Hypericum perforatum extract in burning mouth syndrome: a randomized placebo-controlled study.

Burning mouth syndrome (BMS) or stomatodynia is characterized by a spontaneous burning pain in the oral mucosa without known cause or recognized treatment. This double-blind, randomized, placebo-controlled, single-center study evaluated the effects of systemic Hypericum perforatum extract in patients with BMS. Forty-three patients participated, of whom 39 (35 women, four men, aged 64.9 +/- 4.7 years) completed the study. The patients took indistinguishable 300-mg capsules containing either H. perforatum extract (hypericin 0.31% and hyperforin 3.0%) or placebo three times a day for 12 weeks. The intensity of burning pain was evaluated using a 10-cm visual analog scale (VAS) before the first dose and at visits after 4, 8, and 12 weeks. Furthermore, we also recorded the number of oral mucosa sites with reported burning symptoms and the self-reported descriptions of the patient's condition before and after the treatment. Pain, measured using the VAS, was similar at the beginning of the study and even though a slightly better performance in the test group, the difference was not statistically significant (P = 0.2216). The results failed to demonstrate that 300 mg of H. perforatum extract taken three times a day for 12 weeks improved the pain of BMS patients, although the general reduction in the number of sites with reported burning sensation, a less accurate and objective score, was significant.

Accuracy of referrals to a specialist oral medicine unit by general medical and dental practitioners and the educational implications.

In this study we investigated the accuracy of diagnoses of oral mucosal diseases made by family physicians (without a dental degree), other categories of physicians, and general dental practitioners prior to referring patients to a university oral medicine unit. Over a three-year period, we compared the diagnoses proposed in referral letters with the definitive histological diagnoses made by the specialist unit. Only 305 of 678 (45 percent) of the referral letters included a clinical diagnosis. Eighty-six patients (86/305, 28 percent) were referred by general dental practitioners (GDPs) who had graduated in dentistry; seventy-six (76/305, 25 percent) were sent by GDPs who had graduated in medicine with a postgraduate degree in dentistry; and 143 (143/305, 47 percent) were referred by other categories of physicians. More than 50 percent of the referring professionals were not able to make a clinical diagnosis of oral mucosal diseases. Only 40 percent of the provisional diagnoses (122/305) coincided with the diagnosis made at the specialist unit. The proportion of correct diagnoses was 40 percent for GDPs who had graduated in dentistry, 33 percent for other categories of physicians, and 27 percent for GDPs who had graduated in medicine with a postgraduate degree in dentistry. These findings suggest that Italian dental and medical practitioners have limited knowledge in the field of oral medicine. Consequently, there is a need for better education in the diagnosis and treatment of oral diseases and for improvement in total oral health training.

4.1 Web-based interactive learning programmes.

In the future, the training of competent dentists will need to take advantage of up-to-date digital technologies and learning practices. In order to accomplish this, the following goals should be considered: i) the design of 'customizable' web-based curriculum matrices that accommodate the training philosophies and resources of individual dental schools; ii) the development of digital instructional modules that can be incorporated or downloaded into specific parts of a curriculum; iii) the establishment of an e-consortium, which provides peer view and guidance in the design of teaching modules, and which is responsible for the storage, maintenance, and distribution of teaching modules within the consortium; iv) the development of central human and physical resources at each dental school to enable the seamless delivery of instructional modules in a variety of learning environments; and v) the assessment and provision of ICT training to students and faculty with respect to the use of computers and related digital technologies and educational software programmes. These goals should lead to the creation of a 'virtual dental school'. Within this project summative and formative evaluations should be performed during both the production and development of teaching material (e-learning material) and the learning process. During the learning process the following aspects should be measured and evaluated: i) students' behaviour; and ii) effectiveness, retention and the transfer of e-learned material into the clinical situation. To obtain evidence of the efficacy of e-learning material a certain amount of research has to be done in the near future. It is suggested that all parameters currently known have to be implemented during the development of a learning programme. Previous workers have evaluated the following elements with e-learning: i) planning, ii) programming and technical development, iii) learning behaviours, iv) learning outcomes of both the programme and the student, v) the acquisition of knowledge, skills and attitude and vi) the transfer of e-learned skills into clinical situations.