Aspirin and non-steroidal anti-inflammatory drug use and the risk of upper aerodigestive tract cancer.

BACKGROUND: Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are widely used as analgesics and preventative agents for vascular events. It is unclear whether their long-term use affects cancer risk. Data on the chemopreventative role of these drugs on the risk of the upper aerodigestive tract cancer (UADT) are insufficient and mostly refer to oesophageal cancer. The aim of this study was to investigate the effect of aspirin and other NSAIDs on the risk of UADT cancers. METHODS: A nested case-control study using the Primary Care Clinical Informatics Unit (PCCIU) database. Conditional logistics regression was used for data analysis. RESULTS: There were 2392 cases of UADT cancer diagnosed between 1996 and 2010 and 7165 age-, gender- and medical practice-matched controls from 131 general medical practices. Mean age of cases was 66 years (s.d. 12) and most were male (63%). Aspirin was prescribed in a quarter of cases and controls, COX-2 inhibitors in 4% of cases and 5% of controls and other NSAIDs in 33% of cases and 36% of controls. Aspirin prescription was associated with a nonsignificant risk reduction of cancer of UADT (adjusted OR=0.9, 95% CI=0.8, 1.0), head and neck (HN; adjusted OR=0.9, 95% CI=0.7, 1.1) or the oesophagus (adjusted OR=0.8, 95% CI=0.7, 1.0). Similar results were found for COX-2 inhibitors prescription. Prescription of other NSAIDs was associated with significantly reduced risk of cancer of UADT (adjusted OR=0.8, 95% CI=0.7, 0.9), HN (adjusted OR=0.8, 95% CI=0.7, 0.9) and the oesophagus (adjusted OR=0.8, 95% CI=0.7, 0.9). An increased volume of aspirin prescriptions was associated with a significant risk reduction (test for trend P<0.001). CONCLUSIONS: The decreased risk of cancer of the UADT associated with the use of non-COX-2 inhibitors, NSAIDs and long-term aspirin therapy warrants further exploration of the benefits vs risks of the use of these agents.

Role of medical history and medication use in the aetiology of upper aerodigestive tract cancers in Europe: the ARCAGE study.

BACKGROUND: The study aimed to investigate the role of medical history (skin warts, Candida albicans, herpetic lesions, heartburn, regurgitation) and medication use (for heartburn; for regurgitation; aspirin) in the aetiology of upper aerodigestive tract (UADT) cancer. METHODS: A multicentre (10 European countries) case-control study [Alcohol-Related CAncers and GEnetic susceptibility (ARCAGE) project]. RESULTS: There were 1779 cases of UADT cancer and 1993 controls. History of warts or C. albicans infection was associated with a reduced risk [odds ratio (OR) 0.80, 95% confidence interval (CI) 0.68-0.94 and OR 0.73, 95% CI 0.60-0.89, respectively] but there was no association with herpetic lesions, heartburn, regurgitation or medication for related symptoms. Regurgitation was associated with an increased risk for cancer of the oesophagus (OR 1.47, 95% CI 0.98-2.21). Regular aspirin use was not associated with risk of UADT cancer overall but was associated with a reduced risk for cancer of oesophagus (OR 0.51, 95% CI 0.28-0.96), hypopharynx (OR 0.53, 95% CI 0.28-1.02) and larynx (OR 0.74, 95% CI 0.54-1.01). CONCLUSIONS: A history of some infections appears to be a marker for decreased risk of UADT cancer. The role of medical history and medication use varied by UADT subsites with aspirin use associated with a decreased risk of oesophageal cancer and suggestive of a decreased risk of hypopharyngeal and laryngeal cancers.

Calibration of the modified Huddart and Bodenham scoring system against the GOSLON/5-year-olds' index for unilateral cleft lip and palate.

The GOSLON/5-year-old scoring systems have been used in various national and international studies. This study aims to identify the range of Modified Huddart and Bodenham (MHB) scores, which correlate with each GOSLON and 5-year-old category and thereby create a new scoring system that allows comparison with historical data. Two hundred and eighty-three unilateral cleft lip and palate study models from England and Scotland that had all been previously scored using the 5-year-old and GOSLON indices by calibrated examiners were scored using MHB on two separate occasions a month apart by two examiners. Reliability analysis using intraclass correlation and Bland Altman plots were performed. Ordinal regression was used to define the categories of MHB that correspond to the 5-year-old and GOSLON categories. The results revealed a high level of repeatability for both the 5 and the 10 year old models. The MHB scale was grouped into the five categories of the GOSLON and 5-year-old indices with more precision for the 5 year than the 10 year scores. In conclusion, there was high intra-examiner and inter-examiner agreement using the MHB scoring system. It also correlates well with the 5-year-old and GOSLON indices and has been shown to be a much more sensitive scoring system.

Life course social mobility and risk of upper aerodigestive tract cancer in men.

The aim of this study was to explore associations between social mobility and tumours of the upper aero-digestive tract (UADT), focussing on life-course transitions in social prestige (SP) based on occupational history. 1,796 cases diagnosed between 1993 and 2005 in ten European countries were compared with 1585 controls. SP was classified by the Standard International Occupational Prestige Scale (SIOPS) based on job histories. SIOPS was categorised in high (H), medium (M) and low (L). Time weighted average achieved and transitions between SP with nine trajectories: H --> H, H --> M, H --> L, M --> H, M --> M, M --> L, L --> H, L --> M and L --> L were analysed. Odds ratios (ORs) and 95%-confidence intervals [95%-CIs] were estimated with logistic regression models including age, consumption of fruits/vegetables, study centre, smoking and alcohol consumption. The adjusted OR for the lowest versus the highest of three categories (time weighted average of SP) was 1.28 [1.04-1.56]. The distance of SP widened between cases and controls during working life. The downward trajectory H --> L gave an OR of 1.71 [0.75-3.87] as compared to H --> H. Subjects with M --> M and L --> L trajectories ORs were also elevated relative to subjects with H --> H trajectories. The association between SP and UADT is not fully explained by confounding factors. Downward social trajectory during the life course may be an independent risk factor for UADT cancers.

Vertical marginal and internal adaptation of all-ceramic copings made by CAD/CAM technology.

Vertical marginal and internal adaptation scores of all-ceramic copings made by Computer aided manufacturing/ computer aided design (CAD/CAM) were investigated. Scores were compared between Procera all-ceram copings, Cerec-in-lab copings and IPS Empress 2 copings. A stereomicroscope was used (at x45) to measure vertical marginal scores and also used to measure internal adaptation after dies were sectioned. Procera copings showed better vertical marginal adaptations on dies and master preparation and internal adaptation on dies than both IPS Empress 2 and Cerec- in-lab copings. All copings appeared to produce vertical marginal and internal adaptation scores well within the maximum clinically acceptable gaps.

Predictors of oropharyngeal cancer survival in Europe.

OBJECTIVES: HPV16-positive oropharyngeal cancer (OPC) patients experience better outcomes compared to HPV16-negative patients. Currently, strategies for treatment de-escalation are based on HPV status, smoking history and disease stage. However, the appropriate cut-point for smoking and the role of other non-clinical factors in OPC survival remains uncertain. MATERIALS AND METHODS: We examined factors associated with OPC outcome in 321 patients recruited in a large European multi-center study. Seropositivity for HPV16 E6 was used as a marker of HPV16 positive cancer. Hazard ratios (HR) and confidence intervals (CI) were estimated using Cox proportional models adjusted for potential confounders. RESULTS: Overall 5-year survival following OPC diagnosis was 50%. HPV16-positive OPC cases were at significantly lower risk of death (aHR = 0.51, 95% CI: 0.32-0.80). A significant effect on OPC survival was apparent for female sex (aHR 0.50: 95% CI: 0.29-0.85) and being underweight at diagnosis (aHR: 2.41, 95% CI: 1.38-4.21). A 10 pack year smoking history was not associated with overall survival. Higher stage at diagnosis appeared as the only factor significantly associated with OPC recurrence (aHR: 4.88, 95% CI: 2.12-11.21). CONCLUSION: This study confirms that HPV16 status is an independent prognostic factor for OPC survival while female sex lowers risk of death and being underweight at diagnosis increases the risk of death. Smoking was not an independent predictor of OPC survival.

The changing face of infection: a comparative review of admissions to a regional infection unit over three decades.

BACKGROUND AND AIMS: Our group previously published retrospective analyses of 12 months of admissions to the Grampian Regional Infectious Diseases Unit from 1980-81 and from 1991. This study aimed to collect data in 2001 and to compare annual admission numbers, diagnoses, duration of stay and outcome in 1980-81, 1991 and 2001. METHODS: Data on all admissions was collected prospectively throughout 2001. This was compared with the previously published data. RESULTS: Total admissions rose from 605 in 1980-81 to 900 in 1991 and to 1152 in 2001. Sixty one percent of admissions in 1980-81 were confirmed as having infection compared to 72% in 1991 and to 83% in 2001. The most common reason for admission in 2001 was skin and soft tissue infection, but this was only the ninth commonest reason in 1981. Mean length of stay fell from 9.6 days in 1980-81 to 7.4 days in 1991 and to 5.5 days in 2001. The mortality rate fell from 3.1% in 1981 and 1991 to 1.0% in 2001. CONCLUSIONS: This study demonstrates significant changes in type, number and outcome of admissions to a regional infection unit. We discuss possible reasons for these changes.

Fluoridated milk for preventing dental caries.

BACKGROUND: Dental caries remains a major public health problem in most industrialised countries, affecting 60% to 90% of school children and the vast majority of adults. Milk provides a relatively cost-effective vehicle for fluoride in the prevention of dental caries. OBJECTIVES: To determine the effectiveness of fluoridated milk, as a means of delivering fluoride on a community basis, for preventing dental caries. SEARCH STRATEGY: We searched Cochrane Oral Health Group Trials Register (28 April 2005), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to 17 May 2005), OLDMEDLINE (1950 to 1965), EMBASE (1980 to 2005 week 20), LILACS (1982 to 17 May 2005), BBO (1986 to 17 May 2005), SIGLE (1980 to 17 May2005), Digital Dissertations (1861 to 17 May 2005) and reference lists of relevant articles. Attempts were made to identify both unpublished and ongoing studies. There were no language restrictions. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials (RCTs), with an intervention or follow-up period of at least 3 years, comparing fluoridated milk with non-fluoridated milk. Primary outcome was change in caries experience, as measured by changes in decayed, missing and filled figures on tooth (dmft/DMFT) and surface (dmfs/DMFS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, data extraction and quality assessment were carried out independently and in duplicate. Study authors were contacted for additional information where necessary. MAIN RESULTS: Two RCTs involving 353 children were included. For permanent teeth, after 3 years there was a significant reduction in the DMFT (78.4%, P < 0.05) between the test and control groups in one trial, but not in the other. The latter study only showed a significant reduction in the DMFT until the fourth (35.5%, P < 0.02) and fifth (31.2%,P < 0.05) years. For primary teeth, again there was a significant reduction in the dmft (31.3%, P< 0.05) between the test and control groups after 3 years in one study, but not in the other. The results could not be pooled because of the difference in concentration of fluoride in the milk. AUTHORS' CONCLUSIONS: There are insufficient studies with good quality evidence examining the effects of fluoridated milk in preventing dental caries. However, the included studies suggested that fluoridated milk was beneficial to school children, especially their permanent dentition. The data need to be supplemented by further RCTs to provide the highest level of evidence for practice.

Oral lichenoid lesions related to dental restorative materials.

OBJECTIVES: To determine the effectiveness of replacing restorations considered to be the cause of an oral lichenoid lesion (oral lichenoid reaction)(OLL). DESIGN: Clinical intervention and nine-month follow up. SETTING: The study was carried out in the University Dental Hospital of Manchester, 1998-2002. SUBJECTS AND METHODS: A total of 51 patients, mean age 53 (SD 13) years, who had oral lesions or symptoms suspected to be related to their dental restorations were investigated. Baseline patch tests for a series of dental materials, biopsies and photographs were undertaken. Thirty-nine out of 51 (76%) of patients had their restorations replaced. RESULTS: The clinical manifestations of OLL were variable; the majority of OLL were found to be in the molar and retro molar area of the buccal mucosa and the tongue. Twenty-seven (53%) patients had positive patch test reactions to at least one material, 24 of them for one or more mercury compound. After a mean follow up period of nine months, lesions adjacent to replaced restorations completely healed in 16 (42%) patients (10 positive and 6 negative patch tests). Improvement in signs and symptoms were found in 18 (47%) patients (11 positive and 7 negative patch tests). CONCLUSION: OLLs may be elicited by some dental restorations. Replacing restorations adjacent to these lesions is associated with healing in the majority of cases particularly when lesions are in close contact with restorations. A patch test seems to be of limited benefit as a predictor of such reactions.

Association between female hormonal factors and oro-facial pain: study in the community.

The aim of this study was to determine the relationship between the prevalence of oro-facial pain (OFP) in the population and female hormonal factors. The cross-sectional population study was conducted in a general medical practice in the north-west of England. A random sample of 4000 adults aged 18-65 years were mailed questionnaires, of whom 2504 responded (adjusted participation rate 74%). Of these 1245 women provided information on both OFP and hormonal factors. For pre- or peri-menopausal women, there was no relationship between oral contraceptive use and OFP (age-adjusted relative risk (RR) 1.10; 95% confidence interval (CI) 0.81, 1.45), whilst a high score on a pre-menstrual symptom questionnaire was associated with an age-adjusted RR of 1.87 (95% CI 1.36, 2.57). Those who reported menstruating for 6 days or longer had moderate increase in risk of OFP (age-adjusted RR 1.39; 95% CI 1.01, 1.91). In post-menopausal women, there was a moderate relationship between hormone replacement therapy use and OFP (age-adjusted RR 1.46; 95% CI 1.02, 2.08). For women overall, there was an increased risk of OFP in those who reported ever having had painful periods (age-adjusted RR 1.47; 95% CI 1.20, 1.80), but no association was found with the number of children. This cross-sectional community-based study adds important information on the relationship between female hormonal factors and OFP. Women who report OFP are more likely to report symptoms associated with menstruation. This may indicate either the importance of hormones per se or identify a group of women who are more likely to report symptoms in general.

Predictors of outcome for orofacial pain in the general population: a four-year follow-up study.

Orofacial pain is often persistent, but it is not clear why it lasts in some patients but not in others. We aimed to describe the natural course of orofacial pain in a general population sample over a four-year period and to identify factors that would predict the persistence of pain. A cross-sectional population-based survey was conducted in the United Kingdom, involving 2504 participants (participation rate 74%), of whom 646 (26%) reported orofacial pain. Overall, 424 (79% adjusted participation rate) of these individuals participated at the four-year follow-up, of whom 229 (54%) reported orofacial pain and 195 (46%) did not report such pain. Persistent orofacial pain was associated with females, older age, psychological distress, widespread body pain, and taking medication for orofacial pain at baseline. These findings may have implications for the identification and treatment of patients with orofacial pain.

The influence of alcohol consumption on worldwide trends in mortality from upper aerodigestive tract cancers in men.

STUDY OBJECTIVES: To assess current trends in male mortality from cancers of the oral cavity/pharynx, oesophagus, and larynx (upper aerodigestive tract cancers), and relate these to past national consumption of alcohol and smoking of cigarettes. To assess the impact of current trends in alcohol consumption and tobacco smoking on likely future rates of these cancers. DESIGN: Mortality data for cancers of the oral cavity/pharynx, oesophagus, and larynx were obtained for the years 1955-89 in 25 countries located in North America, Australasia, Europe, and Japan. Information on past and current alcohol consumption was also obtained for these countries, while current national lung cancer rates were used as a proxy measure of past smoking levels. SETTING: The World Health Organization mortality database. MAIN RESULTS: National death rates from cancers of the oral cavity/pharynx, oesophagus, and larynx (considered together) are currently increasing among men and are most strongly associated with the level of per capita consumption of alcohol 20 years previously. They were less strongly associated with the level of alcohol consumption 10 years ago, and only very weakly associated with the current level of lung cancer mortality (a marker of past smoking habits). Regression analysis showed that the national rate of upper aerodigestive tract cancer could be estimated using information on past alcohol consumption and an interaction term between alcohol consumption and current lung cancer rates. Assuming stability in rates of lung cancer, the sizeable increase in alcohol consumption from 5 to 10 litres per capita each year that occurred in some countries during the 1960s and 70s means that increases of around 5 per 100,000 in the death rate from these cancers can be expected in these countries in the next decades. CONCLUSIONS: Previous alcohol consumption in a country is a strong predictor of deaths from cancers of the upper aerodigestive tract in men, and current increases in death rates can probably be related to increases in consumption which took place during the 1960s and 70s. Combined with a reduction in tobacco smoking, which is already taking place in some countries, reversing the trend of increases in consumption of alcohol has the potential for a sizeable impact on the burden of these cancers.

Adhesives for fixed orthodontic brackets.

BACKGROUND: Bonding of orthodontic brackets to teeth is important to enable effective and efficient treatment with fixed appliances. The problem is bracket failure during treatment which increases operator chairside time and lengthens treatment time. A prolonged treatment is likely to increase the oral health risks of orthodontic treatment with fixed appliances one of which is irreversible enamel decalcification. OBJECTIVES: To evaluate the effectiveness of different orthodontic adhesives for bonding. SEARCH STRATEGY: Electronic databases: the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Date of most recent searches: August 2002 (CENTRAL) (The Cochrane Library Issue 2, 2002). SELECTION CRITERIA: Trials were selected if they met the following criteria: randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing two different adhesive groups. Participants were patients with fixed orthodontic appliances. The interventions were adhesives that bonded stainless steel brackets to all teeth except the molars. The primary outcome was debond or bracket failure. DATA COLLECTION AND ANALYSIS: Data were recorded on decalcification as a secondary outcome, if present. Information regarding methods, participants, interventions, outcome measures and results were extracted in duplicate by pairs of reviewers (Nicky Mandall (NM) and Rye Mattick (CRM); Declan Millett (DTM) and Joy Hickman (JH2)). Since the data were not presented in a form that was amenable to meta-analysis, the results of the review are presented in narrative form only. MAIN RESULTS: Three trials satisfied the inclusion criteria. A chemical cured composite was compared with a light cure composite (one trial), a conventional glass ionomer cement (one trial) and a polyacid-modified resin composite (compomer) (one trial). The quality of the trial reports was generally poor. REVIEWER'S CONCLUSIONS: It is difficult to draw any conclusions from this review, however, suggestions are made for methods of improving future research involving orthodontic adhesives.

An evaluation of the surface changes in PMMA biomaterial formulations as a result of toothbrush/dentifrice abrasion.

OBJECTIVES: The objective of this study was to evaluate the abrasion resistance and surface roughness of two injection-molded poly(methylmethacrylate) denture base materials (SR-Ivocap 'Plus', Ipsyl 60 RV), and also one compression-molded material (Trevalon). A fourth group of specimens (prepared from Trevalon using the injection-molding procedure) was compared to the compression-molded specimens. METHODS: Ten specimens were prepared according to manufacturers' instructions. An experiment involving toothbrush and dentifrice abrasion was performed on all specimens from each of the materials and the cumulative percentage weight-loss was calculated after 100,000 brush strokes. A series of surface roughness profile measurements were also obtained from each specimen within the groups. The data were analysed by using the Kolmogorov-Smirnov test. A level of significance of 0.017 was set in order to adjust for multiple comparisons between the three sets of materials. RESULTS: There was found to be no statistically significant difference between the three groups of materials in terms of percentage weight-loss, and no statistically significant difference between the Trevalon specimens when injection-molded or compression-molded. In terms of surface roughness, however, SR-Ivocap 'Plus' recorded the lowest surface roughness profile of the three groups. It was found that there was a statistically significant difference (P<0.017) between this material and Ipsyl RV 60 (producing the highest roughness), and compression-molded Trevalon. Furthermore, there was found to be no statistically significant difference between injection-molded and compression-molded specimens of Trevalon with regard to surface texture. SIGNIFICANCE: From a clinical standpoint, the surface roughness results suggest SR-Ivocap 'Plus' to be the material most likely to produce the least suitable substrate for the accumulation of denture plaque.

Systematic review of population-based epidemiological studies of oro-facial pain.

OBJECTIVES: To conduct a systematic review of epidemiological literature in order to determine the prevalence and associated risk factors of oro-facial pain. DATA: Population based observational studies (cohorts, cross-sectional and case-control studies) of oro-facial pain, published in the English language, prior to 1999 were included. SOURCES: Electronic databases (Medline, Embase, Cinahl, BIDS and Health CD) were searched. Reference lists of relevant articles were examined, and the journals "Pain" and "Community Dentistry and Oral Epidemiology" were handsearched for the years 1994-1998. RESULTS: The results of the search strategy were screened for relevance. A standardised checklist was used to assess the methodological quality of each study by two reviewers before an attempt was made to summarise the results. The median quality score was 70% of the maximum attainable score. Due to methodological issues, it was not possible to pool the data on the prevalence of oro-facial pain. Age, gender and psychological factors were found to be associated with OFP, however there was not enough information on other factors such as local mechanical and co-morbidities to draw any reliable conclusions. None of the factors fully fulfilled criteria for causality. CONCLUSIONS: There is a need for good quality epidemiological studies of oro-facial pain in the general population. To enable comprehensive examination of the aetiology of oro-facial pain, it is necessary to address a broad range of factors including demography and life-style, local mechanical factors, medical history and psychological factors. Future studies should recruit adequately sized samples for precise determination of the prevalence and detection of important associated factors. Data on potential confounders and effect modifiers should also be collected and adjusted for in the statistical analysis.

Association between local mechanical factors and orofacial pain: survey in the community.

OBJECTIVES: The aetiology of orofacial pain (OFP) is not well understood. We aimed to determine the relationship between OFP and local mechanical factors in an unselected general population sample. METHODS: A cross-sectional population-based survey was conducted in the United Kingdom, involving 2504 participants (adjusted participation rate 74%). Postal questionnaire was used to collect information on OFP and local mechanical factors. RESULTS: A significant association was found between OFP and a history of tooth grinding, facial trauma, the jaw getting stuck or locked, a clicking or grating sound in the jaw joint when opening or closing the mouth, difficulty in opening the mouth wide, and chewing of pens or biting finger nails. The jaw getting stuck or locked had the highest relative risk of 2.7 (95% CI: 2.3-3.2). A history of orthodontic treatment, having any type of dentures and using chewing gum were not associated with OFP. There was some evidence of heterogeneity between types of OFP and local mechanical factors. CONCLUSIONS: Local factors play an important role in the aetiology of OFP.

Some aspects of data analysis in dentistry.

In dentistry many studies collect hierarchical data, but this is not always recognised or understood by the researchers. This paper sets out to describe such studies and discusses aspects of their design, data collection and analysis. Sometimes these studies may be dealt with in a simple way, but others may require the help of a professional statistician to deal with analytical problems that are encountered.

Factors associated with health care seeking behaviour for orofacial pain in the general population.

OBJECTIVE: To describe the health care seeking behaviour associated with orofacial pain (OFP) and determine factors associated with such behaviour. DESIGN: Cross-sectional population-based study using postal questionnaires. PARTICIPANTS: Adults aged 18-64 years from a general medical practice in south-east Cheshire, UK (participation rate 74%). RESULTS: Of the 2,504 respondents to the questionnaire 646 reported OFP, of whom 555 (86%) indicated whether or not they sought professional help. A total of 255 (46%) responded that they had sought advice. The majority had sought advice from their medical practitioner (57%) or dentist (51%), and 64% had taken medication because of OFP. The likelihood of seeking treatment increased linearly with age (p < 0.001) while gender, education and psychological distress did not show a significant association with seeking treatment. Persons who were regular dental attenders had an increased likelihood of seeking treatment for OFP (RR 1.4; 95% CI 1.1,1.8). Perception of illness had moderate association with healthcare seeking (RR 0.8; 95% CI 0.7,0.96). There was a significant trend of increasing RR with increasing total number of pain symptoms (p < 0.001), frequency of pain, duration of pain episodes, pain intensity and disability associated with pain. Participants who reported pain duration of more than three months had almost double the likelihood (RR 1.8; 95% CI 1.4,2.3) of seeking treatment. Decrease in self-reported control over pain and ability to decrease pain were both associated with an increased likelihood of seeking professional care (p < 0.001). CONCLUSIONS: The strongest predictors of health care seeking behaviour were different characteristics of pain.

An analysis of an admissions system: can performance in the first year of the dental course be predicted?

The admissions process must be scrupulously fair and select the most suitable students. Data on applicants to the Manchester Dental School for the 1996/97 academic year were analysed. The aims of this project were to: describe the applicants using information from the UCAS (university entrance) form; to relate information from the UCAS form to interview performance and A-level results; and to evaluate whether these factors can predict performance during the first year of the course.

Attitudes to biopsy procedures in general dental practice.

AIM: To investigate biopsy procedures in general dental practice. OBJECTIVES: To assess the views and attitudes of: specialists on the dental specialist surgical registers; dentists in general practice (GDPs) and patients undergoing biopsy procedures. METHOD: Questionnaires were sent to 98 oral and maxillofacial surgeons and surgical dentists, 335 general dental practitioners and 220 patients attending the Oral Medicine Clinic at the Dental Hospital, Manchester. Participation rates were 68 (74%), 227 (72%), and 158 (76%) respectively. RESULTS: Specialists: 47 (70%) would discourage dental practitioners undertaking biopsies. Concerns were a lack of skills and delays in referral; 20 (30%) considered GDPs should be able to perform simple biopsies for benign lesions. Dentists: 33 (15%) reported they had performed oral biopsies in the last two years; 136 (60%) felt they should be competent to biopsy benign lesions. Their main concerns were lack of practical skills and the risk of diagnostic error. PATIENTS: 112 (65%) worried about their biopsy result, 67 (39%) would feel anxious if their dentist did the biopsy, although 40 (23%) were anxious when biopsied in the oral medicine clinic. CONCLUSIONS: Both specialists on the dental surgical registers and GDPs feel there is a need for further training in biopsy technique for GDPs and better advertised and accessible pathology support. The current fee for biopsies may need upward revision. A main concern of patients is fear of an adverse biopsy report. Whilst patients are satisfied with specialist management any concerns were an insufficient reason for biopsy of a benign lesion not being undertaken in general practice.