Reducing general anaesthetic episodes: 'piggyback' procedures - Birmingham Children's Hospital experience.

Introduction Birmingham Children's Hospital (BCH) has a well-established care pathway for joint procedures - 'piggybacks' - under general anaesthetic (GA). The premise behind these joint procedures is that dental treatment is undertaken at the same time as another planned GA, usually completed by the patient's primary medical or surgical specialty, or another speciality attending a dental GA list.Aim The aim of this paper is to share the recent BCH experience of joint procedures and provide a model for secondary and tertiary care providers across the UK to develop their own collaborative working approaches.Method Data were collected retrospectively from May 2021 to May 2023 on the department of paediatric dentistry at Birmingham Children's Hospital. Patients were included if they had any joint procedure undertaken.Results In total, 93 patients were treated as a 'piggyback' procedure during this period. The average age of patient treated was nine years and three months. A total of 39 patients had extractions only during this period, while 19 had scaling only and 12 had both scaling and extractions. Additionally, 269 primary teeth and 22 permanent teeth were extracted during this period.Conclusion BCH has a well-established pathway of care for 'piggyback' procedures. Future workforce planning and patient care pathways should consider joint procedures and further explore this initiative to continue to streamline patient care and reduce waiting lists and risks associated with GA.

Aesthetic management of discoloured incisors in children.

Children can often present with discolouration of their teeth, commonly affecting their permanent maxillary central incisors. These opacities can often cause children to suffer with psychosocial and confidence related issues. With long waiting lists in secondary care, many children may face increased waiting times to receive aesthetic dental treatment. It is important that the dental professional is aware of the different causes of discolouration, the possible treatment options and when to consider a referral to secondary care.

Dento-facial infections in children - A potential red flag for child neglect?

BACKGROUND: Healthcare professionals are often confronted with children presenting to the emergency department with dento-facial infections. These infections may be associated with dental neglect and as such could be a marker for general neglect. The aim of this retrospective study was to ascertain whether dento-facial infections can be used as an indicator for general neglect. METHOD: All children aged 16 years and under, who were admitted for surgical incision and drainage of dento-facial infection between January 2017 and January 2019 at King's College Hospital were examined retrospectively. All patients were discussed with the local safeguarding team/local authority to establish whether they were previously known to social services. RESULTS: This study showed that in our cohort, 48% of children admitted with dento-facial infection were already known to social services and one (2%) had been recently referred. The most commonly affected age group were 5-8-year-olds (50%) indicating that these children have an increased risk of neglect. An average of 5.6 teeth were extracted and four (10%) patients required extra-oral drainage. The average hospital stay was 2.26 days. CONCLUSION: Our retrospective study revealed that social services were already aware of 48% of patients under the age of 16, who were admitted to hospital with a dento-facial infection. This suggests a relationship between dental neglect and generalised neglect. Families of children presenting with dento-facial infection should be supported in accessing appropriate dental services for their children and clinicians should consider dento-facial infection a potential 'red flag' for generalised neglect.

Common Difficult Scenarios for The Newly Qualified Dental Professional.

Dental complaints are at the forefront of many dental practitioners' thoughts, with most dentists likely to have a complaint against them during their practicing lifetime. Difficult clinical scenarios can be particularly challenging for the newly qualified dental professional to manage, with a lack of experience potentially leading to an increased likelihood of a complaint. This article highlights several common clinical scenarios which dental practitioners are likely to face, providing a framework for their management and assessing the impact that the coronavirus pandemic may have on patients presenting for routine dental care.

Demographics and management of paediatric dental-facial trauma in the 'lockdown' period: A UK perspective.

BACKGROUND: The United Kingdom entered 'lockdown' on the 23 March 2020 due to the COVID-19 pandemic. This resulted in school closures forcing children to remain at home. Dental-facial trauma was still likely to be common place due to falls and injuries exercising. The aim of this study was to explore the impact of the COVID-19 pandemic on clinical practice in a paediatric population in a tertiary care hospital and a linked Dental Institute. METHOD: A proforma was designed to capture the demographics, presenting complaints, type of dental-facial injury, treatment need and the treatment received for all paediatric patients presenting face to face with dental-facial trauma to King's College Hospital during the 'lockdown' period (23 March- 14 June 2020). RESULTS: Four hundred and twenty calls were triaged, converting to 102 patients seen face-to-face for dental-facial trauma. The remainder were able to be triaged 'virtually'. Injuries seen included 56 (54.9%) dentoalveolar injuries, 37 (36.2%) lacerations, five (4.9%) suspected facial fractures and four (3.9%) dog bites. Males and females were equally affected. The majority of incidents occurred in the home environment (n = 60, 58.8%), with the remainder (n = 42, 41.2%) occurring outside the home environment. The main causes of dental-facial trauma were falls (n = 47, 46.1%) and bicycles/scooters (n = 29, 28.4%). The most common type of dentoalveolar injury was lateral luxation (n = 15, 26.7%), followed by avulsion (n = 12, 21.4%). Only one child required treatment under general anaesthesia (GA). CONCLUSION: The demographic, presenting complaints and treatment needs of patients who presented during the lockdown period with dental-facial trauma were unusual. The overwhelming majority were able to be treated without the use of GA. The attendance protocol in a tertiary care setting and the use of 'teledentistry' ensured only the most severe trauma cases were seen. This highlights how more complex trauma can still occur during 'lockdown' and requires immediate management.

Paediatric dental pain and infection during the COVID period.

BACKGROUND: During the coronavirus pandemic, paediatric patients will still likely present with dental pain and infection. In order to streamline care at King's College Hospital (KCH), Paediatric Dentistry and Oral and Maxillofacial Surgery (OMFS) have developed a collaborative working approach allowing patients to be treated effectively and to streamline patient care in the absence of easy access to general anaesthetic facilities. METHOD: Presenting complaints, treatment need and the treatment received were recorded for all paediatric patients presenting with dental pain and infection in the "lockdown" period (23rd March- 14th June) during "normal" working hours and "out of hours" to either paediatric dentistry or OMFS. RESULTS: 420 calls were triaged which converted to 67 patients seen face-to-face for oro-facial pain and infection. 41% of children were treated successfully under Local anaesthetic alone, only 13% required a general anaesthetic (GA) in the "lockdown" period. The vast majority of patients had antibiotics prescribed prior to attendance (80%). CONCLUSION: We have demonstrated the demographic, presenting complaints and treatment need of patients who presented to KCH during the lockdown period with dental pain and infection. The majority were able to be treated without needing for GA facilities. This paper highlights how a collaborative approach between paediatric dentistry and OMFS can help streamline patient care and is a model which can be adopted by other units in the event of further "lockdowns".

Dental Bleaching: 'Now I can Smile for my Selfies' - Paediatric Patients' Perspectives.

Children presenting with discoloured teeth commonly suffer from low self-esteem. This paper reports the findings from a questionnaire evaluating changes brought about by dental bleaching and the psychosocial effects of bleaching on 22 patients. All patients reported to like the overall appearance of their teeth following bleaching and reported a significant improvement in mental wellbeing. In the current climate where positive mental health is at the forefront of the minds of commissioners, health care providers, and the general public alike, this service evaluation demonstrates the positive effect that carefully planned dental bleaching can have on the mental wellbeing of under 18-year-olds with discoloured teeth.

IADT 2020 Guidelines: What should the dental professional know?

Traumatic dental injuries are a common occurrence among children. Effective acute and long-term management of traumatic dental injuries can improve patient outcomes, especially in the paediatric patient. It is important that all dental professionals follow up-to-date, evidence-based guidance when treating patients. This article aims to highlight the main changes in the 2020 International Association of Dental Traumatology (IADT) Guidelines for Evaluation and Management of Traumatic Dental Injuries, to ensure that all dental professionals are fully aware of current guidelines and are managing patients appropriately.

COVID-19 pandemic: the first wave - an audit and guidance for paediatric dentistry.

With the use of newly issued guidelines, King's College Hospital has developed new standard operating procedures specifically for the COVID-19 pandemic. Given the unprecedented nature of the current global pandemic, this paper highlights how paediatric dental emergencies can be managed safely and efficiently, as well as new measures which can help reduce transmission of the virus. Furthermore, an audit of the current paediatric dental emergencies attending the hospital is presented. Seventy-six percent of patients attending met the agreed local criteria for urgent treatment, with the most common presentation being irreversible pulpitis. This highlights the types of cases that practitioners enrolled in urgent dental care centres (UDCs) can expect to encounter and how to effectively manage this challenging group of patients.