The use of spit guards (also known as spit hoods) by police services in England, Wales and Northern Ireland: to prevent transmission of infection or another form of restraint?

Spit guards, also known as spit hoods or spit masks (and occasionally bite guards) are devices intended to cover the mouth, face and sometimes the head of a restrained person in order to prevent them spitting at, or biting others. There is substantial controversy about their use with views often polarised between civil and human rights campaigners who express concerns about their utility, their safety, and their possible encroachment on human rights, and in contrast by (predominantly) law enforcement campaigners highlighting concerns about the possible risks of transmission of infection and subsequent need for prophylaxis by law enforcement professionals exposed to biological fluids. This study explored the extent to which police services deploy spit guards and the rationale underpinning their use. A mixed qualitative and quantitative approach was used to analyse data obtained from police services under the Freedom of Information Act. This study shows there is paucity of information readily available from police services in respect of quantifying the numbers of police officers who have contracted infectious disease as a result of spitting and/or bites, despite the fact that risk of infection and the need for subsequent prophylaxis is a driver of police services adopting the use of spit guard devices. Consideration must be afforded to the possibility that the use of spit guards represents a form of mechanical restraint rather than a means to prevent transmission of infection, especially given the paucity of information available from police services in respect of officers who have contracted infectious disease as a result of spiting and/or bites.

School Nursing Protocol for the Management of Human Bites.

Human biting is considered a common stage in pediatric infant growth and development. However, this stage is not considered appropriate once children enter group daycare and school settings, and such behavior can lead to injury, stress, and trauma for other students and staff. When biting occurs in the school setting, staff are often unprepared to respond appropriately, and may seek delayed care, if at all. The school nurse may also be ill-equipped to provide first aid and education if there are no standardized guidelines to follow. Having a protocol in place for human bite incidents in the school setting helps school nurses provide information to students, parents, and staff in a timely manner and assists them with following evidence-based practice. Accurate documentation of the incidents also allows school nurses to identify triggers and knowledge deficits, which can assist them in planning educational interventions and training in the school setting.

Physiological effects of a spit sock.

OBJECTIVES: Healthcare providers and law enforcement utilize spit socks to prevent exposure to communicable diseases transmitted by bodily fluid projection from agitated individuals. There are cases in which death is reported due to breathing being limited by a spit sock. There are no formally published studies on their use and safety. The aim of this study was to evaluate whether wearing a spit sock causes a clinically significant impact on breathing. METHODS: Subjects sat with the spit mask over their heads for 15 min and their vital signs and ventilatory parameters were recorded after 5 min, 10 min and 15 min. Data were compared to baseline using Student's t-test with 95% confidence intervals using SPSS. RESULTS: The median age of the 15 subjects was 28 years and 53% were male. There was no significant difference between baseline and wearing the spit sock for 5, 10 or 15 min for heart rate (p = 0.250, p = 0.181, p = 0.546), oxygen saturation (p = 0.334, p = 1.00, p = 0.173), end-tidal pCO2 (p = 0.135, p = 0.384, p = 0.187), and diastolic blood pressure (p = 0.485, p = 0.508, p = 0.915). The respiratory rate was not significantly different after 5 and 10 min (p = 0.898, p = 0.583), but decreased at 15 min (p = 0.048). The systolic blood pressure was lower after 5 and 10 min (p = 0.028, p = 0.045), but not significantly different at 15 min (p = 0.146). No subject indicated distress nor did the study need to be terminated due to pre-determined concerning vital signs or ventilatory parameters. CONCLUSIONS: In healthy subjects there were no clinically significant changes in the physiologic parameters of breathing while wearing a spit sock.

Bite injuries caused by transcranial electrical stimulation motor-evoked potentials' monitoring: incidence, associated factors, and clinical course.

PURPOSE: The incidence of bite injuries associated with transcranial electrical stimulation motor-evoked potentials monitoring reportedly ranges from 0.13 to 0.19%. However, in clinical practice, bite injuries appear to occur more frequently than previously reported. Our aim was to identify the incidence of and perioperative risk factors associated with bite injuries caused by transcranial electrical stimulation motor-evoked potential monitoring. METHODS: Patients who underwent elective surgery with transcranial electrical stimulation motor-evoked potential monitoring at a single tertiary hospital in Japan between June 2017 and December 2017 were included in this study. All patients were assessed by oral surgeons preoperatively and postoperatively. The associated factors with bite injuries were explored by the univariate analysis. RESULTS: 12 of 186 patients experienced 13 bite injuries, including three lip, six oral mucosa, and four tongue injuries. No patient required suture repair. 11 of 12 patients had uneventful postoperative courses and were cured within 12 postoperative days. One patient with a tongue ulcer and a hematoma had difficulty in oral intake and persistent dysgeusia. Patient severe movement during transcranial electrical stimulation motor-evoked potential monitoring was associated with bite injuries (p = 0.03). CONCLUSIONS: The incidence of bite injuries assessed by oral surgeons was 6.5% in patients with transcranial electrical stimulation motor-evoked potential monitoring, and the patients with severe movement during the monitoring tended to incur bite injuries. In rare cases, transcranial electrical stimulation motor-evoked potential monitoring may cause difficulty in oral intake and dysgeusia.

Correction of cheek biting in a dentate patient.

Postsurgical injury by teeth to oral mucosa (reconstructed by a flap) can lead to ulceration and subsequent infection at the reconstructed site. A prompt intervention by fabricating a specially designed prosthesis to deflect the reconstruction flap away from the occluding teeth has been described for the treatment of cheek biting in the present clinical report.

Human and other mammalian bite injuries of the hand: evaluation and management.

The hand is the most common site for bite injuries. Because of specific characteristics of hand anatomy, bite mechanics, and organisms found in human and animal saliva, even small wounds can lead to aggressive infections. Failure to recognize and treat hand bites can result in significant morbidity. Human and animal bites most commonly lead to polymicrobial bacterial infections with a mixture of aerobic and anaerobic organisms. Pasteurella species are commonly found in dog and cat bite wounds, and Eikenella is characteristic of human wounds. Staphylococcus, Streptococcus, and anaerobic bacterial species are common to all mammals. Although public health measures in developed countries have been highly effective at reducing rabies transmission, dog bites remain the most common source of rabies infection worldwide. Human bites can transmit HIV, hepatitis B, or hepatitis C, especially when contaminated blood is exposed to an open wound. Appropriate management of any mammal bite requires recognition, early wound cleansing, evaluation of injured structures, and infection prophylaxis. Structural repair is performed as indicated by the severity and contamination of the injury, and wounds may require delayed closure. Wound infections typically require débridement, empiric antibiotics, and delayed repair or reconstruction.

Management of oral lesions in Lesch-Nyham syndrome.

Lesh-Nyhan Syndrome is a hereditary disorder that affects the way in which the body handles the production and breakdown of purines. One of its main characteristic is self-mutilation. We present a new appliance which allows healing to occur.

Cheek bumper prosthesis for a patient with a neurofibromatous lesion in the left cheek.

Neurofibromatous lesions of the oral cavity affect the chewing cycle by interposition of cheek mucosa during contact of opposing teeth. In this report, an intraoral prosthesis was fabricated to restore and improve oral function and reduce the incidence of cheek biting on the neurofibromatous lesion. The prosthesis successfully reduced the incidence of cheek biting and improved the patient's oral competency. This report describes the procedure for making an intraoral cheek bumper prosthesis to improve patient oral function.

Unsweetened ice popsicles impart a positive feeling and reduce self-mutilation after paediatric dental treatment with local anaesthesia.

AIM: The purpose of the current study was to assess whether an unsweetened ice-popsicle imparts a positive feeling to children after dental treatment in which local anaesthesia is administered, and whether it reduces the tendency of children to self-mutilate (bite the lip, cheek or tongue) after the administration of local anaesthesia. DESIGN: Crossover study of 31 children aged 4-11 years old who needed similar dental treatments on both sides of the mandible or maxilla under local anaesthesia. At the end of each appointment the child received a toy or an ice-popsicle especially made for this study. Patients and parents answered a questionnaire regarding the children's behaviour and feeling immediately after the treatment, and 10 and 30 min after receiving the ice-popsicle or toy. RESULTS: Children who received ice-popsicles after dental treatment under local anaesthesia felt less discomfort and suffered less soft tissue trauma than they did when they received a toy. Reduction in soft tissue trauma was evident 10 min after receiving the ice-popsicles. CONCLUSION: Licking of an ice-popsicle after dental treatment with local anaesthesia reduces the feeling of discomfort and the biting of soft tissue and self- mutilation.

A report of two cases of lip and tongue bite injury associated with transcranial motor evoked potentials.

Transcranial electric motor evoked potentials (TCeMEPs) are routinely used intraoperatively to detect and prevent iatrogenic injury to the spinal cord, specifically the corticospinal tract. Complications related to TCeMEP testing include the potential for seizure induction, cardiac arrhythmia, scalp burns, infection, and tongue or lip laceration. Among this list of potential complications, tongue and lip lacerations are the most common and most directly attributable to transcranial stimulation. The technique of low voltage stimulation and the correct placement of oral bite blocks is successful in preventing patient bite injuries. We report two cases of patient bite injuries following TCeMEPs and discuss potential mechanisms of injury and prevention.

Self-inflicted oral injury in an infant with transverse myelitis.

Acute transverse myelitis (ATM) is an inflammatory disorder that affects the spinal cord. It is characterized by signs and symptoms of neurologic dysfunction in the motor and sensory tracts of the spinal cord bilaterally, resulting in weakness, sensory loss, and autonomic dysfunction with acute or subacute onset. We report on a child who had ATM and respiratory distress requiring ventilatory assistance who presented with severe self-mutilation involving his lips. Other findings included bruxism that had caused mobility of the primary teeth. Comprehensive dental care was carried out under sedation. The management of the lip trauma was achieved by the use of a soft, plastic mouth guard, and corticosteroid ointment.

Traumatic lesions from congenital insensitivity to pain with anhidrosis in a pediatric patient: dental management.

Congenital insensitivity to pain with anhidrosis is a rare autosomal-recessive disorder characterized by unexplained fever episodes, anhidrosis, pain insensitivity, self-mutilating behavior, and mental retardation. The lack of sensitivity to pain results in traumatic lesions, such as ulcers, fractures, burns, bites, scars, and digital amputations. Several methods have been suggested to treat these patients; however, appropriate management is difficult, especially when the mutilation is particularly severe. This report describes the case of a 2-year-old female patient who had severe self-mutilating injuries to her tongue, hands, lips, and oral mucosa caused by biting. The patient presented digital amputation and also a premature loss of a permanent tooth germ during the treatment. The dental management is described and discussed. It is important to include the dentist on the multidisciplinary team to reduce the frequency and severity of the self-inflicted lesions in these patients, also to prevent complications.

[A maxillary lip bumper used to manage labial self-mutilation]. / Utilisation du lip bumper ou pare-choc labial dans la prise en charge d'une autophagie labiale.

INTRODUCTION: The repair of facial self-mutilation often fails if the reconstruction is not protected. The authors report a case of a lip self-mutilation treated by an orthodontic device: the "lip bumper". OBSERVATION: A four-year-old patient presented with self-mutilation of the lower lip in a context of multiple malformations. The defect concerned two third of the lower lip. The treatment combined antibiotics, local care, psychiatric management and a lip bumper. The evolution was favorable without need for secondary reconstruction. DISCUSSION: The lip bumper is a simple orthodontic device. It pushes the lower lip away from the dental arch. It is used to stop the pattern "agitation-mutilation-infection".

Lesch-Nyhan syndrome: a case report.

Lesch-Nyhan syndrome, a rare inborn error of metabolism, is characterized by mental retardation and self-destructive behavior resulting in self-mutilation through biting and scratching. It is a rare anomaly consisting of deficiency in the production of hypoxanthine phosphoribosyltransferase that leads to the overproduction of purine and accumulation of uric acid. No medical treatment exists to alleviate the symptoms of self-mutilation where direct dental intervention is the only way these behavior can be affected. A unique case of this type affecting a 6-year-old male child is reported.

An occlusal guard for preventing and treating self-inflicted tongue trauma in a comatose patient: a clinical report.

This clinical report describes the treatment of a 48-year-old patient who demonstrated neuropathologic and reflex mastication of her tongue after an intracerebral hemorrhage. Standard medical interventions failed to address the oral condition, and the attending neurosurgeon consulted the dental team. A provisional soft occlusal guard was initially placed, followed by fabrication of a heat-polymerized, acrylic resin occlusal guard. The tongue injury improved after placement of the oral device and administration of systemic hydrocortisone.

Severe tongue injury in an adolescent with epilepsy: a case report.

Epilepsy and other neurological disorders can have profound social, physical and psychological consequences, especially when they begin in childhood. Moreover, seizure episodes may cause fractures, burns, head injuries and oral injuries. This report presents a case history of an adolescent with a severe tongue injury related to epileptic seizures and outlines the proposed treatment, which included use of a maxillary silicone bite guard that allowed healing of the tongue injury within a few months.

Congenital insensitivity to pain--review and report of a case with dental implications.

Pain is a protective mechanism for the body. Absence of pain is a symptom in several disorders, both congenital and acquired. The congenital types are present at birth and affect the number and distribution of types of nerve fibers. At present, 5 types of hereditary sensory and autonomic neuropathies have been identified. The various disorders within this group are classified according to the different patterns of sensory and autonomic dysfunction and peripheral neuropathy and the presence of additional clinical features such as learning disability. However, the field is currently moving away from classification based on clinical presentation toward classification based on underlying genetic abnormality. In the absence of pain, patients are at risk of late presentation with illnesses or injuries, and have an increased incidence of traumatic injury. Self-mutilation is an almost invariable feature of these disorders. We report the case of a patient with congenital insensitivity to pain that presented with self-mutilation injuries to his hands and oral tissues caused by biting. The severe nature of these injuries necessitated serial extraction of his primary teeth soon after eruption, which led to a cessation of the problem. The mutilation has not returned following the eruption of the first of his permanent teeth, suggesting that he has learned not to bite himself, even though to do so causes him no discomfort.

Prevention of habitual cheek biting: a case report.

Oral and peri-oral structures can be traumatized by self-injurious behavior (SIB). Various articles have described prostheses used to prevent SIB-related injuries to the oral tissues of patients who have developmental or medical problems, such as psychological problems, congenital syndromes or mental retardation; however, reports of oral SIB in individuals unaffected by the above conditions are scarce. This case report describes the use of a removable prosthesis to prevent a stress-induced cheek biting habit in 15-year-old girl who did not have any of the commonly related conditions. The report discusses the importance of designing a prosthesis that protects tissues, while considering injury severity and the patient's healthas well as her ability to cooperate with treatment.