Is team-based learning an alternative approach for UK undergraduate dental education? A scoping review of the literature.

Introduction Team-based learning (TBL) is a dialectic, student-focused method of teaching which has become increasingly popular in international institutions for delivering undergraduate dental education. Despite several dental schools in the UK using dialectic teaching methods, such as problem-based learning, none appear to use TBL.Aims This scoping review aims to identify the literature investigating the use of TBL compared with other teaching pedagogies in delivering undergraduate dental education.Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines were adopted. A search strategy was developed using appropriate MeSH (medical subject headings) terms and key words. Medline, Scopus and the Cochrane Databases were searched.Results Overall, five studies were identified for inclusion. Of these, three studies compared TBL to traditional, didactic teaching methods (such as lectures) and found both student satisfaction and student performance to be greater with TBL. The remaining two studies compared TBL to other dialectic methods of teaching. The results on student performance in these studies were conflicting.Conclusions There is some limited but promising evidence that TBL is effective at delivering undergraduate dental education; however, the scarcity of research evidence highlights the need for more robust exploration.

International Multicenter Study of Clinical Outcomes of Sinonasal Melanoma Shows Survival Benefit for Patients Treated with Immune Checkpoint Inhibitors and Potential Improvements to the Current TNM Staging System.

Objectives Sinonasal mucosal melanoma (SNMM) is an extremely rare and challenging sinonasal malignancy with a poor prognosis. Standard treatment involves complete surgical resection, but the role of adjuvant therapy remains unclear. Crucially, our understanding of its clinical presentation, course, and optimal treatment remains limited, and few advancements in improving its management have been made in the recent past. Methods We conducted an international multicenter retrospective analysis of 505 SNMM cases from 11 institutions across the United States, United Kingdom, Ireland, and continental Europe. Data on clinical presentation, diagnosis, treatment, and clinical outcomes were assessed. Results One-, three-, and five-year recurrence-free and overall survival were 61.4, 30.6, and 22.0%, and 77.6, 49.2, and 38.3%, respectively. Compared with disease confined to the nasal cavity, sinus involvement confers significantly worse survival; based on this, further stratifying the T3 stage was highly prognostic ( p < 0.001) with implications for a potential modification to the current TNM staging system. There was a statistically significant survival benefit for patients who received adjuvant radiotherapy, compared with those who underwent surgery alone (hazard ratio [HR] = 0.74, 95% confidence interval [CI]: 0.57-0.96, p = 0.021). Immune checkpoint blockade for the management of recurrent or persistent disease, with or without distant metastasis, conferred longer survival (HR = 0.50, 95% CI: 0.25-1.00, p = 0.036). Conclusions We present findings from the largest cohort of SNMM reported to date. We demonstrate the potential utility of further stratifying the T3 stage by sinus involvement and present promising data on the benefit of immune checkpoint inhibitors for recurrent, persistent, or metastatic disease with implications for future clinical trials in this field.

Artificial intelligence in healthcare and education.

Artificial intelligence (AI) is rapidly transforming the healthcare and medical and dental education sectors. With advancements in AI technology and its integration into routine tasks, the field of healthcare and education is rapidly evolving. This article aims to provide an in-depth analysis of the impact of AI in these sectors and to discuss the advantages and disadvantages of its integration. The article will begin by examining the use of AI in healthcare, including its impact on patient care, diagnosis and treatment, and the benefits it brings to medical professionals and patients alike. The article will then delve into the use of AI in medical and dental education, exploring its impact on student learning and teaching practices, and the benefits and challenges it presents for educators and students. Additionally, this article will also cover the impact of AI on the publishing of scientific articles in journals. With the increasing volume of submissions and the need for more efficient management, AI is being utilised to streamline the peer-review process and improve the quality of peer-review. The article will also delve into the possibility of AI enabling new forms of publication and supporting reproducibility, helping to improve the overall quality of scientific publications. Furthermore, the authors of this article have written it using AI, making it a landmark paper that showcases the true technological power of AI in the field of writing.

Dental implications of some commonly prescribed medicines.

Several medicines can have an impact on oral health or have implications for dental treatment. It is important that general dental practitioners review the medicines that their patients are taking and consider their potential impact. In this article we highlight some of the medicines or groups of medicines that can affect dental treatment and oral health.

An educational evaluation of learner experiences in dentistry open-book examinations.

Introduction The COVID-19 pandemic resulted in substantial global disruptions, with many universities restructuring their examinations to open-book assessments. In this format, learners are allowed to use revision notes, textbooks and other permitted material during their examination. Traditionally, dentistry is assessed using closed-book examinations where the use of such materials is prohibited. Learners will have limited or no prior experience of open-book examinations in dentistry, hence this educational evaluation aimed to explore their experiences and assess suitability for continuity of this examination.Methods A retrospective anonymous survey was conducted on all undergraduate dentistry and oral health sciences learners on completion of their examination and once they received their results. The questionnaire was designed to contain both qualitative and quantitative data items, validated through previous published studies. All authors independently analysed the data through tallying quantitative parameters and thematically analysing qualitative free text.Results In total, 210 learners participated in the survey, with 52.4% strongly agreeing a preference for open-book examinations. In addition, 42.9% of learners either agreed or strongly agreed that less preparation was required for open-book examinations; however, 80.5% reported learning new information. Furthermore, 85.2% disagreed or strongly disagreed that open-book examinations were stressful. Thematic analysis highlighted four core themes: stress, memorisation of facts, motivation to learn and unfairness.Conclusions There were several learning points for both educators and learners that can be actioned for future open-book examinations, including tailoring exam questions to foster application of knowledge rather than resource-searching skills, intended learning objective mapping against curriculum requirements and learner preparation.

Immune infiltrate diversity confers a good prognosis in follicular lymphoma.

BACKGROUND: Follicular lymphoma (FL) prognosis is influenced by the composition of the tumour microenvironment. We tested an automated approach to quantitatively assess the phenotypic and spatial immune infiltrate diversity as a prognostic biomarker for FL patients. METHODS: Diagnostic biopsies were collected from 127 FL patients initially treated with rituximab-based therapy (52%), radiotherapy (28%), or active surveillance (20%). Tissue microarrays were constructed and stained using multiplex immunofluorescence (CD4, CD8, FOXP3, CD21, PD-1, CD68, and DAPI). Subsequently, sections underwent automated cell scoring and analysis of spatial interactions, defined as cells co-occurring within 30 µm. Shannon's entropy, a metric describing species biodiversity in ecological habitats, was applied to quantify immune infiltrate diversity of cell types and spatial interactions. Immune infiltrate diversity indices were tested in multivariable Cox regression and Kaplan-Meier analysis for overall (OS) and progression-free survival (PFS). RESULTS: Increased diversity of cell types (HR = 0.19 95% CI 0.06-0.65, p = 0.008) and cell spatial interactions (HR = 0.39, 95% CI 0.20-0.75, p = 0.005) was associated with favourable OS, independent of the Follicular Lymphoma International Prognostic Index. In the rituximab-treated subset, the favourable trend between diversity and PFS did not reach statistical significance. CONCLUSION: Multiplex immunofluorescence and Shannon's entropy can objectively quantify immune infiltrate diversity and generate prognostic information in FL. This automated approach warrants validation in additional FL cohorts, and its applicability as a pre-treatment biomarker to identify high-risk patients should be further explored. The multiplex image dataset generated by this study is shared publicly to encourage further research on the FL microenvironment.

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.

Simplifying differential diagnoses of orofacial conditions - a guide to surgical sieves and red flags.

Formulation of a differential diagnosis with appropriate diagnostic tests is critical in day-to-day clinical practice. Many specialists or hospital-based practitioners in specialties such as oral medicine and oral surgery will be familiar with the use of surgical sieves and the term 'red flags' in their practice. However, it is the authors' experience that general dental practitioners may not be as familiar with such tools. Primary care practitioners are often the first port of call for patients with uncommon symptoms; therefore, it is essential that appropriate and timely referrals are made. The use of a surgical sieve and heightened awareness of red flags will assist practitioners significantly.

Malignant Odontogenic Tumours: A Systematic Review of Cases Reported in Literature.

Background: Malignant odontogenic tumours (MOTs) arise either de novo from the tooth forming tissues, their developmental residues or from existing odontogenic epithelial or mesenchymal neoplasms in the jaws. Their management requires extensive surgery due to their infiltrative nature and risk of metastasis. There is a need to understand the clinical and pathological features of MOTs to inform both treatment algorithms and prognostication. This is an area of diagnostic pathology which presents substantial difficulties in diagnosis, compounded by inconsistent use of terminology. Thus, this systematic review aimed to describe the clinical and pathological features of MOTs with a view to consolidating the literature and defining problematic areas in diagnosis and classification. Methods: An electronic database search was conducted in Web of Science, PubMed/Medline, and Embase. Additionally, the grey literature and reference lists of selected papers searched for completeness. Nine hundred and sixty articles were initially identified. Following removal of duplicates and application of inclusion/exclusion criteria, 312 articles were included for qualitative analysis. Results: The 312 articles encompassed a total of 507 patients with most lesions located within the mandible (74.3%). The most common first histological diagnosis was ameloblastic carcinoma (25.7% of all diagnoses), but there is considerable variation in how and when various diagnostic terms are used, and several misdiagnoses were reported. An initial benign diagnosis was made in 24.7% of patients, followed by a later malignant diagnosis and in this sub-group, the most common benign first diagnosis was ameloblastoma (42.4%). Cervical lymph nodes were the most common site of metastasis (9.3% of patients). With respect to distant metastasis (DM), the lungs were the most common organ affected (11.2% of DM patients) with metastasising ameloblastoma the most commonly reported tumour which metastasised to the lungs. Overall, 26.8% of patients developed recurrence. Conclusion: Overall, the quality of the literature on MOTs is poor. This review of the literature has highlighted variations in diagnostic terms and criteria which has resulted in areas of confusion with potential for misdiagnosis. This consolidation of primary data has identified key areas for targeted research including further discussion on the malignant potential of ameloblastoma.

The COVID-19 pandemic and dentistry: the clinical, legal and economic consequences - part 2: consequences of withholding dental care.

As routine care was suspended in most countries, one could anticipate progression of undiagnosed and managed oral disease. Patients are usually unaware of the development of oral disease as it is not visible to them and largely asymptomatic, especially in its early stages. The natural progression of conditions such as caries and periodontitis is inevitable without diagnosis and management. The full extent of patient harm because of the suspension of routine dental care can only be estimated when routine oral examinations are fully re-established, and even then, we will probably never know the number of individuals impacted or the extent of disease progression and harm.In first-world countries, there has always been a back-up emergency treatment system for dental problems. For example, in the UK, the safety net for life-threatening swellings and for acute pain relief is the accident and emergency services. This system remained in place during the COVID-19 pandemic. Courts could be expected to understand the coronavirus context and would take this into account should there be a complaint against the clinician about access to care.The suspension of routine dental care to save lives will lead to the closure of many dental practices due to substantial financial impact. The return to routine care will be slow, with prioritisation of non-aerosol generating procedures while we look to further understand methods to mitigate transmission risk via infected aerosol and spatter. Inevitably, the cost of personal protective equipment and the lower volume of patients pose a continued threat to businesses.

The COVID-19 pandemic and dentistry: the clinical, legal and economic consequences - part 1: clinical.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus which causes COVID-19, is highly contagious. Dentistry is a high-risk profession for occupational virus transmission because of the close proximity of the operator to the patient during treatment and the procedural generation of aerosols.The impact on the provision of dental care has been profound, with routine care restricted or paused for a period around the world. There have been adverse consequences for dental education and clinical research. Emergency and urgent care provisions have generally proceeded. However, even when a patient's condition is deemed urgent, access to the appropriate care may not have been possible due to lack of the recommended personal protective equipment. The common dental diseases of caries and periodontitis usually present with signs and symptoms after some advancement, hence the recommended regular dental examination so that these may be diagnosed early by a professional with suitable lighting, instruments and radiography. Conditions such as oral cancer similarly present in their early stages without symptoms. Many countries introduced telephone and video consultations for patients with symptoms but much disease has gone undiagnosed and without management.It is difficult to ascertain the full effect of the disruption to dental services, education and research but it is likely to be substantial. The immediate future will focus on return to routine care provision with likely longer-term permanent changes.

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.

Challenges in plain film radiographic diagnosis for the dental team: a review of the maxillary sinus.

The maxillary sinus is the largest of the paranasal sinuses, with its structure and contents commonly visualised on dental radiographs. Dental practitioners are required to evaluate the entire radiograph, and it is likely there is limited exposure to maxillary sinus pathoses and radiological interpretation in the undergraduate curriculum and routine continuing professional development courses. This review covers radiological features of common benign and malignant sinus disease. Identification of normal anatomical features, common variations and pathoses can facilitate holistic patient management and potentially early detection of neoplastic disease.

Global prevalence of molar incisor hypomineralisation.

Data sourcesPubMed, Web of Science, ScienceDirect, Chinese Biological Medical Literature Database, Chinese Wanfang Database, Chinese National Knowledge Infrastructure and reference lists of key publications. Language restrictions were placed with inclusion of English and Chinese texts only. No date restrictions were applied.Study selectionOriginal population-based studies that described the diagnostic criteria of MIH and provided prevalence data or sufficient information that could be used to calculate MIH prevalence.Data extraction and synthesisTwo reviewers independently extracted the data. Meta-regression was done using a random effects model for parameters of age, gender and region. Heterogeneity was assessed using I2 statistic.ResultsSeventy studies were included that encompassed a total of 89,520 people and 10,823 cases of MIH. The pooled global prevalence of MIH was 14.2% (95% CI 12.6-15.8), with South America having the highest prevalence (18%; 95% CI 13.8-22.2) and Africa the lowest (10.9%; 95% CI 4.2-17.6). There was no significant difference between male and female participants. Prevalence of MIH amongst children ten years of age or younger (15.1%, 95% CI 12.1-18.2) was higher than older children (12.1%, 95% CI 8.0-16.3).ConclusionsThis meta-analysis showed the average global prevalence of MIH as 14.2%. Some geographic regions had higher than average prevalence, which could inform oral health policy in those areas.