Obstructive sleep apnoea/hypopnoea syndrome: a feasibility study to review NICE guidelines.

Introduction Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a sleep-related respiratory condition, leading to repeated temporary cessation of breathing. OSAHS affects approximately eight million people in the UK and can contribute to many comorbidities. Recently, there has been updated National Institute for Health and Care Excellence (NICE) guidelines for the management of OSAHS in the UK.Aims To assess the current care pathway for OSAHS patients in St George's Hospital (SGH) and if the hospital was complying with current NICE guidelines.Methods A retrospective case note analysis of 50 adult patients who have attended SGH for OSAHS in 2022 was undertaken to review their care pathway. Patient notes were reviewed to determine if key criteria of NICE guidelines were followed.Results The OSA clinic follows some of the NICE guidelines and had this recorded in the notes for 40% of the standards/criteria reviewed (10 out of 25 standards were met and recorded).Discussion This service evaluation reveals patients have multiple appointments and have varying treatment compliance. Further discussions are required with the sleep clinicians to determine an efficient pathway for patients who require consideration for alternative therapies for OSA and understanding the funding flows.Conclusions There is a need to raise awareness of these guidelines and improve record-keeping of lifestyle advice given and monitoring treatment efficacy, as the NICE guidelines were not yet being routinely followed.

Dento-skeletal effects of different rapid maxillary expanders for growing patients-which is better?

DESIGN: Single-blind, two-arm parallel-group randomised controlled trial. CASE SELECTION: Patients aged 11-14 years old attending for comprehensive orthodontic treatment between January and July 2018. All subjects needed to have the following: present upper first premolars and first permanent molars; transverse maxillary deficiency; unilateral or bilateral posterior crossbite. The exclusion criteria was: cleft lip or palate, previous orthodontic treatment; congenital deformity; absent permanent teeth. INTERVENTION: Rapid maxillary expansion via two techniques were used and placed by the same orthodontist. Group A were treated via the tooth-bone-borne Hybrid Hyrax expander, Group B had the tooth-borne (hyrax) expander. CBCT scans of the maxilla were taken before treatment and 3 months after the activation phase when the appliances had been removed. DATA ANALYSIS: Analysis of the dental and skeletal changes was completed via measuring pre and post treatment CBCT scans using Dolphin software for Group A and Group B. Measurements included: specific naso-maxillary widths in the first premolar region (i.e. nasal cavity, nasal floor, maxilla, palate), naso-maxillary widths in the first molar region, premolar/molar inclination, buccal cusp distance, and apices distance, as well as suture maturation. Baseline characteristic data was compared using one-way ANOVA. Intergroup comparison of changes was analysed using ANCOVA. P < 0.05 (5%) was considered statistically significant. Inter-rater reliability was assessed using correlation coefficient. RESULTS: Skeletal effects: The Hybrid Hyrax patients (HHG) showed a significantly higher increase in dimensions in the nasal cavity, nasal floor and maxilla in the premolar region only, of 1.5 mm, 1.4 mm and 1.1 mm, respectively, compared to the Hyrax expander patients (HG), to a 5% significance level. The HHG showed a significantly higher increase in dimensions in the nasal cavity of 0.9 mm, in the molar region, compared to the HG. Dental effects: Premolar inclination was significantly higher in the HG, with the difference being -3.2 degrees on the right 1st premolar and -2.5 degrees on the left 1st premolar. The higher the amount of activation, the higher the nasal skeletal changes in the Hybrid Hyrax group. CONCLUSIONS: The Hybrid Hyrax (tooth-bone-borne expander) resulted in increased skeletal dimension changes (i.e. in the nasomaxillary structures in the first premolar region, and nasal cavity in the first molar and first premolar region) and only minimal premolar inclination/tipping compared to the Hyrax (tooth-borne expander). There were however no differences between the expanders for position of premolar or molar apices, or molar crowns.

The voice of the child in dental care plans: a service evaluation.

Introduction The voice of the child (VOC) is vitally important in the dental setting as 'patient participation' is a key clinical governance pillar. A recent Care Quality Commission review of Bradford District Care NHS Foundation Trust identified 'the voice of the patient was not always clear in the care plans stored on the electronic system'.Aims To determine if Bradford District Care NHS Foundation Trust's Community Dental Service was recording and acting upon the voice of children and young people (CYP) regarding their dental care.Methods Retrospective case note analysis of CYP who had completed a course of treatment between January and March 2019. Patient notes were reviewed to determine if key indicators of the VOC were included. Verbal communication, communication barriers and evidence treatment options were discussed with CYP wherever feasible and whether comments by CYP were used to tailor their care.Results Review of 200 patients aged 4-16 years old found that no CYP notes recorded all key VOC indicators. In total, 36% of dentists recorded if the CYP had verbal communication or otherwise; 26% of notes evidenced treatment options had been discussed; and 11% of notes evidenced that CYP comments were used to tailor their care.Discussion Presentation of results to clinicians locally highlighted the importance of the VOC and the need to improve documentation. Subsequently, implementation of a modified clinical note pro forma has taken place which includes VOC indicators, thus providing evidence that CYP are being listened to and, where feasible, their opinions used to tailor care.Conclusion The VOC was not routinely being documented in clinical notes, thus it was difficult to prove/disprove if the VOC was being listened to.

Availability of 'Do-It-Yourself' orthodontics in the United Kingdom.

OBJECTIVE: To identify the number of companies providing Do-It-Yourself (DIY) orthodontics and explore information available on websites for DIY brace providers operating in the UK. DESIGN: Web search and review of websites providing DIY braces. SETTING: Leeds, UK. METHODS: A Web search was completed in November 2020 and April 2021 of all companies providing DIY braces for UK consumers. Each website was evaluated, and the following data collected: name; year started operating; costs; process; involvement of a dental professional; average 'treatment' length; retention; consent process; information on risks and benefits; aligner material; social media presence; age suitability; and consumer ratings on Trustpilot. Quality of website information was assessed via the DISCERN tool. RESULTS: Seven DIY orthodontic companies were operating in the UK. Websites reviewed revealed the following: product costs were in the range of £799-£1599, 'treatment' length quotes were in the range of 4-12 months; Trustpilot reviews were in the range of 1.6-4.8 stars; and websites claimed their aligners were suitable for individuals with an age range of 12-18 years. Quality of content regarding risks described on websites varied, and there was limited information regarding involvement of a dental professional. Quality of websites information scored 'poor' or 'very poor' on the DISCERN scoring. CONCLUSIONS: There has been an increase in the number of DIY orthodontic companies operating in the UK over the last three years. There is a need to determine whether these products constitute dental treatment in their own right. If so, it is crucial to ensure these are regulated appropriately with adequate information available to satisfy informed consent and have greater transparency over dental professional involvement to safeguard the public.

Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting.

BACKGROUND: Anesthesia in lactating women is frequently indicated for time-sensitive procedures such as postpartum tubal ligation. Ketamine and diazepam are two of the most commonly used anesthetic agents in low resource settings, but their safety profile in lactating women has not been established. METHODS: Medical records of post-partum tubal ligations between 2013 and 2018 at clinics of the Shoklo Malaria Research Unit were reviewed for completeness of key outcome variables. Logistic regression identified presence or absence of associations between drug doses and adverse neonatal outcomes: clinically significant weight loss (≥95th percentile) and neonatal hyperbilirubinemia requiring phototherapy. RESULTS: Of 358 records reviewed, 298 were lactating women with singleton, term neonates. There were no severe outcomes in mothers or neonates. On the first postoperative day 98.0% (290/296) of neonates were reported to be breastfeeding well and 6.4% (19/298) had clinically significant weight loss. Phototherapy was required for 13.8% (41/298) of neonates. There was no association between either of the outcomes and increasing ketamine doses (up to 3.8 mg/kg), preoperative oral diazepam (5 mg), or increasing lidocaine doses (up to 200 mg). Preoperative oral diazepam resulted in lower doses of intraoperative anesthetics. Doses of intravenous diazepam above 0.1 mg/kg were associated with increased risk (adjusted odds ratio per 0.1 mg/kg increase, 95%CI) of weight loss (1.95, 95%CI 1.13-3.35, p = 0.016) and jaundice requiring phototherapy (1.87, 95%CI 1.11-3.13, p = 0.017). CONCLUSIONS: In resource-limited settings ketamine use appears safe in lactating women and uninterrupted breastfeeding should be encouraged and supported. Preoperative oral diazepam may help reduce intraoperative anesthetic doses, but intravenous diazepam should be used with caution and avoided in high doses in lactating women.

Can orthodontic care be safely delivered during the COVID-19 pandemic? Recommendations from a literature review.

Data sources Five electronic databases were searched: COVID-19 Open Research Dataset (CORD-19-2020); PubMed; MEDLINE; Scopus; and Google Scholar.Study selection Titles of articles and abstracts were identified during the electronic database searches and then screened for relevance. Publications up until the date of the literature search, 19th March 2020, were used. All articles with the appropriate topics pertaining to COVID-19, dentistry, orthodontics, and infection control were used irrespective of language. The author did not state whether they were selective about the study type or design of articles screened. References of these articles were also screened, via the 'snowballing technique', to obtain as much relevant literature as possible.Data extraction and synthesis Articles were reviewed by the cited author, and one research assistant. Data was extracted from each study by this author. The data obtained was combined and discussed narratively, in a qualitative manner. Due to the broad scope of studies included, it was not possible to conduct a meta-analysis.Results This literature review describes ways to reduce COVID-19 transmission in orthodontic practice. Overview of the literature discusses how the virus may be transmitted in the orthodontic setting: by human-human contact; saliva; aerosols; and use of orthodontic instruments. The literature review illustrates the need for optimum infection control and strict cleaning, detailing surface disinfection and sterilisation protocols. It highlights the need for optimal hand hygiene, use of high standard personal protective equipment, controlling aerosol use, appropriate ventilation, and treating emergency cases only.Conclusions While there are no known cases of COVID-19 cross-transmission within the dental setting currently reported, utmost vigilance is required by orthodontic professionals to reduce risk of transmission. The review reinforces crucial measures required to reduce infection, as outlined in the Results section above. While the virus is still emerging, knowledge is limited and as such it is difficult to provide robust and complete recommendations for best practice. Further studies to inform future practice are required.