to adult mental health services in the Republic of Ireland: an investigation of process and operational practice.

AIM: Ensuring a seamless transition from child to adult mental health services poses challenges for services worldwide. This is an important process in the ongoing care of young people with mental illness; therefore, it is incumbent on all countries to probe their individual structures to assess the quality of mental health service delivery to this vulnerable cohort. To date, there have been no published studies on the transition from Child to Adult Mental Health Services in the Republic of Ireland. To this end, a nationwide survey of transition policies of community mental health teams in both services was conducted in order to compare best practice guidelines for transition with current process and experience in clinical practice. METHOD: Structured interviews were conducted with 57 consultant psychiatrists (representing 32 CAMHS teams and 25 AMHS teams) to obtain information on annual transition numbers, existing transition policies and operational practice from the professional perspective. RESULTS: Numbers of young people considered suitable for transfer to adult services (M = 7.73, SD = 9.86, n = 25) were slightly higher than numbers who actually transferred (M = 4.50, SD = 3.33, n = 20). There is a lack of standardized practice nationwide regarding the service transition boundary, an absence of written transition policies and protocols, and minimal formal interaction between child and adult services. CONCLUSIONS: The findings suggest that there are critical gaps between current operational practice and best practice guidelines. Future studies will investigate the impact this has on the transition experiences of young people, their carers and health-care professionals.

Electrical stimulation and splinting were not clearly more effective than splinting alone for contracture management after acquired brain injury: a randomised trial.

QUESTION: Is electrical stimulation and splinting more effective than splinting alone for the management of wrist contracture following acquired brain injury? DESIGN: A multi-centre randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Thirty-six adults with first stroke or traumatic brain injury and mild to moderate wrist flexion contractures. INTERVENTION: The experimental group received electrical stimulation to the wrist and finger extensor muscles for 1 hour a day over 4 weeks while the control group did not. Both groups wore a splint for 12 hours a day during this 4-week period. OUTCOME MEASURES: The primary outcome was passive wrist extension measured with a 3Nm torque and with the fingers in extension. Secondary outcomes included passive wrist extension, wrist and finger extensor strength, wrist flexor spasticity, motor control of the hand, and Global Perceived Effect of Treatment, and perception of treatment credibility. Outcome measures were taken at baseline, at the end of the intervention period (4 weeks), and after a 2-week follow-up period (6 weeks). RESULTS: At 4 and 6 weeks, the mean between-group difference (95% CI) for passive wrist extension was 7 degrees (-2 to 15) and -3 degrees (-13 to 7), respectively. Secondary outcomes were statistically non-significant or were of borderline statistical significance. CONCLUSION: It is not clear whether electrical stimulation and splinting is more effective than splinting alone for the management of wrist contracture after acquired brain injury. Therapists' confidence in the efficacy of electrical stimulation for contracture management is not yet justified.

Circuit class therapy can provide a fitness training stimulus for adults with severe traumatic brain injury: a randomised trial within an observational study.

QUESTIONS: Can circuit class therapy provide sufficient exercise dosage (at least 20 minutes at ≥ 50% heart rate reserve or total caloric expenditure ≥ 300 kilocalories) to induce a cardiorespiratory fitness effect in adults with traumatic brain injury? Can feedback from heart rate monitors influence exercise intensity? DESIGN: Randomised controlled trial within an observational study. PARTICIPANTS: Fifty-three people with severe traumatic brain injury, of whom 40 progressed into the trial. INTERVENTION: All participants undertook circuit class therapy. Participants allocated to the experimental group received exercise intensity feedback from a heart rate monitor and the control group received no feedback. OUTCOME MEASURES: Proportion of participants exercising at ≥ 50% heart rate reserve for at least 20 minutes or expending ≥ 300 kilocalories during circuit class therapy. The primary outcome measure for the trial was the time spent in the heart rate training zone (ie, at ≥ 50% heart rate reserve) during the intervention and re-assessment periods. RESULTS: Circuit class therapy provided sufficient cardiorespiratory exercise dosage for 28% (95% CI 18 to 42) of the cohort according to the heart rate reserve criteria and 62% (95% CI 49 to 74) according to the caloric criteria. Feedback did not increase the time in the training zone during the intervention (mean difference 4.8 minutes, 95% CI -1.4 to 10.9) or re-assessment (1.9 minutes, -4.4 to 8.3) periods. CONCLUSION: The low intensity, long duration structure of circuit class therapy can provide sufficient exercise dosage for a fitness training effect for 62% of people with traumatic brain injury. Feedback from heart rate monitors does not necessarily influence exercise intensity. TRIAL REGISTRATION: ACTRN12607000522415.