Oral mucosal lesions in patients with COVID-19: a systematic review.

COVID-19 is a new disease that presents mainly with respiratory symptoms. However, it can present with a multitude of signs and symptoms that affect various body systems and several oral manifestations have also been reported. We carried out a systematic review to explore the types of oral mucosal lesions that have been reported in the COVID-19-related literature up to 25 March 2021. A structured electronic database search using Medline, Embase, and CINAHL, as well as a grey literature search using Google Scholar, revealed a total of 322 studies. After the removal of duplicates and completion of the primary and secondary filtering processes, 12 studies were included for final appraisal. In patients with COVID-19 infection, we identified several different types of oral mucosal lesions at various locations within the oral cavity. Most of the studies appraised had a high risk of bias according to the Joanna Briggs Institute checklist. The current published literature does not allow differentiation as to whether the oral lesions were caused by the viral infection itself, or were related to oral manifestations secondary to existing comorbidities or the treatment instigated to combat the disease. It is important for healthcare professionals to be aware of the possible link between COVID-19 and oral mucosal lesions, and we hereby discuss our findings.

Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area.

PURPOSE: The UK government introduced a nationwide lockdown on the 23rd March 2020 to prevent the spread of COVID-19. All elective hospital and dental practice assessments and procedures were mandated to stop. Key hospital dental workers were required to work, and Guy's and St Thomas' NHS Foundation Trust became a designated Urgent Dental Care Centre (UDC) for the greater London area. The paediatric dental emergency walk-in service was suspended and replaced with a telephone triage system and evaluation of digital images sent by parents/carers when needed. The aim of this paper is to describe the emergency service provided by staff in the department of Paediatric Dentistry at St Thomas' Hospital during the first lockdown. METHODS: A prospective service evaluation of the modified paediatric dental emergency service was carried out between 25th March and 29th May 2020. RESULTS: Four-hundred and sixty-four patients accessed the paediatric dental emergency service via telephone during the service evaluation period. Of these, 192 (41%) had dental pain, 121 (26%) had pain and swelling of dental origin, and 89 (19%) had trauma. CONCLUSIONS: Remote telephone consultations and digital photographs were useful to screen emergency paediatric dental patients, but lack of face-to-face consultations with radiographic assessment and access to general anaesthetic services were major limiting factors.

The effect of premature extraction of primary teeth on the subsequent need for orthodontic treatment.

AIM: This was primarily to examine the effect of premature extraction of primary teeth (PEPT) on subsequent malocclusion and need for orthodontic treatment in the permanent dentition. The secondary aim was to correlate the effect of PEPT with loss of space in the primary and mixed dentitions. METHODS: A predefined protocol was developed and registered prospectively with PROSPERO database. The electronic databases, searched, were MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials. The study designs considered for inclusion were controlled trials, cohort, and case-control studies. Risk of bias was assessed using a validated quality assessment tool. RESULTS: 513 studies were identified. Sixteen studies were included in the systematic review, one study reported on malocclusion, and 15 studies reported on space changes. Narrative synthesis was undertaken owing to the heterogeneity of the included studies. No study examined the effect of PEPT on orthodontic need. Most studies reported on space dimensions used a split-mouth design and were at a high risk of bias. CONCLUSIONS: The included literature identified that PEPT led to various features of malocclusion and space loss in the mixed and permanent dentitions. No studies, that met the inclusion criteria, described the effect of PEPT on the subsequent need for orthodontic treatment.

Case report: Dental management of Berardinelli-Seip congenital lipodystrophy.

BACKGROUND: Berardinelli-Seip congenital lipodystrophy (BSCL) is a very rare autosomal recessive condition caused by mutations of the AGPAT2 gene or the BSCL2 gene. BSCL is associated with a number of dental manifestations. There are no published case reports of dental treatment under general anaesthesia (GA) in patients with this condition. CASE REPORT: A 6-year-old girl with BSCL characterised by classical features of the condition including a growth disorder, precocious puberty, endocrine disturbances, hypertrophic cardiomyopathy and fatty infiltration of the liver was referred for treatment under GA. Dental manifestations included aberrant tooth morphology, macrodontia and generalised severe crowding. TREATMENT: Dental treatment was carried out under GA following consideration of various options. In conjunction with other medical specialists, a number of peri-operative precautions were taken. Comprehensive dental care was provided which included restorations, extractions and fissure sealants. FOLLOW-UP: The patient was reviewed post-operatively and at regular intervals between 3 and 6 months for review and prevention. CONCLUSION: The patient had a number of dental manifestations associated with BSCL. Peri-operative planning is essential for some patients who may have a number of medical conditions.

The effect of premature extraction of primary teeth on the subsequent need for orthodontic treatment.

AIM: To investigate if premature extraction of primary teeth was associated with orthodontic need in the permanent dentition. STUDY DESIGN: This was a case-control study based on retrospective dental records. METHODS: As part of NHS (UK) Dental Epidemiology Programme a sample of 366, 12-year-old children from Bradford and Airedale were examined. The survey collected data on patient demographics, dental health status including orthodontic need. Data linkage was undertaken for those children participating in the NHS Dental Epidemiology Programme who had previously accessed the local Salaried Dental Service (SDS). For these children, retrospective dental information was collected about premature extraction of primary teeth. RESULTS: From the 366 children who were surveyed, 116 children had received treatment at the local SDS in the past. Significantly more children from ethnic minorities, low socioeconomic backgrounds and high caries rate (p < 0.001) were seen in the SDS. For the 107 children who attended SDS, an increased total number of primary teeth extractions was positively associated with orthodontic need (odds ratio:1.18, CI -1.01 to 1.37). STATISTICS: Multilevel modelling was undertaken to identify variables associated with orthodontic need. CONCLUSIONS: In the study group, orthodontic need was significantly associated with the number of primary teeth extracted.

Common things are common: a case series of oral foreign bodies in paediatric patients.

Reports of foreign bodies in the oral cavity are few in number. Three cases of children of varying ages, presenting with oral foreign bodies, and their subsequent diagnosis and management, are described. The importance of considering foreign bodies, as part of a differential diagnosis in paediatric patients, where aetiology is uncertain and clinical appearance is unusual, is highlighted.

An unusual anatomical variant of the vascular anatomy in the anterolateral thigh free flap.

The anterolateral thigh flap is a fasciocutaneous flap based on the descending branch of the lateral circumflex femoral artery. The vascular pedicle and its perforators have a varied anatomical course that has led to difficulties in flap harvest. Many papers have described the anatomical variation in the origin and path of this vessel, but they all show one artery and two accompanying venae commitantes. The authors report the first case of duplication of the descending branch of the lateral circumflex femoral artery. They discuss whether this variation requires two arterial anastomoses.