An overview of assessment and management of acute dental pain.

Dental care practitioners are often the first port of call for patients presenting with acute dental pain. Due to the increasing backlog of patients in the UK resulting from the COVID-19 pandemic, it is expected that an increasing number of patients will present to dental care practitioners with acute dental problems. This article aims to provide an overview of common presentations of acute dental pain, the importance of thorough assessment and accurate diagnosis, and the management of such conditions.

Making dental extractions predictable: A methodological approach.

Dental extractions are one of the most commonly undertaken procedures in dentistry. However, for some dentists it can be a stressful and daunting treatment to undertake. This paper explores the importance of planning and the salient aspects in the assessment that should be considered. A methodical approach to assessment will avoid important factors from being overlooked.

Temporomandibular disorder: A guide for general dental practitioners.

The presentation of patients with symptoms associated with temporomandibular disorders (TMDs) is a common finding in general dental practice. The management of patients with TMDs is often complicated by its multifactorial aetiology. This paper aims to provide a guide for dental practitioners to the clinical examination, diagnosis, and recognition of red flags in relation to TMDs and inform the busy practitioner when to refer patients presenting with TMDs for specialist/secondary care management.

An evaluation of patient informed consent for dental extractions.

Dental practitioners are well versed in informing patients of the risks and benefits associated with dental extractions. The purpose of this service evaluation was to determine whether patients understood and recalled information relevant to their planned oral surgery procedure, prior to second stage consent.A questionnaire was distributed to patients who were attending for their elective treatment appointment. This explored their ability to recall the planned intervention, the modality of treatment (local anaesthetic, intravenous sedation, or general anaesthetic), understanding of alternative treatment options and the risks associated with the procedure. Completed responses were received from 29 of the distributed questionnaires (response rate=58%). The majority of patients were not aware of the following risks with their procedure: pain, bleeding, bruising, swelling, infection, damage to adjacent structures.Despite a well-documented consent form and comprehensive discussion, we identified that patients may not comprehend or recollect the risks associated with their dental extraction. As dental professionals we have a duty to seek ways to facilitate patient understanding and maximise their autonomy.

When dental extractions go wrong: An overview of common complications and management.

The extraction of teeth carries a risk of associated complications, some of which may be predicted, providing an opportunity for them to be prevented or their effects minimised. Prior to embarking on any extraction, the dentist must be confident that they are able to deal with any complication that may arise. This paper provides an overview of the complications of dental extraction which are commonly encountered, considers the factors which predispose to them arising, suggests how the risk of them occurring can be reduced, and describes how they should be managed.

An audit of dental nurses' confidence with intravenous sedation within an oral surgery department at a UK dental hospital.

The Oral Surgery department at King's College Hospital, London provides a large volume of treatment under intravenous sedation (IVS) with midazolam. The Oral Surgery team includes over 20 dental nurses, each with varying levels of training and knowledge around IVS. The dedicated team approach needed to manage complex or difficult patients requires a keen understanding of the treatment modality and drugs involved, through regular continuing professional development (CPD) activities to refresh and update knowledge. An audit was designed to assess the levels of confidence among a cohort of dental nurses in the Oral Surgery department. Completion of the audit cycle resulted in improved levels of confidence through identification of teaching needs and targeted teaching. This article outlines the validity of regular team-based education in targeted areas to maximise learning outcomes and improve patient care and experience.

Retrospective evaluation of sensory neuropathies after extraction of mandibular third molars with confirmed "high-risk" features on cone beam computed topography scans.

OBJECTIVES: The objective of this study was to identify the incidence of inferior alveolar nerve (IAN) injury after extraction of mandibular third molars with confirmed "high-risk" features on cone beam computed topography scans and establish any risk factors that significantly increase the chances of sustaining an IAN injury. STUDY DESIGN: This study is a retrospective analysis of outcomes after surgical extraction of 500 mandibular third molars over a 5-year period. All teeth showed signs of contact with or compression of the IAN on cone beam computed topography scans. RESULTS: The overall incidence of IAN injury was 6.6%, with permanent neuropathies accounting for 1.8% within this high-risk cohort. Statistically significant factors shown to increase the risk of nerve injury included increasing age (P = .002), compression of the nerve evident on cone beam computed topography scan (P = .005), and buccal or interradicular position of the nerve (P = .042). CONCLUSIONS: Results indicate a low incidence of IAN injury, particularly given the high-risk nature of all teeth that were extracted. It highlights the benefits of cone beam computed topography scans in surgical planning. These data are an important contribution to the existing literature and valuable in the consent procedure for patients undergoing surgical removal of mandibular third molars in contact with the IAN.

COVID-19: establishing an oral surgery-led urgent dental care hub.

COVID-19 has changed the face of dentistry in the UK and around the world. The potential for aerosol generation, the presence of the virus within saliva and the fact that dental professionals work with the oral-pharyngeal environment determines that dental treatment poses a risk of viral transmission. At the start of the pandemic, the cessation of routine dental care across the country necessitated the rapid establishment of an emergency dental service at King's College Hospital. This paper describes its evolution to date and the challenges encountered along the way.

Guide for commissioning oral surgery: the development of a calibration tool.

Aims In previously published work a calibration tool used within the Department of Oral Surgery, King's College Dental Hospital London, identified a consensus of 68% in classifying levels of complexity of cases as per NHS England's Guide for Commissioning Oral Surgery and Oral Medicine. The authors postulated that the same challenges in triaging patients would be experienced by clinicians working in less supported environments. A pilot survey attempted to ascertain the level of compliance with the commissioning framework on a national scale.Materials and methods Twenty cases treated at the Department of Oral Surgery, King's College Dental Hospital London, were identified for inclusion. Radiographs and case histories were compiled within an online questionnaire and circulated via NHS email links and online e-questionnaire platforms. Results were analysed by a specialty registrar and consultant in oral surgery.Results One hundred and fifty-four responses were received. An average of 66.2% responses received were in agreement with the predetermined answers of the survey.Discussion The results can be interpreted as a consensus of 66.2% nationally, which is similar to previous local results. This study demonstrates shortcomings of the commissioning framework, conflicts between the commissioning framework and the oral surgery training curriculum and ambiguity of modifying factors. Collectively, these may in some cases result in greater inefficiencies of care.

What is the role of senior house officer or dental foundation year two posts in professional careers? Exploring the motivations for, and perceived benefits of, undertaking SHO posts in two London hospitals.

AIMS: To investigate the motivations for, and perceived benefits of, undertaking senior house officer (SHO) posts, and to explore the career pathways of those who do, examining trends in successive cohorts. METHOD: Postal cross-sectional questionnaire survey of all dental and maxillofacial SHOs (DF2s) who had worked for two South London hospitals within the previous nine years (n=137). Respondents were grouped into three cohorts to enable responses to be examined in relation to respondents' entry to their first SHO post. RESULTS: There were responses from 83 (61%) potential participants. The most frequent motivation for carrying out SHO posts from 79 (95%) of the respondents was the desire to 'learn from experienced clinicians'. The most common perceived benefit reported by those who had completed posts at the time of the survey was 'an improved understanding of the role of the hospital dental service' from 68 (97%) of those who answered this question. Difficulty in securing a job in general dental practice was not reported as a notable motivating factor, either before or after the implementation of the new dental contract. 'Fulfil approved training post requirements for postgraduate examinations' reduced as a motivator from 28 (88%) for the earlier cohort of SHOs to nine (36%) for the more recent cohort. Fifty-four of 78 (69%) respondents declared a definite plan to seek admission to the General Dental Council Specialist Lists in future, 24 (83%) in the first cohort, compared with 11 (46%) in the last (P=0.05). Of the males, 13 (52%) were significantly more likely to report that they were currently working in general practice compared with 15 (27%) females (P=0.028). CONCLUSION: The findings suggest that multiple benefits are identified from undertaking SHO posts. However, some of the motivations for undertaking SHO posts may have changed over the nine-year period investigated. Possible influences are discussed. This paper highlights the perceived benefits of junior training posts at a time of significant transition within the profession.