RESUMEN
OBJECTIVES: To estimate the frequency of trigeminal nerve injuries associated with local anaesthetic administration, as experienced by UK dentists. METHOD: A convenience sample of clinicians attending 12 study days over the UK was invited to complete an anonymised questionnaire exploring the nature of professional practice, dentists' practice demographics, experience of nerve injuries and related factors. Dental procedures related to reported trigeminal nerve injuries (TNIs) were divided into low risk, likely local anaesthetic (LA) related nerve injury, and high risk procedures, more likely to be direct nerve damage by the procedure (procedural related nerve injury). Data were analysed using Microsoft Excel and SPSS V17. RESULTS: Overall 79% of attendees completed a questionnaire (n = 415); clinicians held an average of 19 years' clinical experience. The numbers of clinicians surveyed included general dental practitioners (n = 290; 64%) and oral surgery (OS) specialists (n = 125; 36%). The estimated incidence of TNIs for the UK GDP workforce was 3,770 TNIs per year or 0.13 TNI per dentist per year. For specialists the incidence was increased to 0.39 TNI per specialist per year. Of all injuries only half were reported, mainly to indemnity organisations. LA-related injuries were most common for GDPs and third molar surgery for OS specialists. It is estimated that TNIs will occur in 1 in 3,289 high risk procedures such as third molar surgery and 1 in 14,330 for low risk procedures, such as restorative dentistry, most likely LA-related. From 25% to 29% of these dental procedures related TNIs were permanent. CONCLUSIONS: Nerve-related injuries in dentistry are not uncommon. Dental practitioners should be aware of the significant disability associated with iatrogenic nerve injuries and risk factors relating to LA-related trigeminal nerve injury. Clinicians should familiarise themselves with infiltration LA-techniques that may reduce these nerve injuries and with the Care Quality Commission regulations for reporting injuries to patients as a result of treatment.
Asunto(s)
Anestesia Dental/estadística & datos numéricos , Anestésicos Locales/efectos adversos , Odontólogos/estadística & datos numéricos , Enfermedad Iatrogénica/epidemiología , Traumatismos del Nervio Trigémino/epidemiología , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Restauración Dental Permanente/estadística & datos numéricos , Odontología General/estadística & datos numéricos , Humanos , Incidencia , Lidocaína/administración & dosificación , Tercer Molar/cirugía , Bloqueo Nervioso/estadística & datos numéricos , Prevalencia , Estudios Prospectivos , Recuperación de la Función/fisiología , Factores de Riesgo , Cirugía Bucal/estadística & datos numéricos , Extracción Dental/estadística & datos numéricos , Reino Unido/epidemiologíaRESUMEN
Aspects of residential units provided for children under the Sheffield Development Project were studied. A variety of issues were raised which could be helpful in planning future services. The demand for places was considerably less than had been expected under the Project plans, and a greater than predicted proportion of the children had severe handicaps. Units had not specialized as intended, but had developed their own admission criteria. All unit heads felt smaller group sizes would have been preferable and most favoured smaller bedrooms. Fewer institutional staff management practices took place in the more domestic environments. Provision for outdoor play tended to be neglected.