The continuation of oral anticoagulation and antiplatelet therapy for dento-alveolar surgery: a service evaluation.

Background Patients taking oral anticoagulants (OACs) and oral antiplatelets (OAPs) have a risk of post-operative bleeding when dental extractions are required. Guidance exists to assist dental practitioners on how best to clinically manage these patients, but this is based upon low-quality evidence. The current service evaluation provides real world clinical data when these drugs are not discontinued for oral surgery procedures.Materials and methods All OACs and OAPs were continued and patients requiring dental extractions had local haemostatic measures (local anaesthesia with adrenaline, socket packing with haemostat and resorbable sutures). All patients were offered a follow-up via a telephone clinic service after surgery to assess any post-operative bleeding.Results A total of 439 patients underwent 513 surgical episodes, equating to 1,001 dental extractions. Overall, 412 (95.9%) patients reported no post-operative bleeding complications. A total of 18 (4.1%) patients reported post-operative bleeding requiring further intervention. All but two patients were managed with local haemostatic measures, and no patient required hospital admission. For the single novel OAC cohort of patients, 8/185 (4.3%) procedures had post-operative bleeding.Conclusion This current service evaluation highlights that the risk of significant or life-threatening bleeding following dental extraction when OACs or OAPs are continued remains rare.

Oral and maxillofacial injuries from electric scooters in Bristol: a retrospective observational study.

The 'Voi' (Voi Technology) electric scooter (e-scooter) pilot scheme was initiated in Southwest England on 29 October 2020.The aim of this study was to describe the patient demographic and patterns of oral and maxillofacial injuries related to the use of e-scooters in the Bristol area, to target public safety interventions at high-risk groups. Data were collected retrospectively from patients attending the Bristol Royal Infirmary Emergency Department (ED) over a six-month period. A total of 42 patients attending the ED had the search term 'scooter' in their initial presenting complaint.The majority of patients (n = 35) were discharged without follow up, with only three requiring admission to oral and maxillofacial surgery. Overall trauma injuries related to e-scooters increased incrementally over the study period.Only two patients were reported to be wearing a helmet at the time of injury, versus one fifth not wearing one. More worryingly, 33% of injured users were intoxicated.The majority of injured patients appeared to be young males (n = 33, median age 26 years). Understanding the local epidemiology of e-scooter injuries will help authorities target public safety interventions at high-risk groups. The results of this study will be shared with the West of England Combined Authority, to improve future e-scooter policy-making and safety implementation in this region.

The impact of the cessation of primary dental care services on oral cancer diagnosis at a single institution in the UK's epicentre during the COVID-19 pandemic.

Aims: COVID-19 put an unprecedented strain on healthcare services that was complicated by the widespread cessation of all face-to-face primary care dental activity from 23 March 2020 for 7 weeks. This led to a focus on telephone triage and remote prescribing that potentially impeded urgent referrals for suspected oral cancer. Guy's and St Thomas' NHS Foundation Trust (GSTFT) screens and diagnoses potential head and neck cancer patients via a 2-week wait (2 WW) clinic and provides access to patients with urgent oral health needs through an Acute Dental Care (ADC) service. The current service evaluation aims to assess and report on the impact of COVID-19 and the cessation of primary care dentistry on oral cancer diagnosis at GSTFT during a period of time where patients had extremely limited access to healthcare. Materials and Methods: Data regarding oral cancer diagnoses were collected retrospectively from secure logbooks and clinical records from the point at which routine dental practice was nationally halted (23 March 2020) to the date at which services were permitted to resume (08 June 2020). Individual patient pathways prior to diagnosis and through to treatment were recorded. Results: Sixteen new diagnoses of oral cancer were made during the described timeframe. Findings suggest that the paralysis of routine dental services resulted in delayed referral of suspicious lesions and highlights the limitations of a predominately telephone-based assessment service in primary care. Conclusion: The importance of the role of the primary care practitioner in the early identification of oral cancer has been emphasised.

Provision of dental services at a single institution in the UK's epicentre during the COVID-19 pandemic.

Coronavirus disease 2019 (COVID-19) has had a significant impact on dentistry in the UK due to the perceived risks associated with infection control. These concerns have led to a complete paralysis of routine dental care with provisions for emergency dental care only, which have been scarce. Considering the latter, this article presents a service evaluation of a hospital-based acute dental care service, which was rapidly adapted and enhanced to continue managing dental emergencies during the COVID-19 pandemic. The analysis is based upon the dental diagnoses, management and geography of travel of over 1,500 attending patients in a five-week period during the rise and peak of COVID-19 in the UK. In addition, we assess our dental workforce's COVID-19 sickness reporting for those providing urgent dental care within this enhanced service. The article aims to provide additional and valuable frontline clinical information, experience and outcomes, including our categorisation of personal protective equipment used for varying face-to-face dental management during COVID-19.