Steroid Prophylaxis: The knowledge and practices of New Zealand General Dental Practitioners.

OBJECTIVE: To describe the knowledge and practices of New Zealand (NZ) General Dental Practitioners (GDPs) concerning the use of steroid prophylaxis. METHODS: An online survey was conducted in 2013 involving a sample of 500 NZ GDPs who met inclusion criteria and had email addresses on the Dental Council register. RESULTS: A total of 214 dentists responded, giving a 44.5% response rate after accounting for undelivered questionnaires. Nearly two-thirds (61 .7%) did not currently recommend corticosteroid prophylaxis, although nearly three-quarters (74.8%) believed that dental treatment posed a potential risk to patients with adrenal suppression. Over half (53.4%) believed that oral corticosteroids could cause adrenocortical suppression, and a similar proportion (58.3%) believed that a specific dose of oral prednisolone of 7.5 mg per day could do so. Most practitioners (79.6%) supported the formulation of steroid prophylaxis guidelines. CONCLUSION: Despite most NZ GDPs believing the dental setting to pose a risk of adrenal crisis for patients taking corticosteroids, there is some confusion among dentists identifying at-risk patients and their ability to manage if such an event was to occur in their practices. There is further confusion over whether steroid prophylaxis is warranted for perceived at-risk patients, and which regime to follow when it is. There is an associated tendency to be over-cautious when determining the need for steroid prophylaxis, and to rely on their undergraduate steroid prophylaxis guidelines when doing so. There is a need for evidence-based guidelines to be formulated by an expert panel.

Trends in paediatric maxillofacial trauma presenting to Dunedin Hospital, 2006 to 2012.

OBJECTIVES: The purpose of this study was to review the epidemiology, aetiology and management of maxillofacial injuries in the paediatric population seen in Dunedin, New Zealand from 2006 to 2012. MATERIALS AND METHODS: A retrospective descriptive analysis was conducted over a 7 year period. Data concerning demographics, injuries and management of patients between the ages of 0-17 years who presented to the oral and maxillofacial service in Dunedin were gathered and analysed. RESULTS: 340 incidents that excluded pure dental trauma were recorded. Falls were found to be the most common cause of injury; followed by contact with animate objects (other individuals and animals), contact with inanimate objects and road traffic accidents. Injuries in younger age groups were found to be caused by falls and contact with inanimate objects more often, receiving predominantly soft tissue injuries. In the older age group, a higher number of facial fractures were seen with a change in the most common causes to road traffic accidents and contact with animate objects. An increase in alcohol-related road traffic accidents was noted among females. For all injuries the male to female ratio was 2:1 which is similar to previous reports from New Zealand and overseas. For the sub group of facial fractures a much higher ratio of males were seen at a ratio of 8.5:1. CONCLUSIONS: Causes of injury and anatomical location followed similar patterns to reports worldwide, along with a similar male to female ratio. Although the incidence of road traffic accident related facial injuries is relatively low, the high proportion of these accidents involving paediatric patients and alcohol is of concern.

Diagnosis and management of potentially malignant oral disorders.

The optimum management strategy for potentially malignant disorders remains a constant challenge as our present knowledge is still short of being conclusive. In spite of its shortcomings as an accurate predictive marker, the assessment of the severity of epithelial dysplasia continues to be useful in risk assessment. It is important to use a combination of epidemiological, clinical and histopathological input when deciding on the most appropriate management for an individual patient. Advanced research exploring molecular markers for diagnosis and risk predictions appear to be promising. However, these tests have not evolved to a stage that they could be used for routine diagnostics at the clinical setting.

Mid-maxillary distraction osteogenesis of cleft patients using a special custom-made tooth-borne device.

A relatively new approach to maxillary advancement by maxillary distraction using a combined surgical and modified orthodontic technique is described. This protocol and the technique have been used for the past 3 years (2006 to 2009) on more than 60 patients, aged between 14-29 years. Distraction of between 7 and 18 mm has been achieved, creating class 1 or mild class 2 arch relationships in cleft lip and cleft palate patients who had class 3 arch relationship compounded by significant maxillary retrusion. The technique is simple, inexpensive and less time consuming.