Making dental extractions predictable: A methodological approach.

Dental extractions are one of the most commonly undertaken procedures in dentistry. However, for some dentists it can be a stressful and daunting treatment to undertake. This paper explores the importance of planning and the salient aspects in the assessment that should be considered. A methodical approach to assessment will avoid important factors from being overlooked.

Safe intravenous sedation for oral surgery in a primary care setting.

Conscious sedation is a useful adjunct in oral surgery due to the invasive nature of procedures and the prevalence of dental anxiety in the general population. The most common conscious sedation technique used in the UK is intravenous sedation with a single drug, midazolam, which has an excellent record of safety. This paper gives an overview of areas to consider when planning oral surgery procedures in primary care under intravenous sedation with midazolam, to enhance success and patient safety. The fundamentals of providing safe sedation include careful patient assessment, patient preparation, a good understanding of the complexity of treatment, and an appropriately trained team. This paper also reviews the current guidance on conscious sedation in the UK, the governance of sedation in dentistry, the medications used, and training of the sedation team.

Record-keeping in intravenous sedation: Are we meeting the standards?

As primary care dental services continue to offer conscious sedation in practice, this article presents the findings from a record-keeping audit carried out at a dental teaching hospital in the UK. National guidance was used to set out the gold standards for record-keeping. Various shortcomings in terms of documentation were identified. This article enables dental practitioners involved in dental sedation to review their own sedation record-keeping to meet current national standards and ultimately improve clinical practice and the quality of patient care.

Retrospective evaluation of sensory neuropathies after extraction of mandibular third molars with confirmed "high-risk" features on cone beam computed topography scans.

OBJECTIVES: The objective of this study was to identify the incidence of inferior alveolar nerve (IAN) injury after extraction of mandibular third molars with confirmed "high-risk" features on cone beam computed topography scans and establish any risk factors that significantly increase the chances of sustaining an IAN injury. STUDY DESIGN: This study is a retrospective analysis of outcomes after surgical extraction of 500 mandibular third molars over a 5-year period. All teeth showed signs of contact with or compression of the IAN on cone beam computed topography scans. RESULTS: The overall incidence of IAN injury was 6.6%, with permanent neuropathies accounting for 1.8% within this high-risk cohort. Statistically significant factors shown to increase the risk of nerve injury included increasing age (P = .002), compression of the nerve evident on cone beam computed topography scan (P = .005), and buccal or interradicular position of the nerve (P = .042). CONCLUSIONS: Results indicate a low incidence of IAN injury, particularly given the high-risk nature of all teeth that were extracted. It highlights the benefits of cone beam computed topography scans in surgical planning. These data are an important contribution to the existing literature and valuable in the consent procedure for patients undergoing surgical removal of mandibular third molars in contact with the IAN.

The incidence of medication-related osteonecrosis of the jaw following tooth extraction in patients prescribed oral bisphosphonates.

Aims To determine the incidence of medication-related osteonecrosis of the jaw in patients prescribed oral bisphosphonate medication following dental extraction in a dedicated clinic within the Department of Oral Surgery of King's College Hospital. The effect of factors such as sex, duration of therapy, medical comorbidities and site of extraction, which have previously been reported to significantly affect the risk of developing osteonecrosis of the jaw, was also examined.Materials and methods Data were gathered from the dental records of patients who had extractions over an eight-year period and were included in this retrospective study. Patients with previous or current exposure to intravenous bisphosphonates, denosumab, novel-targeted chemotherapies used in the oncology setting or radiotherapy to the head and neck were excluded from this study.Results The incidence of medication-related osteonecrosis of the jaw following tooth extraction in this group of 652 was 0.8%. A significantly increased risk of developing medication-related osteonecrosis of the jaw was evident in patients prescribed oral bisphosphonates for four years or more (p = 0.02), with an incidence in this group of 1.6%.Conclusion This study demonstrates that, following dental extraction, patients who are prescribed oral bisphosphonates are at risk of developing medication-related osteonecrosis of the jaw and that this risk increases significantly when the patient has been taking the bisphosphonate for four years or more.

Multiple sclerosis and its impact on dental care.

Multiple sclerosis affects approximately 130,000 people in the UK. Due to the wide variation in the symptoms associated with this condition and their variable severity, the provision of dental care for affected patients must be determined by an individual's specific needs. This will often vary significantly over time. This paper reviews the aetiology, presentation and current management of multiple sclerosis, and explores the impact of these on oral health and the provision of dental care.

COVID-19: establishing an oral surgery-led urgent dental care hub.

COVID-19 has changed the face of dentistry in the UK and around the world. The potential for aerosol generation, the presence of the virus within saliva and the fact that dental professionals work with the oral-pharyngeal environment determines that dental treatment poses a risk of viral transmission. At the start of the pandemic, the cessation of routine dental care across the country necessitated the rapid establishment of an emergency dental service at King's College Hospital. This paper describes its evolution to date and the challenges encountered along the way.

An audit into the reasons why treatment was not completed as planned under intravenous sedation in an adult oral surgery department, and the cost implications.

This audit aimed to identify the prevalence of, and reasons for failed intravenous conscious sedation in an adult oral surgery department, to develop recommendations to reduce such failures and to identify any cost implications. Data were collected prospectively for three months for all intravenous sedation appointments in the Oral Surgery department. Data were collected for 109 sedation appointments of which 83 were successful (76%). The failure rate (24%) was higher than the acceptable departmental failure rate (10%), and included reasons for failure that should have been avoided by a thorough patient assessment prior to treatment. Of the 26 failures, the most common reasons for failure were: cancellation: 8 patients (30.8%), failure to attend: 6 patients (23.1%), excessively late arrival of patient: 4 patients (15.4%) and failure to cannulate: 3 patients (11.6%). When sedation was unsuccessful, 13 of the 26 patients (50%) had their treatment successfully completed under local anaesthesia alone, 10 patients (38%) were rebooked for sedation and 3 patient. (12%) were rebooked for a general anaesthetic. Identifying and correcting the reasons for failure can result in vast savings in appointment time, clinical resources and cost. That 13 patients subsequently had their treatment completed under local anaesthesia alone opens the debate on how rigorous the patient assessment and allocation of sedation appointments was, and the potential to achieve savings.