A survey of dental school's emergency departments in Ireland and the UK: provision of undergraduate teaching and emergency care.

AIM: Emergency dental care is a vital service that new graduates should be prepared to offer. There are few published data relating to emergency dental care education. To assess this, and to gain a profile of accident and emergency departments (A&E) in dental schools, an online survey was sent to all of the dental schools in the Republic of Ireland and the UK. SETTING: The survey addressed the school's A&E curriculum, teaching methods, undergraduate exposure and departmental details. RESULTS: The majority of A&E departments operated during normal working hours with a minority offering an out-of-hours service. Teaching of A&E topics, and undergraduate experience, vary significantly between schools. A&E departments were diversely named and exhibited significant regional variation. Approximately half employed a triage system. It is unclear what represents an adequate level of undergraduate exposure, and more research is required in this area. CONCLUSIONS: Assessment of undergraduates following time in clinic is an important component of any A&E module. We consider a reflective portfolio to represent a suitable form of assessment, and would recommend their introduction. In addition, we recommend that dental hospitals consider a nurse-led triage system.

Fractured root tips during dental extractions and retained root fragments. A clinical dilemma?

Root tip fracture can occur during the extraction of teeth. The clinician must then decide to either leave the root fragment in situ, or to attempt its removal. A similar decision is made when retained root fragments are found incidentally on oral radiographs. The prevalence of retained root fragments is reported as 11-37%. This article aims to highlight the risk benefit matrix of the removal or retention of retained root fragments, in light of the present evidence base.

Effect of alveolar bone support on zygomatic implants in an extra-sinus position--a finite element analysis study.

The objective was to investigate the influence of maxillary alveolar bone on the stress distribution of zygomatic implants in an extra-sinus position. A three-dimensional finite element model was created based on a computed tomography scan of an edentulous female patient. Two zygomatic implants were modelled and placed in the skull in an extra-sinus position. These were supported by the zygomatic bone and the maxillary alveolar bone and were connected by a fixed bridge. This model was duplicated, and the area of the maxillary alveolar bone supporting the implants was removed. Occlusal and lateral forces were applied to both models and the maximum von Mises stresses were recorded. Higher maximum stresses were noted in the model with no alveolar support. Occlusal stresses were higher than lateral stresses in the model with no alveolar support, while occlusal stresses were lower than lateral stresses in the model with alveolar support. Low stresses were noted in the zygomatic bone in both models. Maxillary alveolar bone support is beneficial in the distribution of forces for zygomatic implants placed in an extra-sinus position.

Limited dissection and early primary closure of the tracheostomy stoma in head and neck oncology operations: a retrospective study of 158 cases.

Tracheostomy is an efficient and widely used method to secure a patent airway in patients undergoing major oral and maxillofacial oncology operations. The inferiorly based Björk flap technique, through a limited incision, followed by early primary skin closure, has been the preferred method in our unit. Patients who underwent tracheostomy for major oral and maxillofacial oncology operations during the period June 2005 to December 2012 were reviewed. Age, gender, preoperative diagnosis, duration the tracheostomy tube was in situ, tracheostomy-associated complications, and long-term sequelae were evaluated. A total 158 tracheostomies were performed using the same surgical approach in patients aged 18-84 years (median 59, mean 58.2, standard deviation 14.24 years). The time the tracheostomy tube was in situ ranged from 3 to 40 days (median 7, mean 9.0, standard deviation 6.52 days). The complication rate was 5.06% (8/158 patients). A major concern highlighted in previous publications is the risk of surgical emphysema with early closure. In this study, no patients developed surgical emphysema, tracheal fistula, clinical tracheal stenosis, or cosmetically unacceptable scarring of the neck. No patient died of a tracheostomy-related cause. In summary, the Björk flap with early primary closure of the skin by simple sutures provides a safe and easily managed approach, causing minimal postoperative morbidity.

Infection of the Beard area. Kerion: a review of 2 cases.

Folliculitis barbae is a common condition of both infective and non-infectious aetiology. It most frequently presents as a superficial folliculitis, with fine pustules appearing at the opening of hair follicles in the beard area, often associated with shaving; known as Bockhart impetigo and usually due to infection caused by Staphylococcus aureus. If untreated, the infection and inflammation can progress, leading to a more deeply seated infection known as sycosis barbae. Perifollicular nodules, termed furuncles, may appear and when these are multiple and coalesce, a deep-seated, communicating, pustulating plaque called a carbuncle develops, often with associated systemic upset. Such an appearance, which can prompt incision and drainage, should not, however, be assumed to be solely due to staphylococcal infection. Particularly in the context of a history of close animal contact or a lack of response to antibiotic treatment, a diagnosis of tinea barbae should be considered and investigated. Prompt treatment with antifungal agents and often systemic steroids is required once the diagnosis is made. This will help reduce an exacerbation of the pronounced destruction that results from the immune response to the fungal infection, known as a kerion, which would be compounded by surgical intervention. In this article, we review two such cases and review the investigation and management of the disease.

Transient facial nerve paralysis (Bell's palsy) following administration of hepatitis B recombinant vaccine: a case report.

Bell's palsy is the sudden onset of unilateral transient paralysis of facial muscles resulting from dysfunction of the seventh cranial nerve. Presented here is a 26-year-old female patient with right lower motor neurone facial palsy following hepatitis B vaccination. Readers' attention is drawn to an uncommon cause of Bell's palsy, as a possible rare complication of hepatitis B vaccination, and steps taken to manage such a presentation.

Effect of alveolar bone support on zygomatic implants: a finite element analysis study.

The objective of this study was to investigate the influence of maxillary alveolar bone on the stress distribution of zygomatic implants. A three-dimensional finite element model was created of half of a skull. Two zygomatic implants were modelled, placed in the skull supported by the zygomatic bone and the maxillary alveolar bone and connected by a fixed bridge. This model was duplicated, and the area of the maxillary alveolar bone supporting the implants was removed. Occlusal and lateral forces were applied to both models and the maximum von Mises stresses were recorded. Higher maximum stresses were noted in the model with no alveolar support. Occlusal stresses were higher than lateral stresses in the model with no alveolar support. Low stresses were noted in the zygomatic bone in both models. In conclusion, maxillary alveolar bone support is beneficial in the distribution of forces for zygomatic implants.

Performing mucosal tissue biopsies in general dental practice.

One of the roles of a dental practitioner is the identification and management of oral mucosal disease (pathology) in its many forms. A tissue biopsy is an important step in the diagnostic process for oral lesions, while the skill required to perform a biopsy should be well within the capability of most practising dentists. The purpose of this article is to help dental practitioners to identify lesions suitable for biopsy in a dental practice setting, and to outline the equipment and explain the techniques used.

A review of the relationship between alcohol and oral cancer.

This paper aims to review the current literature regarding the association between alcohol consumption and oral cancer. The authors have discussed the constituents of alcohol-containing beverages, the metabolism of ethanol and its effect on the oral microflora. The local and systemic carcinogenic effects of alcohol have been detailed. The beneficial effects of alcohol consumption on general health have also been considered. A possible relationship between alcohol-containing mouthrinses and oral cancer has been suggested in the literature. The authors conclude that this relationship has not yet been firmly established. However, the use of alcohol-containing mouthrinses in high-risk populations should be restricted, pending the outcome of further research.

The role of the health services in the prevention of alcohol-related facial injury.

This paper outlines the preventive health strategic measures that are currently in place and it endeavours to consider how improvements can be made to our national preventive strategy with the goal of reducing alcohol-related facial injuries. It is based on a review of the literature sourced through PubMed, Ovid Medline and the Cochrane database. The main findings are that increased funding, legislative amendment and media involvement are key to improving the work of the health services in their struggle to limit the ever increasing alcohol-related incidents that are experienced by society today.

Medical emergencies in dental practice.

Serious medical emergencies are fortunately a rare occurrence in the dental practice environment; however, if an emergency situation is encountered a delay in treatment may result in potentially avoidable consequences. The risk of mortality or serious morbidity can be reduced by ensuring that basic emergency equipment and medications are in place, and that the dental team is appropriately trained in basic life support measures. This article aims to provide an overview of the basic emergency medications and equipment that should be present in dental practices, and to discuss specific responses to some of the more common adverse medical events that can present while providing dental treatment.

IV access in dental practice.

Intravenous (IV) access is a valuable skill for dental practitioners in emergency situations and in IV sedation. However, many people feel some apprehension about performing this procedure. This article explains the basic principles behind IV access, and the relevant anatomy and physiology, as well as giving a step-by-step guide to placing an IV cannula.

Osteonecrosis of the jaw: a rare and devastating side effect of bisphosphonates.

Evidence has emerged that bisphosphonate use in cancer patients is associated with osteonecrosis of the jaw. This form of osteonecrosis has been termed bisphosphonate induced osteonecrosis of the jaw (BIONJ). BIONJ is commonly precipitated by a tooth extraction in patients treated with long term, potent, high dose intravenous bisphosphonates for the management of myeloma, breast or prostate cancer. The overall prevalence of BIONJ is about 5% in patients with these malignancies. Current evidence shows that the risk of BIONJ in non-cancerous patients, such as those with osteoporosis, is very low and appears to be comparable with that of the general population. Prescribing physicians need to encourage cancer patients to see their dentists before the initiation of bisphosphonate treatment, and regularly thereafter.

Renal disease and chronic renal failure in dental practice.

Patients with renal diseases are increasingly common in dental practice. This is due to advances in medicine, and the increasing life expectancy of western populations. Chronic renal failure is a serious condition that general dental practitioners may see in their practice. This article discusses the functions of the kidney, and the causes and medical management of chronic renal failure, as well as considerations in the dental management of these patients. Common complications such as infection and bleeding are discussed. General recommendations are made, based on current evidence with respect to prescribing of medications.

Epilepsy in dental practice.

Epilepsy is a neurological condition characterised by seizure activity. It has an approximate incidence of 1%. General dental practitioners will encounter these patients in practice. This article discusses the types of epilepsy, the medical management and considerations in dental management of epileptic patients. General recommendations are made, based on current evidence, with respect to prescribing of medications. The management of an epileptic seizure is discussed. Status epilepticus is a rare but serious complication of epileptic seizures. An easy-to-follow algorithm is provided to assist the practitioner in managing seizures.

Stress fracture of the tibia following a vascularised free fibular flap.

A 49-year-old female presented with a T4 N2 Mo moderately differentiated squamous cell carcinoma of the right cheek mucosa and involving the mandible. Patient treatment included resection of the tumour with partial mandibulectomy, maxillectomy and a free osteocutaneous fibular flap to reconstruct the bony mandibular and soft tissue intraoral defects. Six weeks postoperatively the patient developed a stress fracture of the right tibia, a complication which has not been reported in the literature previously. Pre- and postoperative measures should be considered to avoid such a complication.

Is intravenous conscious sedation for surgical orthodontics in children a viable alternative to general anaesthesia?--a case review.

AIM: The aim of this case review was to describe the use of local anaesthesia (LA) and intravenous conscious sedation (IVCS) as a safe and effective means of managing patients requiring surgical orthodontic procedures as an alternative to general anaesthesia (GA) in children between the age of 11 and 15 years. MAIN OUTCOME MEASURES: 1) Whether treatment was completed, partially completed or not completed; 2) assessment of physiological parameters to verify safety profile of the technique. METHODS: Records were reviewed retrospectively for all patients included in the series undergoing planned surgical orthodontic procedures between January 2001 and January 2004 under IVCS. All patients had been pre-assessed and deemed to be of sufficient mental and physical maturity to be treated with IVCS. Written informed consent was gained from patients and their parents/guardians with full discussion of the alternative pain and anxiety control methods available including GA. All cases were undertaken by experienced SAS grade surgeons assisted by two dental nurses holding the certificate in dental sedation nursing and their recovery was supervised by registered general nurses. Patients were clinically monitored throughout together with continuous pulse oximetry and intermittent recording of non invasive blood pressure and pulse at 10-15 minute intervals. Patients were reviewed post operatively and any complications or comments noted. RESULTS: Over a three year period a total of 107 patients underwent surgical procedures to aid orthodontic treatment, 28 (26%) under IVCS and 79 (74%) under GA. Twenty-five out of 28 patients in the IVCS group successfully completed all of their planned treatment. CONCLUSIONS: Based on this case series, IVCS would appear to offer a safe and effective alternative to GA for this group of patients providing they are selected and managed by an appropriately trained team in a suitable setting. Further prospective evidence is needed if IVCS is to be recommended for general dental treatment in patients under the age of 16 years.

Speeding and maxillofacial injuries: impact of the introduction of penalty points for speeding offences.

On 31 October 2002 the Irish Government introduced a point demerit scheme for road speeding offences. To evaluate the impact of the scheme, we made a comparative assessment of the number of maxillofacial operations necessitated by road crashes at two tertiary surgical centres in the year before and the year after the introduction of penalty points. There were no significant differences in the composition of the groups between the two study periods. There were 57 operations in the year before and 22 in the year after for injuries caused by collisions (a 61% reduction). No changes were seen in the distribution or severity of maxillofacial injuries or in the pattern or severity of other injuries. Severity was assessed using the Abbreviated Injury Scale (AIS) and Maximum Abbreviated Injury Severity Scale (MAIS), and bodily injuries by the Injury Severity Scale (ISS). The number of patients requiring intensive care and the duration of admission to the unit were unchanged, as was the total duration of hospital admission. There were no differences in the requirement for other specialist management.