Delivery of a brief motivational intervention to patients with alcohol-related facial injuries: role for a specialist nurse.

UNLABELLED: In this paper we focus on providing an alcohol screening and intervention service within maxillofacial surgery. Two trained nurses screened patients with alcohol-related facial injuries who attended maxillofacial outpatient clinics, and gave brief motivational interventions to those who had been drinking to a hazardous level. Patients were followed up at 3 and 12 months after the intervention. 195/249 patients (78%) drank to a hazardous level. One hundred and ninety-five patients received an intervention. Duration of intervention was between 5 and 65 minutes. Reasons for refusal to participate included lack of interest or time, and the main reason for exclusion was length of time since injury. The follow up rate was 103 (53%) at 3 months and 134 (69%) at 12 months. CONCLUSIONS: The high level of hazardous drinking among people with facial trauma suggests a clear need for alcohol screening and intervention. It is feasible for nursing staff to deliver brief interventions in a busy maxillofacial trauma clinic.

Bilateral block: is it safe and more efficient during removal of third molars?

OBJECTIVE- to assess the safety, acceptability, and efficacy of removing bilaterally impacted wisdom teeth as a one-stage rather than a two-stage procedure. DESIGN- randomised controlled trial. Setting - district hospital. SUBJECTS- 100 consecutive patients who required removal of bilaterally impacted third molars. INTERVENTIONS- 50 patients were randomised to have the teeth removed in two stages, 3-4 weeks apart, the other 50 to have the teeth removed at one visit. All operations were done under local anaesthetic (2% lignocaine and 1/80 000 adrenaline) and intravenous midazolam 0.07-0.13 mg/kg titrated against sedative effect individually. Main outcome measures - morbidity, time off work, anxiety scores (assessed by visual analogue scale), and patient opinions. RESULTS- 5 patients were withdrawn because they were not given the randomised treatment, and 10 were lost to follow-up, leaving 40 in the two-stage group and 45 in the one-stage group for analysis. Two patients in the one stage group developed SaO2 of less than 90% which was corrected by deep breathing, and another had a temporary parasthesia of the inferior alveolar nerve that resolved within a week. One patient in the two stage group had a haemorrhage after the first stage that required packing of the socket in the emergency department, and this patient refused to have the second tooth removed. The mean number of days taken off work was significantly less in the one stage group (mean 3 days compared with 5 days (P < 0.005), and the anxiety scores did not differ significantly between the two groups. A quarter of the patients in the two-stage group would have preferred a one-stage procedure, but none in the one-stage group would have preferred a two-stage operation. CONCLUSIONS- removal of bilaterally impacted wisdom teeth under local anaesthesia and sedation in one session is safe, cost effective and acceptable to patients.

An evaluation of different doses of soluble aspirin and aspirin tablets in postoperative dental pain.

1. The efficacy of three different single doses (600, 900 and 1200 mg of soluble aspirin and aspirin tablets) was determined in a randomized placebo-controlled parallel study in 140 patients (70 females) with postoperative pain after removal of impacted third molars. 2. Patients treated with soluble aspirin 600 mg, 900 mg, 1200 mg and aspirin tablet 1200 mg reported significantly less pain (P less than 0.01) throughout the investigation period than those treated with placebo. 3. Overall pain scores after treatment with aspirin tablets 600 and 900 mg did not differ significantly from those after treatment with placebo (P greater than 0.05). 4. On a comparative dose basis, soluble aspirin was significantly more potent (P less than 0.05) than aspirin tablets.