Investors in people: what is it all about?

Recently, there has been a proliferation of press releases from organizations recognized as Investors in People including the BDTA, the DPB, the BDA and many individual dental practices. Indeed, the number of dental practices recognized as Investors in People has more than doubled in the last six months. What is this sudden interest in Investors in People within the dental profession all about? This article is a guide to what the Investors in People (IiP) standard is, what relevance it has to dental practice and what benefits can be gained from working towards this standard. I have used my own experiences in gaining the standard in our dental practice to act as an example throughout the article.     

Early diagnosis in primary oral cancer: is it possible?

In this treatise oral carcinogenesis is briefly discussed, particularly with regard to the number of cell divisions that is required before cancer reaches a measurable size. At that stage, metastatic spread may have already taken place. Therefore, the term "early diagnosis" is somewhat misleading. The delay in diagnosis of oral cancer is caused both by patients' delay and doctors' delay. The total delay, including scheduling delay, work-up delay and treatment planning delay, varies in different studies, but averages some six months. The total delay is more or less evenly distributed between patients' and doctors' delay and is partly due to the unawareness of oral cancer among the public and professionals, and partly to barriers in the health care system that may prevent patients from seeking dental and medical care. Due to the relatively low incidence of oral cancer it will be difficult to increase the awareness of this cancer type among the public, thereby reducing patients' delay. However, it should be possible to considerably reduce doctors' delay by increasing the awareness of oral cancer among professionals and by improving their diagnostic ability. Population-based annual or semi-annual screening for oral cancer is not cost-effective, high-risk groups such as heavy smokers and drinkers perhaps excluded. Dentists and physicians, and also oral hygienists and nurse practitioners, may play a valuable role in such screening programs.     

How relevant is counselling in relation to dentistry?

This article attempts to explain reasons behind the general public's fear of dentistry by examining the historical perspective and, using case scenarios, demonstrates areas where patients' dental treatment might have been helped by the use of counselling. Distinguishing between the use of counselling skills vis-à-vis professional counselling, the wider issues for the dental profession - education, boundaries and the need for referrals - are explored. It is suggested that if a counsellor were included as part of the dental team, patients and professionals would benefit. The counsellor could act as an advisor and educator for the team in addition to undertaking professional counselling on referral. Patients with anxiety or phobias could be recognised and helped appropriately and occupational stress experienced by practitioners would be reduced.     

Providing a numerical measure of oral health--can it be done and how accurate is it?

An Index of Oral Health (OHX) was developed by Burke and Wilson in the mid 90s. Use of the index involves assessing patient comfort and satisfaction in addition to the assessment of caries, periodontal disease, toothwear, mucosa, occlusion and dentures, where appropriate. On completion of this structured examination, the clinician arrives at an overall oral health index (OHX) for the patient, which is expressed as a fraction of the maximum achievable score. The index was modified by Denplan UK by amending the calculations to produce the Oral Health Score (OHS). The Reproducibility of the OHX and OHS was tested at Birmingham Dental Hospital and School during 2001 and 2002 and was found to be satisfactory. The dentists' opinions on the OHX and OHS were assessed by means of questionnaires. Most of the dentists felt that both were easy to use.     

Myofibroblasts in oral potentially malignant disorders: Is it related to malignant transformation?

In oral cancer, acquisition of α‐smooth muscle actin (α‐SMA)‐positive fibroblasts, known as myofibroblasts or carcinoma‐associated fibroblasts (CAF), is an important event for progression and metastasis. However, the contribution of myofibroblasts in oral potentially malignant disorders (OPMD) remains controversial. This systematic review provides evidence that immunodetection of myofibroblasts may identify oral submucous fibrosis (OSMF) with high risk of malignant transformation, but does not represent an auxiliary tool to predict the malignant potential of leukoplakia and erythroplakia, the most common OPMD.     

Orthognathic surgery in COVID-19 times,is it safe?

COVID-19 has impacted the provision of orthognathic surgery globally. Uncertainty around its effects and transmission in aerosol generating procedures (AGP’s) has led to disagreement within maxillofacial surgeons into the safety of orthognathic surgery during the pandemic. We present a local case series of orthognathic surgery undertaken during the COVID-19 pandemic. To our knowledge no such similar study has been reported worldwide. Data was collected from the 1^st June to 30^th November 2020 for all patients undergoing orthognathic surgery by a single consultant. All procedures and inpatient stays were performed ‘off site’ at the local Spire Healthcare Group plc© facility. A strict preoperative two-week self-isolation period and negative COVID-19 testing was mandatory. All procedures were classified as AGP’s and personal protective equipment (PPE) was worn in line with local guidelines. The primary outcome was 30-day COVID-19 infection among patients, with day 0 the date of surgery. Secondary outcome measures included duration of stay, return to theatre and complications. A total of 59 patients were identified. 42/59 had bimaxillary procedures and 17/59 single jaw. 9/17 had maxillary and 8/17 had mandibular procedures. A total of 3/59 had simultaneous genioplasty. Median duration of stay was one night (range 1-3). Immediate and late complications were seen in 3% (2/59) and 3% (2/59) respectively. Only 1% (1/59) returned to theatre. Zero patients tested positive in the 30-day postoperative period. No staff members tested positive for the duration of the study. Adopting strict safety protocols, orthognathic surgery can be safely delivered during the pandemic without detriment to the patient or staff.     

Safety of local anaesthesia in dental patients taking oral anticoagulants: is it still controversial?

The aim of this study was to investigate the safety of local infiltration techniques and the inferior alveolar nerve block (IANB) in dental patients taking oral anticoagulants. A total of 352 patients were given a total of 560 injections of local anaesthetic (119 IANB and 441 others). The study group comprised 279 patients with therapeutic international normalised ratios (INRs), and the control group 73 patients who were taking oral anticoagulants but had subtherapeutic INR on the day of operation. Blood was aspirated 7 times (7.3%) during the IANB in the study group. However, there were no clinical signs of prolonged haemorrhage into the medial pterygoid muscle or pterygomandibular space after 96 IANB, including those from whom blood had been aspirated. Only two minor haematomas developed after multiple infiltrations in the lingual sulci. The results suggest that bleeding as a result of the use of local anaesthesia in patients with therapeutic INR is unlikely, provided that the IANB is done correctly.     

What is evidence-based dentistry, and do oral infections increase systemic morbidity or mortality?

From Celsus' first reports of rubor, calor, dolor, tumor, and functio laesa, has come an understanding of inflammation's manifestations at the organ, tissue, vascular, cellular, genetic, and molecular levels. Molecular medicine now raises the opposite question: can local oral infections and their inflammatory mediators increase systemic morbidity or mortality? From these perspectives we examine the clinical evidence relating caries, periodontal disease, and pericoronitis to systemic disease. Widespread affirmation of an oral-systemic linkage remains elusive, raising sobering cautions.     

Oral clinical status and oral health-related quality of life: is socioeconomic position a mediator or a moderator?

Aim: To evaluate whether socioeconomic position exerts a mediating and/or moderating effect on the association between oral clinical measures and oral health-related quality of life (OHRQoL) in adolescents. Materials and methods: The study analysed data on 5,445 adolescents aged 15–19 years from the Brazilian Oral Health Survey (SBBrasil Project). The numbers of decayed and missing teeth, number of sextants with gingivitis and malocclusion were assessed through oral clinical examinations. Participant’s age, sex, OHRQoL and socioeconomic position were also collected. Monthly family income was used to indicate the participant’s socioeconomic position, and OHRQoL was assessed using the Oral Impacts on Daily Performance. Moderation was tested using Poisson regression models. Structural equation modelling and Sobel’s test assessed the mediation effects. Results: Oral clinical measures, OHRQoL and socioeconomic position were significantly correlated (P < 0.001). The moderator effect of socioeconomic position on the association between all oral clinical measures and OHRQoL was observed. The impact of all oral clinical conditions on adolescents’ OHRQoL was lower in the low-family-income groups compared with those with a better income. Socioeconomic position partially mediated the relationship between the four oral clinical measures and OHRQoL. Sobel’s test confirmed these findings (P < 0.001). Conclusions: The findings suggest the importance of socioeconomic position as a moderator and mediator factor between oral clinical measures and OHRQoL. Disadvantaged adolescents are likely to experience poor OHRQoL due to oral conditions. The reduction of the impact of oral conditions on quality of life in adolescents may be enhanced by addressing social inequalities related to oral health.Key words: Oral health, quality of life, socioeconomic status, adolescent     

Child dental neglect: is it a neglected area in the UK?

This commentary focuses on the condition of dental neglect (DN) in children in the UK. It is divided into three sections: the first section defines DN in children and its consequences, the second section discusses who may be responsible for dental diseases in children as a result of neglect and the third section proposes a holistic approach to address DN in children in the UK.     

Is early diagnosis of oral cancer a feasible objective? Who is to blame for diagnostic delay?

Oral Diseases (2010) 16 , 333–342 Worldwide, oral cancer has one of the lowest survival rates and poor prognosis remains unaffected despite recent therapeutic advances. Reducing diagnostic delay to achieve earlier detection is a cornerstone to improve survival. Thus, intervention strategies to minimize diagnostic delays resulting from patient factors and to identify groups at risk in different geographical areas seem to be necessary. The identification of a ‘scheduling delay’ in oral cancer justifies the introduction of additional educational interventions aimed at the whole health care team at dental and medical practices. The access to and the kind of healthcare system in a particular country are also relevant in this context, particularly the referral system. The design of a simple, clear, fail‐safe, fast‐track referral scheme for those suspected with cancer may diminish greatly the length of the delay. Moreover, there is a need for future investigations, which are methodologically adequate, that consider cultural and geographical aspects and use patient survival as the final outcome, that are able to recognize the agents/factors responsible for diagnostic delay by patients as well as healthcare providers and those attributable to the healthcare systems.