How dental teams can help patients with temporomandibular disorders receive general dental care: An International Delphi process.

BACKGROUND: Many patients with temporomandibular disorders (TMD) find it difficult to undergo dental care due to challenges caused by their condition, previous temporomandibular joint surgery or invasive dental procedures, and the impact of comorbid conditions. Managing routine dental care for some patients with TMD can be seen as challenging by some dental practitioners. OBJECTIVE: The objective of this study was to work with patients experiencing TMD and clinicians to co-produce recommendations aimed at helping general dentists to provide routine dental care for patients with TMD. METHODS: A modified Delphi process was used to co-produce recommendations. Six patients experiencing TMD, patient advocates and seven clinicians took part, including international TMD clinicians. Two meetings were held with patient participants, mediated by a trained facilitator. Recommendations suggested by patient participants were distributed to clinicians who were asked to add additional suggestions, but not to modify patients' recommendations unless to aid clarity. Additional themes were identified from the existing literature, and the recommendations were then reviewed by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) consortium. RESULTS: Recommendations were given to support patients before, during and after dental treatment. Participants identified specific and practical recommendations to help patients with TMD receive routine dental care, but also emphasised the need for professionals to listen sensitively to patients' concerns and work with patients in an empathetic and non-judgmental way. CONCLUSION: These recommendations, co-developed with patients experiencing TMD, should help dental professionals to provide supportive general dental care for patients with TMD.

Do oral piercings cause problems in the mouth?

Aim This systematic review and meta-analysis aimed to synthesise the current evidence for the association of oral piercings with oral complications.Data sources Research published before January 2022 was identified from the Cochrane Library, Virtual Health Library, Web of Science, Scopus, PubMed, Embase, Google Scholar and OpenGrey databases. Experts in the field were approached via email to request access to relevant ongoing studies and unpublished results.Study design Two independent reviewers determined the eligibility of studies based on the predefined inclusion criteria. Where the outcome was unclear, a third reviewer was consulted to reach consensus. Using the Joanne Briggs institute criteria for critical appraisal, 15 studies achieved good methodological quality.Meta-analysis was conducted to determine the event rate of gingival recession and damage to teeth in participants with oral piercings and to determine odds ratios of these outcomes in participants with oral piercings compared to those without.Results In total, 54 studies published between 2000-2021 met the inclusion criteria, providing a total sample of 27,963 piercings covering various anatomical sites: tongue (39 studies), lip (29 studies) and other sites, such as oral frenula or cheek (11 studies).Meta-analysis showed that there was a 34% prevalence of dental fracture (DF) in participants with oral piercings and this was 34% for tooth wear, 33% for gingival recession (GR), 27% for non-specified dental damage and 22% for tooth chipping. A significant association was found between oral piercings and the presence of GR and DF, with a seven-fold and three-fold increased risk, respectively, when an oral piercing was present. Reporting bias was not observed and evidence certainty for these outcomes was low.Conclusions The presence of oral piercings is associated with an increased risk of gingival recession and dental fracture.

What is the malignant transformation potential of oral lichen planus?

Data sources In this systematic review and meta-analysis, Medline, Scopus and Web of Science databases were searched using Medical Subject Headings (MeSH) to identify studies assessing the risk of malignant transformation in oral lichen planus (OLP).Study selection Observational studies published in English between 2003-2020 were independently assessed for inclusion by two blinded investigators.Data extraction and synthesis Data were extracted independently by two investigators followed by discussion to reach consensus. This included: study design and patient characteristics; length of follow-up; risk of bias; method of OLP diagnosis; oral squamous cell carcinoma (OSCC) risk factors; rate of malignant transformation; and individual characteristics of malignant transformation cases. Cases of malignant transformation in the included studies were only included in meta-analysis if: 1) OLP diagnosis met current diagnostic criteria; 2) OSCC developed in the same site as previously diagnosed OLP after at least six months' follow-up; 3) the patient had no history of systemic immunosuppressive therapy, head and neck malignancy, or organ transplantation. Risk of bias was assessed using the modified Newcastle-Ottawa scale, and meta-analysis was conducted to estimate overall risk of OLP malignant transformation using the DerSimonian and Laird method. Pooled univariate odds ratios (OR) for malignant transformation were calculated based on gender, smoking status, alcohol consumption, hepatitis C infection and OLP subtype.Results In total, 593 studies were identified after removal of duplicates and 33 studies were included for data extraction. The included sample comprised 12,838 patients with OLP, and 151 malignant transformation cases were reported in the included studies. The authors excluded 56 malignant transformation cases from the meta-analysis, most commonly because of the absence of pathological OLP diagnosis. Among included malignant transformation cases, the mean (SD) age was 58.1 (12.4) years, and 64% of the sample was female. Random-effects meta-analysis estimated an OLP malignant transformation rate of 0.2% (95%CI: 0.1-0.3%). Heterogeneity was low (I2 = 28.74%, p = 0.065). Malignant transformation was significantly higher among smokers (OR = 4.62, p = 0.001), alcohol consumers (OR = 3.22, p = 0.05), those with hepatitis C (OR = 3.77, p = 0.03) and atrophic or erosive OLP subtypes (OR = 2.70, p = 0.03). Gender was not associated with increased risk of malignant transformation.Conclusions The malignant transformation rate of OLP is likely to be lower than previously reported, possibly as a result of variable diagnostic criteria. Whilst encouraging, clinical vigilance remains necessary, as OLP does carry a small risk of malignant transformation. Smoking, alcohol use, hepatitis C infection and erosive or atrophic subtypes appear to have a greater rate of malignant transformation.

Safeguarding: Doing the Difficult Thing.

As dentists, we are well positioned to detect signs of abuse. Though many practitioners are aware of their duty to report concerns, multiple barriers to referral still exist. This article defines abuse, safeguarding and our role as dental healthcare professionals. It provides an overview of the types of abuse and signs that raise concern.Uncertainty over the findings was highlighted as the most common barrier to referral. This article provides an overview of the referral process. Regular training is recommended to improve familiarisation with the safeguarding procedure. Furthermore, discussing concerns with colleagues when uncertain can provide reassurance to the referring practitioner. Additional barriers include fear of the consequences to the patient, fear of implications for the practice, and time pressures. By focusing on preparation and a supportive environment, we can reduce the influence of these barriers.Although raising concerns can be stressful, there are many resources available to support dental healthcare professionals. The key focus must be the wellbeing and safety of the vulnerable patient. Your referral may help the patient and family access the support they need.