Clinical status of established MRONJ in oncology patients continuing bone-modifying agents.

The continuation of bone-modifying agents (BMAs) in patients with established medication-related osteonecrosis of the jaw (MRONJ) is a common concern among dentists and oncologists. There is little evidence supporting or refuting the continued use of BMAs or drug holidays and their impact on established MRONJ. This paper evaluates the outcome of continued BMAs use on the patient's MRONJ status. A retrospective review of 29 oncology patients undergoing active cancer care for either metastatic disease or multiple myeloma was conducted. Data on demographics, oncological status, BMA history and MRONJ status were collected. In total, 90% of patients were judged to have healed or stable MRONJ while continuing BMAs. Most patients (69%) continued the same BMA regime (three- or four-weekly) that they were on before developing MRONJ. The average number of BMAs doses received after an MRONJ diagnosis was 12 (range 1-48). Three patients (10.3%) were found to have MRONJ progression, with two patients developing new sites of necrosis. This real-world dataset suggests that the majority of MRONJ cases remain stable and will not worsen with the continuation of BMAs.

The continuation of oral anticoagulation and antiplatelet therapy for dento-alveolar surgery: a service evaluation.

Background Patients taking oral anticoagulants (OACs) and oral antiplatelets (OAPs) have a risk of post-operative bleeding when dental extractions are required. Guidance exists to assist dental practitioners on how best to clinically manage these patients, but this is based upon low-quality evidence. The current service evaluation provides real world clinical data when these drugs are not discontinued for oral surgery procedures.Materials and methods All OACs and OAPs were continued and patients requiring dental extractions had local haemostatic measures (local anaesthesia with adrenaline, socket packing with haemostat and resorbable sutures). All patients were offered a follow-up via a telephone clinic service after surgery to assess any post-operative bleeding.Results A total of 439 patients underwent 513 surgical episodes, equating to 1,001 dental extractions. Overall, 412 (95.9%) patients reported no post-operative bleeding complications. A total of 18 (4.1%) patients reported post-operative bleeding requiring further intervention. All but two patients were managed with local haemostatic measures, and no patient required hospital admission. For the single novel OAC cohort of patients, 8/185 (4.3%) procedures had post-operative bleeding.Conclusion This current service evaluation highlights that the risk of significant or life-threatening bleeding following dental extraction when OACs or OAPs are continued remains rare.

Orofacial manifestations of sickle cell disease: implications for dental clinicians.

Sickle cell disease is a multisystem disease associated with episodes of acute illness and progressive organ damage. It is one of the most common severe monogenic disorders worldwide and is now the fastest growing genetic disorder in the UK. Dental awareness of orofacial manifestation varies geographically due to the inheritance pattern and patient population affected by the disease. This article details the epidemiology, pathophysiology and the orofacial manifestations in light of current literature.

Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital.

Introduction As COVID-19 rapidly developed across the UK, health services were forced to make radical changes. Within the dental department, all elective procedures were cancelled and staff members were redeployed to support other services within the trust. Studies have demonstrated increased prevalence of psychiatric disorders among healthcare workers during virus pandemics.Aims To assess the psychosocial implications of COVID-19 on members of the dental team working within a large dental teaching hospital.Methodology A survey comprising a series of questions (closed and open) and a Generalised Anxiety Disorder assessment (GAD-7) was distributed to members of the dental team between 1-3 April 2020.Results A total of 120 surveys were completed; 53.3% of respondents displayed symptoms of generalised anxiety. The highest average GAD-7 score was noted among dental nurses. The most common concern was the impact of COVID-19 on friends and family followed by personal health and nature of the disease.Conclusion(s) High anxiety levels and significant psychosocial implications were noted among dental staff during this virus pandemic. Our findings add to a growing body of data on the psychosocial impact of virus outbreaks on healthcare workers and highlight the importance of wellbeing initiatives for healthcare workers to be placed at the forefront of future pandemic crisis planning.

Provision of dental services at a single institution in the UK's epicentre during the COVID-19 pandemic.

Coronavirus disease 2019 (COVID-19) has had a significant impact on dentistry in the UK due to the perceived risks associated with infection control. These concerns have led to a complete paralysis of routine dental care with provisions for emergency dental care only, which have been scarce. Considering the latter, this article presents a service evaluation of a hospital-based acute dental care service, which was rapidly adapted and enhanced to continue managing dental emergencies during the COVID-19 pandemic. The analysis is based upon the dental diagnoses, management and geography of travel of over 1,500 attending patients in a five-week period during the rise and peak of COVID-19 in the UK. In addition, we assess our dental workforce's COVID-19 sickness reporting for those providing urgent dental care within this enhanced service. The article aims to provide additional and valuable frontline clinical information, experience and outcomes, including our categorisation of personal protective equipment used for varying face-to-face dental management during COVID-19.

Coronectomy of mandibular teeth other than third molars: a case series.

Coronectomy is gaining popularity for the management of mandibular third molars that pose a risk of injury to the inferior dental nerve, as it considerably reduces the risk when compared with extraction. The technique could also be beneficial to other teeth. We report 17 patients who had coronectomy of mandibular teeth that were not third molars. Clinical and radiographic follow up for a median (range) of 12 (1-79) months showed satisfactory healing and no transient or permanent injury to the nerve. None of the retained roots have required retrieval.