Remote triaging of urgent suspected head and neck cancer referrals: our experience during the first wave of the COVID-19 pandemic.

PURPOSE: In response to the coronavirus disease 2019 (COVID-19) pandemic, otolaryngology departments across the United Kingdom have adopted non-face-to-face clinics with consultations being carried out remotely, via telephone or video calls. By reducing footfall on hospital sites, the aim of this strategy was to limit direct contact and curb the spread of infection. This report outlines our experience of conducting a telephone triage clinic in the assessment of urgent suspected head and neck cancer referrals during the first wave of the COVID-19 pandemic. METHODS: New patients who were referred on the urgent suspected head and neck cancer pathway were prospectively identified between 1 May 2020 and 31 August 2020. Patients were triaged remotely using telephone consultations. Risk stratification was performed using the 'Head and Neck Cancer Risk Calculator' (HaNC-RC v.2). RESULTS: Four-hundred and twelve patients were triaged remotely during the 4-month study period. Of these, 248 patients were deemed 'low risk' (60.2%), 78 were classed as 'moderate risk' (18.9%) and 86 were considered 'high risk' (20.9%) according to the HaNC-RC v.2 risk score. Twenty-four patients who were assessed during the study period were diagnosed with head and neck cancer (5.82%). CONCLUSION: The use of teleconsultation, supported by a validated, symptom-based risk calculator, has the potential to provide a viable and effective adjunct in the assessment and management of new suspected head and neck cancer patients and should be considered as part of the inherent re-shaping of clinical service delivery following the ongoing pandemic.

Two-piece zirconia versus titanium implants after 80 months: Clinical outcomes from a prospective randomized pilot trial.

OBJECTIVES: To prospectively evaluate, as part of an ongoing randomized pilot trial, the clinical outcomes of two-piece zirconia implants in comparison with titanium implants 80 months after delivery of all-ceramic (lithium disilicate) single-tooth restorations. MATERIAL AND METHODS: The original sample included 31 (16 zirconia and 15 titanium) implants in 22 healthy patients. In addition to evaluating implant survival and success, a number of clinical or radiographic parameters were statistically analyzed: plaque index (PI), bleeding on probing (BOP), pink esthetic score (PES), and marginal bone loss (MBL). Both implant groups were compared using a Mann-Whitney U test. RESULTS: Three implants (2 zirconia and 1 titanium) had been lost, so that 28 implants (14 zirconia and 14 titanium) in 21 patients could be evaluated after a mean of 80.9 (SD: 5.5) months. All surviving implants had remained stable, in the absence of any fixture or abutment fractures and without any chipping, fracture, or debonding of crowns. The zirconia implants were associated with PI values of 11.07% (SD: 8.11) and the titanium implants with 15.20% (SD: 15.58), the respective figures for the other parameters being 16.43% (SD: 6.16) or 12.60% (SD: 7.66) for BOP; 11.11 (SD: 1.27) or 11.56 (SD: 1.01) for PES; and 1.38 mm (SD: 0.81) or 1.17 mm (SD: 0.73) for MBL. CONCLUSIONS: No significant differences were found between the clinical outcomes of two-piece zirconia and titanium implants based on the aforementioned parameters after 80 months of clinical service. Our results should be interpreted with the limited sample size in mind.

Behaviour Management of Children Presenting in the Emergency Department with OMFS Problems.

Introduction: This paper is a summary of three case reports of patients treated by Oral and Maxillofacial (OMFS) Dental Foundation Trainees (DF2s) at a busy London paediatric Accident and Emergency (A&E) department. Discussion: Behavioural management for paediatric patients is challenging. The authors discuss various non-pharmacological behavioural management methods as stand-alone techniques or as an adjunct to drugs (sedation or anaesthesia). They highlight three cases where a dedicated Play-Specialist is employed to assist treatment undertaken in an acute hospital setting. Here we discuss options available to clinicians for behaviour management as well as three case scenarios detailing the use of Play-Specialists alongside conventional pharmacological and non-pharmacological methods. Conclusion: Through implementing appropriate behavioural management methods (with or without drugs), optimal patient care can be achieved. The benefit of having a specialist solely trained in engaging with children, with respect to their behavioural tendencies, is demonstrated, highlighting their value in an acute setting.

Outcomes of 44 Consecutive Complete Bilateral Cleft Lip and Palate Patients Treated With Secondary Alveolar Bone Grafting and Premaxillary Osteotomy.

OBJECTIVE: To report the surgical outcomes of secondary alveolar bone grafting with premaxillary osteotomy in a single surgeon cohort of complete bilateral cleft lip and palate patients. DESIGN: Retrospective review of 44 consecutive patients using hospital notes and radiographs. SETTING: Single specialist cleft lip and palate center, UK. PATIENTS: Consecutive patients with complete bilateral cleft lip and palate who were being treated with secondary alveolar bone grafting incorporating premaxillary osteotomy. OUTCOME MEASURES: Assessment of success of bone graft by Kindelan score; canine eruption; closure of fistulae and assessment of morbidity. RESULTS: Between January 6, 2000, and August 8, 2013, 44 patients with complete BCLP underwent secondary ABG with a premaxillary osteotomy as a one-stage procedure. The mean follow-up was 7.3 years (range 1.4 to 14.6). Eighty-five percent of ABGs were successful (a Kindelan score of 1 or 2), and canine eruption was 89%. Failure of the ABG occurred in 7%. Fistulae recurrence rate was 11%, all of which were asymptomatic. No premaxillae were devitalized. CONCLUSION: Incorporating a premaxillary osteotomy into the secondary ABG surgical protocol can be a safe technique that gives excellent surgical exposure for fistula repair.

Causes of subcutaneous emphysema following dental procedures: a systematic review of cases 1993-2020.

Objectives Causes of subcutaneous emphysema (SE) following dental treatment have changed with new operative techniques and equipment. This review demonstrates the frequency and aetiology of SE to inform prevention strategies for reducing SE occurrences.Methods A systematic search of Medline, Embase and PubMed databases identified 135 cases of SE which met inclusion criteria after independent review by two authors. Trends in frequency and causes of SE were displayed graphically and significant differences in frequency of SE by time period, site and hospital stay were analysed using t-tests.Results Dental extractions often preceded development of SE (54% of cases), commonly surgical extractions. Treatment of posterior mandibular teeth most often resulted in development of SE. Most cases were iatrogenic, with 51% resulting from an air-driven handpiece and 9% from air syringes. Factors such as nose blowing accounted for 10%. There was a significant (p <0.05) increase in cases over time. Mandibular teeth had increased hospital stay time compared to maxillary teeth (p <0.01).Conclusion Increased risks of SE were identified following use of air-driven handpieces during dental extractions and when treating lower molar teeth. Use of air-driven handpieces should be avoided during dental extractions to reduce risks and subsequent morbidity that results from SE.

The appropriateness of oral surgery referrals and treatment in contracted intermediate minor oral surgery practices in East Kent.

Objectives To assess the appropriateness of oral surgery referrals, after triage, to intermediate minor oral surgery (IMOS) practices in East Kent and whether or not referrals vary according to the referring general dental practitioner's (GDP's) place of qualification and experience.Design A retrospective study of the records of 441 triaged referrals sent to three IMOS practices in East Kent, over a ten-week period. An assessment tool was developed in line with local and national referral guidelines. Information on all referrals was obtained from the IMOS provider and referral records. Descriptive analysis of the data was performed.Results The most common reason for referral was for extraction of teeth requiring bone removal (n = 155; 35%). However, the majority of teeth removed were recorded as a non-surgical extraction (n = 363; 82%). Medical histories were included appropriately in the referral communications, with only 0.2% of all referrals being inappropriate. The proportion of appropriate and inappropriate referrals was very similar and it was found that referral rate was lower from dentists who had been qualified for more than ten years. GDPs working in the same location as the IMOS provider made a greater total number of referrals as well as more inappropriate referrals.Conclusions In the group of GDPs and IMOS providers studied, a wide variation was observed between the GDP's reason for referral and the treatment provided. It may be concluded that the vast majority of extractions were safely completed in an IMOS dental practice in a primary care setting.

Is less-than-full-time training in dentistry swimming against the tide?

With ongoing changes to the demography of the dental workforce coupled with the changing expectations of those participating in early career post-graduate training, dentistry is experiencing a shift in how it might manage trainees. Drawing on experience from medicine and the anticipated behavioural differences, it is worth considering a way in which training might be able to adapt to the requirements of newer graduates, to ensure that the profession does not lose out on preparing the best candidates possible for careers that improve the state of dentistry both as a vocation and for patient benefit.

Tier 2: A Warm welcome or a Cold Reality?

Since the introduction of the 2006 NHS dental contract, various waiting list initiatives and the subsequent release of NHS commissioning guidance for dental services, there has been a remarkable and rapid shift towards the provision of intermediate services within the profession. the complexity surrounding those non-specialist providers working within these services has lead to much confusion and the further development of competencies required to work within these settings. this paper focuses on explaining and exploring the topics that arise from an area that has attracted much discussion and debate.

Postgraduate education in dental implantology in the United Kingdom: a review.

BACKGROUND: The qualified dentists in the United Kingdom (UK) are not expected to be competent in practising implant dentistry without further training in the subject and there is now greater emphasis on postgraduate training in Dental Implantology. There are three main education pathways at present, yet their training standards vary significantly. This study aims to identify UK postgraduate academic qualifications and continuing professional development (CPD) courses available in the field of Dental Implantology and evaluates the current standard of the postgraduate training programmes against the Training Standards in Implant Dentistry (TSID) guidelines from Faculty of General Dental Practice (FGDP (UK)). RESULTS: There were eight master level courses with varying types of qualification and study mode. The mean duration and tuition fee of the courses were 2.50 years and £23,635.50 per course, respectively. There were eight postgraduate diploma part-time courses with the mean duration of 2.00 years, and the mean tuition fee of £20,177.08 per course. The mean duration for two postgraduate certificate part-time courses was 1.00 year with the mean tuition fee of £9441.50. However, there were no full-time study options for these courses. All courses identified stated their compliance with TSID guidelines. The mean duration for 13 CPD courses identified was 0.94 years and all courses were delivered in a part-time mode. Eleven of these courses were verifiable CPD courses, and two courses were providing certificates only. Not all courses were fully compliant with TSID guidelines. Ten courses clearly stated that they provide mentoring for implant placements, and the number of supervised cases varied considerably between 1 and 50. CONCLUSION: Development of FGDP (UK) TSID guidelines has led to a significant improvement in the quality of postgraduate education in Dental Implantology in the UK. However, not all courses are fully compliant with these guidelines and the provision of mentoring for implant placements also needs to be standardised. Quality-assured training is directly related to patient safety, and therefore all UK postgraduate training pathways must ensure their compliance with the current guidelines.