Gender differences in patients with severe dental infections presenting to hospital.

Introduction Gender differences have been documented in prevalence and morbidity of caries, gingivitis and oral health, but not previously in cervicofacial infection. Identification and minimisation of gender inequalities is a World Health Organisation priority, and there are physiological, behavioural and cultural reasons to suspect that sex and gender differences may be present.Methods Analysis was carried out of the MTReC National Snapshot audit of cervicofacial infections. This database was created by oral and maxillofacial surgery trainees in 2017 and records over 400 variables in 1,002 individual patients admitted to hospital with severe odontogenic infection.Results Records were available for 1,002 patients with cervicofacial infection (456 females and 546 males). There were significant differences between recorded gender in those presenting with airway compromise (male 7% vs female 2%, p = 0.001), severe inflammatory response syndrome (male 60% vs female 39%, p = 0.007) and requirement for awake fibre-optic intubation on admission (male 4% vs female 1%, p = 0.014).Discussion These results suggest that male patients access healthcare later in their disease than female patients, and with more severe systemic compromise. This may be due to prevalent cultural and behavioural norms. As equality of access is the responsibility of the administrator, we discuss methods which might improve timely presentation in males with cervicofacial infections.

Oral bacterial diversity is inversely correlated with mucosal inflammation.

OBJECTIVE: We investigated the relationship amongst the oral mucosal bacterial community, clinical severity and inflammatory markers in the two most common immune-mediated oral mucosal diseases, namely recurrent aphthous stomatitis (RAS) and oral lichen planus (LP). METHODS: Patients with RAS (n = 15) and LP (n = 18) and healthy controls (n = 13) were recruited using criteria to reduce the effect of factors that influence the microbiota structure independently of oral mucosal disease. Clinical severity was quantified using validated scoring methods. DNA was extracted from oral mucosal swabs for 16S rRNA gene high-throughput sequencing. Salivary cytokines were measured using cytometric bead assays. Correlation studies were conducted amongst microbial diversity, clinical scores and cytokine concentrations. RESULTS: We observed a significant reduction of bacterial diversity in LP and RAS patients compared to controls (p = .021 and .044, respectively). Reduced bacterial diversity in LP and RAS correlated with increased clinical scores of the two conditions (⍴ = -0.551 to -0.714). A negative correlation was observed between microbial diversity and salivary interferon-γ, interleukin-17A and interleukin-1ß (⍴ = -0.325 to -0.449). CONCLUSIONS: This study reports reduced oral microbial diversity in the context of increased mucosal inflammation and supports the role for microbial diversity as a marker or contributor to oral mucosal inflammatory disease activity and development.

Oral and maxillofacial trauma and the use of telemedicine in the grampian region of Scotland: a retrospective study.

OBJECTIVES: To evaluate the amount and nature of adult facial trauma in Aberdeen, Scotland's third largest city, that requires referral to Aberdeen Royal Infirmary oral and maxillofacial surgery department by the Emergency Department and Grampian's telemedicine service over a six month period. MATERIAL AND METHODS: A retrospective audit using oral and maxillofacial surgery trauma clinic and theatre records to identify Emergency Department (ED) notes for those patients presenting with facial trauma. ED notes were examined to extract demographic data on each patient as well as information on the nature and outcomes of the facial trauma. This data was compared with previously published national and international statistics. RESULTS: 137 patients were identified with a mean age of 33.7 years with a standard deviation of 16.7. 83.2% of facial trauma victims were male and 62% of facial injuries were caused by alleged assault. Only 1 patient was referred to Aberdeen Royal Infirmary by telemedicine. CONCLUSIONS: Aberdeen has a high number of injuries caused by interpersonal violence. Telemedicine is an underused resource in the referral and review of facial trauma at Aberdeen Royal Infirmary.

Pharmacological interventions for pain in patients with temporomandibular disorders.

BACKGROUND: Temporomandibular disorders (TMD) are a group of disorders affecting the temporomandibular joints and the muscles of mastication. TMDs are treated with a wide range of drugs. The extent to which the use of these drugs is based upon evidence is unknown. OBJECTIVES: To assess the effectiveness of pharmacological interventions both alone and in combination with non-pharmacological therapy in relieving pain in patients with chronic TMD. SEARCH STRATEGY: Electronic searches of the Cochrane Oral Health Group's Trials Register (2 August 2010), CENTRAL (The Cochrane Library 2010, Issue 3), MEDLINE via OVID (1950 to 2 August 2010), EMBASE via OVID (1980 to 2 August 2010) and CINAHL via EBSCO (1981 to 2 August 2010) were conducted. Reference lists of articles and previous reviews were scanned for relevant articles and authors were contacted for further information where appropriate. SELECTION CRITERIA: Randomised controlled trials (RCTs) in which a pharmacological agent was compared with placebo for the management of pain in patients with TMD. Parenteral routes of administration were excluded. DATA COLLECTION AND ANALYSIS: Duplicate data extraction and assessment of risk of bias in included studies was performed. MAIN RESULTS: Eleven studies were included with a total of 496 participants. The primary outcome of most of the studies was pain. The risk of bias in the included studies was variable. Whilst four studies showed significant pain relief for the active treatment, three were of poor quality. Most adverse effects were mild to moderate in severity. Four studies reported withdrawals due to severe adverse reactions, but insufficient information was provided regarding the trial groups from which the withdrawals occurred. No meta-analysis was conducted due to lack of similarities across the included studies. AUTHORS' CONCLUSIONS: There is insufficient evidence to support or not support the effectiveness of the reported drugs for the management of pain due to TMD. There is a need for high quality RCTs to derive evidence of the effectiveness of pharmacological interventions to treat pain associated with TMD.