An evidence-based oral health promotion programme: Lessons from Leicester.

OBJECTIVES: To provide an overview and draw lessons from the establishment of a local oral health promotion programme for preschool children in Leicester, England (2013-2017). The article provides information on the strategic approach taken in Leicester, one of the most ethnically diverse cities in England, and also one of the most deprived. Over a third of children aged 3 years, and half of those aged 5 years, have experience of obvious dental decay. METHODS: A description of the evolution and development of the programme is provided along with commentary by the authors. This includes the origins, design and evaluation of the programme. RESULTS: Progress so far has been promising. There has been a statistically significant 8% decrease in the proportion of 5-year-old children in Leicester with dental decay from 2011/2012 to 2014/2015. This will need to be sustained and further developed to deliver the 10% reduction required within the strategy. CONCLUSIONS: The successful implementation of a local oral health improvement programme in Leicester has required leadership to coordinate a multiagency partnership approach to embedding effective concepts and realising opportunities collaboratively. However, longer term sustainability remains a concern.

Plasminogen activator system in oral squamous cell carcinoma.

BACKGROUND: The plasminogen activator system consists of two plasminogen activators, urokinase (uPA) and tissue (tPA); PA inhibitors (PAI-1, and -2), and a cell surface receptor for uPA (uPAR). The plasminogen activator system is involved at many stages of the metastatic cascade, including matrix remodelling, cell proliferation, and migration. AIMS: To compare tissue concentrations of the components of the plasminogen activator system in paired tumour tissue and normal tissue in patients with oral squamous cell carcinoma, and to correlate these with the histopathological grading of the tumour. METHODS: Thirty-eight paired tissue samples were analysed by enzyme-linked immunosorbent assays (ELISA; ng/mg protein) for uPA, tPA, uPAR, PAI-1, and PAI-2. RESULTS: Concentrations of uPA, uPAR, PAI-1, and PAI-2 were significantly higher in tumour than in normal oral tissue (median in uPAR tumour 1.6 (range; 0.1-7.5) ng/mg protein; normal=0.2 (0-2.3), p<0.05). There were strong correlations between the concentrations of certain components of the plasminogen activator system in particular between uPA, uPAR, and PAI-1 (p<0.05). Tissue concentrations of some components of the plasminogen activator system correlated with clinical and pathological indexes of aggression of tumours, including differentiation and T-stage. CONCLUSION: The relation between components of the plasminogen activator system, in particular uPA, uPAR, and PAI-1 in invasion, metastasis, prognosis, and survival, requires further investigation in oral squamous cell carcinomas.

Sarcoidosis presenting as an isolated facial swelling--an unexpected diagnosis?

UNLABELLED: Sarcoidosis is a rare chronic granulomatous disease of unknown aetiology that primarily affects individuals between 30 and 50 years of age. It is usually characterized by the presence of non-caseating, granulomatous, epithelioid tissue at the sites affected with involvement of lymphoid tissue. Sarcoidosis confined to lymph nodes, salivary glands and other tissue in the head and neck is uncommon and usually indicative of a more generalized systemic process. Within the differential diagnosis of isolated masses associated with the head and neck, sarcoidosis is indeed rare. We report a case of systemic sarcoidosis presenting as a small localized facial swelling. The report illustrates that other symptoms, albeit mild, may direct the clinician to a provisional diagnosis of generalized sarcoidosis. CLINICAL RELEVANCE: Within the differential diagnosis of isolated facial swellings, sarcoidosis is extremely uncommon. However, clinicians should consider the diagnosis, especially in the presence of other, albeit mild, symptoms.

The matrix metalloproteinase system in oral squamous cell carcinoma.

BACKGROUND: The matrix metalloproteinase (MMP) system is responsible for degradation of tissue in both normal and pathological processes, including tumour invasion and metastasis. AIM: To compare tissue concentrations of components of the MMP system between tumour tissue and normal tissue in patients with oral squamous cell carcinoma, and to correlate concentrations with pathological grade of tumour. METHODS: Thirty-eight paired tissue samples from tumours and normal tissue were analysed by three laboratory techniques: firstly, enzyme linked immunosorbent assays (ELISA) in ng/mg protein for MMP-1, MMP-3, and tissue inhibitors of metalloproteinases (TIMPs) -1 and -2. Secondly, gelatinase activity assays to measure concentrations of total and endogenous active gelatinases, MMP-2 and MMP-9 (ng/mg protein). And thirdly to use quenched fluorescent substrate hydrolysis to measure total MMP activity (pM/min). RESULTS: The concentration of all MMPs was significantly higher in tumour than in normal oral tissue (p < 0.05, Mann-Whitney U-test). Tissue concentrations of some of these factors correlated with clinical and pathological indices of aggressiveness of tumours, including T-stage, N-stage, tumour differentiation, and anatomical level of involved nodes. However, the study was not powered to show statistical significance. CONCLUSION: It is the balance between proteinases and their inhibitors that controls tissue degradation at each stage of tumour invasion and metastasis. Measurement of MMPs in oral mucosal biopsy samples may establish the invasive potential of tumours at their initial presentation.

Bilateral eyelid necrosis as a complication of pseudomonal septicaemia.

We present a case of bilateral eyelid necrosis as a result of Pseudomonas aeruginosa infection. This is a rare condition that occurs only in neutropenic patients. It may be unilateral or bilateral and requires aggressive management with correction of the neutrophil count, local debridement and systemic antibiotic therapy.

Diagnostic laparoscopy for suspected appendicitis: only useful in young women.

The clinical diagnosis of acute appendicitis is inaccurate and can be associated with a negative appendicectomy rate in excess of 40%. The latter has an attendant, albeit low, potential for increased morbidity and mortality, particularly related to infection. In this two year prospective audit of 282 patients presenting with the symptoms and signs of acute appendicitis, preliminary diagnostic laparoscopy (PDL) was performed on 145 patients with the remainder (137) proceeding directly to open appendicectomy. In the PDL group, appendicectomy was undertaken when there was clear clinical evidence of inflammation or when the appendix was not visualised. The negative appendicectomy rate was similar in both groups (21.6% vs. 21.2%) with a male predominance in the PDL group. Whereas women of childbearing age obtained most benefit from PDL with avoidance of unnecessary open operation, the results of our audit showed little benefit for men.

Pre- admission clinics in ENT: a national audit of UK practice and opinion.

A one-year prospective audit (1989) of patient non-attendance for elective surgery in our department showed that of those summoned, five per cent defaulted on the day of admission without contacting the hospital (Hampal and Flood, 1992). Contributing factors such as lengthy waiting lists and inefficient communication with the patients were amenable to correction by the hospital. However, the current admission policy made inevitable a significant waste of theatre time. The pre-admission clinic (PAC), an outpatient attendance shortly before surgery, was recommended in ENT practice by Robin (1991) and introduced into our department the year. Failure to attend the PAC allowed adequate time for replacement on the theatre list and was recommended as a solution to the problem of unfilled theatre sessions (Dingle et al., 1993). A subsequent four-year experience of conducting PACs has confirmed several expected advantages. However, some of the hopes for development expressed in our earlier work (Dingle et al., 1993) have failed to materialize. This study aims to review retrospectively our experience and compare it with the admission practice and desires of ENT departments in the United Kingdom as revealed by a postal survey. The findings are of relevance to all surgical specialties and to anaesthetic departments wishing to adopt this system of admission.

Screening for syphilis in patients with carcinoma of the tongue.

The oral signs of syphilis have been comprehensively described and can be identified at each stage of the infection. Despite the historical recognition that inadequately treated or untreated syphilitic leukoplakia may undergo malignant transformation, many surgical units no longer routinely screen patients presenting with malignant or premalignant lesions. In this study, five of the 63 patients (8%) who presented with neoplasms of the tongue reacted to syphilis antibodies. These results indicate that syphilis is still prevalent in this group of patients and suggest that serological investigations may be warranted in the initial assessment of all patients with oral cancer.

A survey of in-dwelling intravenous cannula use in general dental practice.

A study to ascertain the use of in-dwelling intravenous cannulae in general dental practice was performed. A self-completion questionnaire was distributed to the 149 dental practitioners registered with the Cleveland Family Health Services Authority. A total of 131 dentists (88%) completed and returned the questionnaire: 58% of practitioners were practising either general anaesthesia (GA) or intravenous sedation (IVS) and 59% of these practitioners routinely used an in-dwelling intravenous cannula to administer the anaesthetic or sedative agents. This was supervised by a medically qualified anaesthetist in 100% of GA cases and 55% of IVS cases. Sixty per cent of respondents had received didactic instruction at undergraduate level on gaining intravenous access, but 72% of these stated that the teaching had been inadequate. Seventeen per cent of the practitioners had never received formal training in gaining intravenous access. These results suggest the need for formal practical instruction in obtaining intravenous access may have to be addressed.

Maxillofacial fractures: a study of recurrent victims.

A study of 760 patients treated for maxillofacial fractures over a 2 year period revealed 3 per cent of them to have had one or more previous fractures in the maxillofacial region. This group of patients are nearly all victims of assault but are indistinguishable from a control group of patients with maxillofacial injuries on the grounds of age, sex, anatomical type of injury or socioeconomic status. They are however more likely to have been drinking alcohol at the time of their injury than the control group. We advocate targeting of this sub-group of patients with maxillofacial fractures for appropriate counselling.

Modification of a standard aspirator for orbital floor procedures.

An inexpensive method of achieving controlled and atraumatic aspiration during orbital floor surgery is described and illustrated.

Gorlin's syndrome and von Recklinghausen's disease occurring in one family.

A family is presented in which both Gorlin's Syndrome (Basal Cell Naevus Syndrome) and von Recklinghausen's neurofibromatosis have been inherited. The features and treatment of these syndromes are discussed and the management of families with these diseases is considered.