MaxSim: a novel simulation-based education course for OMFS emergencies

For oral and maxillofacial surgery (OMFS) senior house officers (SHOs) with no formal medical training, the first exposure to emergency scenarios will be the first time they have to manage them, usually alone. Simulation-based education (SBE) has been demonstrated to increase experience and confidence when used in medical education, so an OMFS SBE course was created to facilitate this. The course was centred on scenarios that necessitate a rapid response, including sepsis, retrobulbar haemorrhage, and carotid artery blowout. A questionnaire with a 10-point numerical score was given to assess the change in confidence when managing these scenarios. Learner numbers were limited due to the COVID-19 pandemic, but all 10 completed both questionnaires. There was an even distribution between first and second-year SHOs. Two had received simulation training before, but it was very limited. In all stations every learner felt an increase in confidence, on average by 45% (range 38%-56%, p<0.05) on the 10-point scale. Positive feedback was also given by them all. SBE has been shown to be an invaluable method of training for clinical scenarios and needs to become common in OMFS. The course is to be expanded post COVID-19 to become available nationally.     

Dental trainees’ mental health and intention to leave their programs during the COVID-19 pandemic

BackgroundDental trainees (dental students, graduate students, and postdoctoral residents) are at increased risk of experiencing poor mental health, which can lead to intentions to leave their program, especially during the COVID-19 pandemic.MethodsThe authors invited 355 dental trainees at the University of Washington School of Dentistry to complete an 83-item questionnaire in August and September 2020. The outcome analyzed was intention to leave their programs. There were 4 self-reported predictors: anxiety, burnout, depression, and COVID-19 impact on overall mental health. The authors ran multiple variable logistic regression models to evaluate relationships between each predictor and outcome (α = .05) and reported odds ratios (ORs) and 95% CIs.ResultsThe survey response rate was 35.5%. Overall, 12.7% of participants reported any intention to leave. In total, 22.2% and 16.7% of participants endorsed clinically significant anxiety or depression symptomatology, respectively; 28.6% reported 1 or more burnout symptoms; and 69.0% reported that COVID-19 affected their overall mental health. Participants reporting anxiety (OR, 8.87; 95% CI, 1.80 to 43.57; P = .007), depression (OR, 11.18; 95% CI, 1.84 to 67.74; P = .009), or burnout (OR, 8.14; 95% CI, 1.73 to 38.23; P = .008) were significantly more likely to report intention to leave than those not reporting mental health problems. All participants reporting that the COVID-19 pandemic impacted their mental health expressed intention to leave.ConclusionsPoor mental health is common among dental trainees and is associated with intention to leave their program.Practical ImplicationsCOVID-19 has exacerbated the prevalence and consequences of poor mental health among dental students, highlighting the importance of providing wellness resources.     

Training in oral and maxillofacial surgery in Germany - Residents’ satisfaction and future challenges

The aim of this study was to analyze the current situation of trainees in OMFS in a nationwide survey at German universities and teaching hospitals.A questionnaire about their training in OMFS and discrimination, gender (in-)equality, and reconcilability of work and family life was sent to many OMFS residents in Germany.Seventy-five questionnaires were included. The average age of the participants was 32.15 years (± 0.75 years); 47 participants were male, 22 female, and 3 “diverse”. The participants’ overall satisfaction rate was good. Training concepts existed in most of the teaching hospitals (54.67%). 8.11% of the participants stated discrimination existed against men while, 24.32% agreed that discrimination existed against women. Stating that discrimination against women exists, it was associated with female gender (p < 0.001), being married (p = 0.042), and not aiming for further academic degrees (p = 0.009).Overall, the training situation in Germany seems structured in most teaching hospitals. Apart from the residents’ general satisfaction with the training concepts, there seems to be a matter of concern regarding discrimination especially against women and the reconcilability of work and family life in OMFS training. Furthering the establishment of structured training concepts might be useful to overcome these issues in the course of training in OMFS.     

Comparison of oral and maxillofacial trauma during the first and third lockdown of the COVID-19 pandemic in the United Kingdom

The incidence and management of maxillofacial trauma was compared between the first and third lockdowns in the United Kingdom due to the COVID-19 pandemic. From 6 January, 2021 to 8 March 2021, the units that had participated in the collection of data during the first lockdown were asked to update their information into the same database for the third. Nine units participated with 929 entries. Compared to the first lockdown, the number of patients whose treatment had been changed due to the pandemic reduced from 7.6% to 0.4% in the third lockdown. In the UK during the third lockdown there were higher numbers infected with COVID-19 and admitted to hospital than in the first lockdown. Despite this OMFS units that participated in the second study were able to continue the management of maxillofacial trauma without the pandemic affecting care.     

Management of odontogenic cervicofacial infections presenting to oral and maxillofacial units during the first wave of the COVID-19 pandemic in the United Kingdom

On 25 March 2020, the Chief Dental Officer issued national guidance restricting the provision of all routine, non-urgent dental services in response to the spread of COVID-19. We analysed odontogenic cervicofacial infections (CFI) presenting to oral and maxillofacial surgery (OMFS) departments during the first wave of COVID-19 in the United Kingdom.From 1 April 2020 until 31 July 2020 a database was used to prospectively collect records for all patients with CFI who presented to oral and maxillofacial teams. Information gathered included clinical presentation, location/origin of infection, and how this was managed. The OMFS units were asked to compare the patient’s care with the treatment that would usually have been given prior to the crisis. A total of 32 OMFS units recorded 1381 cases of CFI in the UK. Most of the infections were referred via the emergency department (74%). Lower first or second molars were the most common origin, contributing 40% of CFI. Collaborators reported that patients' treatments were modified as a response to COVID in 20% of cases, the most frequently cited reason being the application of COVID-19 hospital policy (85%). The impact of the first wave of COVID modified the management of a significant number of patients presenting with CFI, and there was a proactive move to avoid general anaesthetics where possible. Some patients who presented to secondary care were given no treatment, suggesting they could have been managed in primary dental care if this had been available. We recommend that OMFS units and urgent dental care centres (UDCCs) build strong communication links not only to provide the best possible patient care, but to minimise COVID exposure and the strain on emergency departments during the pandemic.     

新型冠状病毒肺炎防控时期口腔颌面外科病房诊疗模式的构建与运行

自新型冠状病毒肺炎（COVID-19）疫情爆发以来,中山大学附属口腔医院口腔颌面外科病房从未间断诊疗及护理相关工作。疫情期间,口腔颌面外科医护人员认真学习并严格遵守国家及地区颁布的新型冠状病毒（2019-nCoV）感染疫情防控相关法律法规文件,制定符合疫情防控要求的口腔颌面外科病房诊疗工作模式,有效地开展口腔颌面外科疾病临床治疗及护理工作,从而为口腔颌面部创伤、恶性肿瘤等急危重症患者争取了手术治疗时机。     

Oral and maxillofacial surgery patient satisfaction with telephone consultations during the COVID-19 pandemic

Due to the COVID-19 pandemic most oral and maxillofacial surgical (OMFS) units have moved to conducting patient consultations over the telephone. The aim of this study was to assess patients' satisfaction with telephone consultations during the COVID-19 pandemic. A retrospective survey was conducted of OMFS patients at our hospital who had telephone consultations between 1 April - 8 June 2020. The survey was conducted by independent interviewers and used the Generic Medical Interview Satisfaction Scale (G-MISS) along with a previously published additional questionnaire. Variables recorded included age, gender, theme of consultation, grade of clinician, and type of consultation. Statistical analysis was performed to assess for any differences between patient groups. The records of 150 consecutive patients were reviewed and 135 met inclusion criteria. A total of 109 patients completed the survey giving a response rate of 80.74%. The total G-MISS score for satisfaction was high, which indicates a high level of satisfaction among all patients. We found no statistical difference in satisfaction when comparing patients in terms of gender, age, theme of consultation, or level of clinician. A significant difference was found in compliance levels between review and new patients, with review patients demonstrating higher compliance levels (p=0.004). Overall, 83.48% of patients said they would be willing to have a telephone consultation in future. The majority of patients in this study reported high levels of satisfaction with telephone consultations. New patients reported lower levels of compliance which may suggest this type of consultation is less suited to telephone consultation.     

Microvascular reconstructions in oral and maxillofacial surgery — Results of a survey among oral and maxillofacial surgeons in Germany,Austria, and Switzerland

This study aimed to evaluate the use of microvascular free flaps (MFF) in oral and maxillofacial surgery (OMFS) in Germany, Austria, and Switzerland.A dynamic online questionnaire, using 42–46 questions, was sent to OMF surgeons based in hospitals in Germany, Austria, and Switzerland. The questionnaire was evaluated internally and externally. Aside from general information, data were collected on organizational aspects, approaches, MFF types and frequency, presurgical planning, intraoperative procedures, perioperative medications, flap monitoring, and patient management.Participants mostly performed 30–40 MFF each year (11/53). Most stated that the COVID-19 pandemic did influence MFF frequency (25/53) to varying extents. Radial forearm flap was most frequently used (37/53), followed by ALT (5/53), and fibula flap (5/53). Primary reconstruction was performed by most participants (35/48). Irradiated bony transplants were mostly used for implant placement after 12 months (23/48). Most participants (38/48) used reconstruction plates, followed by miniplates (36/48), PSI reconstruction (31/48), and PSI miniplates (10/48). Regarding the postoperative use of anticoagulants, low-molecular-weight (37/48) and unfractioned heparins (15/48) were widely used, most often for 3–7 days (26/48). Clinical evaluation was mostly preferred for flap monitoring (47/48), usually every 2 h (34/48), for at least 48 h (19/48).Strong heterogeneity in MFF reconstructions in OMFS was found, especially regarding the timepoints of reconstruction, types of osteosynthesis, and postoperative MFF management. These findings provide the chance to further compare the different treatment algorithms regarding relevant MFF aspects, such as postoperative management. This could create evidence-based treatment algorithms that will further improve the clinical outcomes in MFF reconstructions.     

COVID-19–Related Factors Delaying Dental Visits of Workers in Japan

BackgroundThe aim of this research was to investigate the factors associated with postponing dental attendance amongst Japanese workers during the coronavirus disease 2019 (COVID-19) pandemic.MethodsWe conducted an internet-based survey in Japan from November 24 to 29, 2021. The participants were selected from people registered with an online research company. The inclusion criteria for this study were full-time or part-time workers aged 20 to 69 years. Participants filled out a questionnaire about their oral health, behaviour, and working conditions.ResultsA total of 1840 participants were included in the analysis. Three hundred ninety-eight participants (21.5%) answered that they postponed dental attendance due to COVID-19. Multiple logistic regression showed that women were more likely to postpone dental attendance (odds ratio [OR], 1.74; 95% confidence interval, 1.33–2.26). Moreover, employment status, household income, changes in income, working at home, interdental cleaning device use, regular dental attendance, awareness of untreated teeth, and dental pain were also associated with postponing dental attendance. The results of decision tree analysis showed that regular dental attenders with dental pain were the most likely to postpone dental attendance.ConclusionsThe characteristics of postponed dental visits for Japanese workers differ depending on whether one is a regular dental attender or not. Amongst regular dental attenders, worsening oral health due to interruptions in dental attendance is concerning. Meanwhile, untreated teeth might be neglected amongst nonregular dental attenders. Preventing patients from refraining from dental attendance, regardless of whether or not they are regular dental attenders, is important during the COVID-19 pandemic.Key words: COVID-19, Postponed dental attendance, Dental visits, Regular checkups     

COVID-19–Related Factors Delaying Dental Visits of Workers in Japan

BackgroundThe aim of this research was to investigate the factors associated with postponing dental attendance amongst Japanese workers during the coronavirus disease 2019 (COVID-19) pandemic.MethodsWe conducted an internet-based survey in Japan from November 24 to 29, 2021. The participants were selected from people registered with an online research company. The inclusion criteria for this study were full-time or part-time workers aged 20 to 69 years. Participants filled out a questionnaire about their oral health, behaviour, and working conditions.ResultsA total of 1840 participants were included in the analysis. Three hundred ninety-eight participants (21.5%) answered that they postponed dental attendance due to COVID-19. Multiple logistic regression showed that women were more likely to postpone dental attendance (odds ratio [OR], 1.74; 95% confidence interval, 1.33–2.26). Moreover, employment status, household income, changes in income, working at home, interdental cleaning device use, regular dental attendance, awareness of untreated teeth, and dental pain were also associated with postponing dental attendance. The results of decision tree analysis showed that regular dental attenders with dental pain were the most likely to postpone dental attendance.ConclusionsThe characteristics of postponed dental visits for Japanese workers differ depending on whether one is a regular dental attender or not. Amongst regular dental attenders, worsening oral health due to interruptions in dental attendance is concerning. Meanwhile, untreated teeth might be neglected amongst nonregular dental attenders. Preventing patients from refraining from dental attendance, regardless of whether or not they are regular dental attenders, is important during the COVID-19 pandemic.     

Trialling a novel socially-distanced teaching approach for OMFS dental core trainees: case-based discussions through WhatsApp©

In our tertiary level centre, the oral and maxillofacial (OMFS) rotas often change at short- notice due to service requirements and the development of guidance relating to the COVID-19 pandemic. Consequently, we have developed a novel teaching method for our dental core trainees (DCTs) to accommodate hectic schedules and conflicting availability between junior and senior staff. Here, we describe the innovative teaching approach we have established using case-based discussions via WhatsApp©. Feedback has been excellent. Respondents have stated that the most useful aspect is flexibility to participate in between tasks and across multiple sites, and 87% stated that they use the searchable summaries when managing patients. This teaching method is highly beneficial for OMFS DCTs. It allows flexibility for fluctuating schedules, is interactive, and provides an easily accessible resource whilst on call. We believe that other teams may benefit from the method if scheduling the time for regular didactic teaching is difficult, or they wish to supplement existing practices.     

Multifaceted impact of COVID-19 on dental practice: American dental care professionals prepared and ready during unprecedented challenges

BackgroundThe purpose of this study was to evaluate the multifaceted impact of the COVID-19 pandemic on dental practices and their readiness to resume dental practice during arduous circumstances.MethodsThe authors distributed an observational survey study approved by The University of Texas Health Science Center at San Antonio Institutional Review Board to dental care practitioners and their office staff members using Qualtrics XM software. The survey was completed anonymously. The authors analyzed the data using R statistical computing software, χ² test, and Wilcoxon rank sum test.ResultsNearly all participants (98%) felt prepared to resume dental practice and were confident of the safety precautions (96%). Only 21% of dentists felt the COVID-19 pandemic changed their dental treatment protocols, with at least two-thirds agreeing that precautions would influence their efficiency adversely. Although most participants were satisfied with the resources their dental practice provided for support during the pandemic (95%), most were concerned about the impact on their general health and safety (77%) and to their dental practice (90%), found working during the pandemic difficult (≈ 60%), and agreed there are challenges and long-term impacts on the dental profession (> 75%).ConclusionsDental care professionals, although affected by the COVID-19 pandemic and at high risk of developing COVID-19, were prepared to resume dental practice during most challenging circumstances.Practical ImplicationsThe pandemic has affected dental care practitioners substantially; thus, there is need to formulate psychological interventions and safety precautions to mitigate its impact. Further research should evaluate the long-term effects on dentistry and oral health and interceptive measures for better communication and programming around future challenges.     

Does the current oral and maxillofacial surgery training pathway disadvantage female trainees?

Women make up a minority of OMFS consultants and trainees. The long training pathway has been highlighted as a barrier for prospective applicants. Maternity leave and less than full-time training extend time in training. Efforts to streamline and shorten the training pathway will help ensure the diversity and inclusivity of OMFS.     

Impact of the Coronavirus on Providing Oral Health Care in the Netherlands

ObjectiveTransmission of SARS-CoV-2 during oral health care is potentially increased compared to regular social activities. Specific amendments to the Dutch national infection control guidelines were promulgated. This study aimed to map the impact of the coronavirus pandemic on providing oral health care during the first wave of the coronavirus pandemic in 2020 in the Netherlands.MethodsA cross-sectional web-based survey was sent via email to a representative sample of dental hygienists and dentists in the Netherlands.ResultsOf the 1700 oral health care practitioners approached, 440 (25.9%) responded to the survey. Patient access to oral health care was severely restricted during the lockdown in the spring of 2020. A total of 1.6% of the oral health care practitioners had laboratory-confirmed COVID-19 during the study period, although this is likely to be an underrepresentation due to limited access to testing at that time. Over half of the participants perceived an increased risk of virus transmission during aerosol-generating treatments in their practices. A large majority (65.0%–87.1%) of the oral health care practitioners followed the COVID-19-specific amendments to the national infection control guidelines. Compared to the pre-pandemic period, additional personal protective equipment and protocols were applied. Factors related with compliance with the additional recommendations were age, employment status, and occupation.ConclusionsThe pandemic had a profound impact on both the accessibility and practice of oral health care. This survey study found that most Dutch oral health care practitioners paid extra attention to hygiene and infection control. Also, a low number of COVID-19 infections detected amongst Dutch oral health care practitioners was reported in the Netherlands. These overall outcomes suggest that safe oral health care can be provided when following the current infection control recommendations.Key words: SARS-CoV-2, COVID-19, Dental infection control, Dental care, Dental practice management, Dentists     

Attitude of clinical medical students to Oral and Maxillofacial Surgery as a career: a perspective from two English Medical Schools

Oral and Maxillofacial Surgery (OMFS) has been increasing in popularity amongst medicine first trainees. Despite this, there is still limited exposure at the undergraduate level. This study aimed to: evaluate the experience of medical students in the field of OMFS, the awareness of medical students to OMFS resources/societies and to determine the greatest motivators and deterrents for students in pursuing a career in OMFS. An online survey was distributed to 198 students spread across two English universities. 131 students (66.2%) were from University A and 67 (33.8%) students were from University B. A total of 61.1% of undergraduate medical students had no exposure to OMFS up until their current stage of training with no statistically significant differences in OMFS exposure between the year groups (p>0.05). 37% of students considered OMFS as a potential career path with dual qualification being the deterrent in 44% of cases. 97.0% of students were not able to state any organisations/resources available to support them in pursuing a career in OMFS. Within our cohort exposure to OMFS was greater than earlier reports, however; undergraduate exposure to OMFS is still very limited in UK medical schools. Conducting a dental degree following the primary medical qualification appears to be the greatest obstacle to students considering OMFS training. OMFS remains unknown to medical students and healthcare professionals. We need grass root changes at undergraduate level to improve the future of OMFS training.     

The influence of 2020 coronavirus lockdown on presentation of oral and maxillofacial trauma to a central London hospital

The novel coronavirus COVID-19 was first identified in China in December 2019. Its spread resulted in a pandemic, with the United Kingdom entering a period of national lockdown on 23 March 2020 to reduce disease burden on the National Health Service (NHS). King’s College Hospital is a Major Trauma Centre serving an inner-city population of 700,000 with 120,000 patients attending the emergency department (ED) annually. We aimed to determine the effect of lockdown on OMFS trauma presentations and lessons learned from emergency service provision during a pandemic. All referrals to the oral and maxillofacial surgical (OMFS) team from ED during the first six weeks of the lockdown period – 23 March 2020 - 3 May 2020 – were compared with the same six-week period in 2019. A total of 111 referrals were made to OMFS during the first six weeks of the lockdown period in 2020 compared with 380 referrals in 2019. Of these, 50.5%, (n = 192) were related to facial trauma in 2019 vs (63.1%, n = 70) in 2020. Fewer patients were admitted under OMFS: 17.4% (n = 35) in 2019 vs 2.9% (n = 2) in 2020, and a greater number of patients were discharged from OMFS care directly from the ED: 63.2% (n = 127) in 2019 vs 82.9% (n = 58) in 2020. There was profound effect of the lockdown on referrals to OMFS from the ED, in number and type of diagnosis. This is potentially reflective of the increased availability of acute/emergency dental services in South-East London during the lockdown period. This gives us valuable insight for service planning in the event of further restrictions.     

Oral and Maxillofacial Surgery (OMFS) Consultant Workforce in the UK: reducing consultant numbers resulting from recruitment issues,pension pressures,changing job-plans,and demographics when combined with the COVID backlog in elective surgery,requires urgent action

Mean retirement age for UK doctors is 59.6 years, giving the average OMFS consultant approximately 20 years of practice. Current pension tax regulations, new consultant posts typically restricted to a maximum of 10 sessions (40 hours), increasing proportions of consultants working less than full time (LTFT), all combined with the backlog of elective care created by COVID-19 will create a significant gap between workforce capacity and clinical demand. The age of current OMFS consultants was estimated using the date of their primary medical/dental qualification. Changes in job plans were estimated using data from the BAOMS Workforce Census and from recently advertised posts. Reports of unfilled posts were collated by OMFS Regional Specialty Professional Advisors (RSPAs). First degree dates were identified for 476 OMFS substantive consultant posts. Estimated current average age of OMFS consultants was 52.7 years (minimum 35.9, maximum 72.1), 75th centile age 59.0 and 23% of the current consultant workforce above the average retirement age for doctors. The 10 sessions of new OMFS consultants posts is significantly less than existing consultants' average of 12.1 sessions (48.4 hours). Unfilled consultant posts in Great Britain are 13% of the total compared to 20% in Northern Ireland and Ireland. Many (23%) of the OMFS consultant workforce are above average retirement age. Forty-hour contracts; new consultants working LTFT; and early loss of senior colleagues because of pension pressure will reduce NHS’ capacity to treat OMFS disorders and injuries. This paper suggests increasing consultant posts, increasing trainee numbers, and actively retaining senior surgeons to maintain capacity.     

Lost tribe? Awareness of oral and maxillofacial surgery (OMFS) among the general public

OMFS has important links with other disciplines in medicine and dentistry. Therefore it is important that people are aware of this speciality. A study was devised to determine the awareness of OMFS among the general public and to improve their understanding. A questionnaire was distributed among the participants attending a dental practice. 100 participated and the mean age was 42.5 years. Only 17% were aware of OMFS. 96% recognised the duty of OMFS practitioner while 74% did agree dual qualification was necessary. 68% identified hospital as the main place of work and 61% thought that the training was 5–6 years long.     

Management of oral and maxillofacial trauma during the first wave of the COVID-19 pandemic in the United Kingdom

We assess the effect of coronavirus disease 2019 (COVID-19) on UK oral and maxillofacial (OMF) trauma services and patient treatment during the first wave of the pandemic. From 1 April 2020 until 31 July 2020, OMF surgery units in the UK were invited to prospectively record all patients presenting with OMF trauma. Information included clinical presentation, mechanism of injury, how it was managed, and whether or not treatment included surgery. Participants were also asked to compare the patient’s care with the treatment that would normally have been given before the crisis. Twenty-nine units across the UK contributed with 2,229 entries. The most common aetiology was mechanical fall (39%). The most common injuries were soft tissue wounds (52%) and, for hard tissues, mandibular fractures (13%). Of 876 facial fractures, 79 patients’ treatment differed from what would have been normal pre-COVID, and 33 had their treatment deferred. Therefore the care of 112 (14%) patients was at variance with normal practice because of COVID restrictions. The pattern of OMFS injuries changed during the first COVID-19 lockdown. For the majority, best practice and delivery of quality trauma care continued despite the on-going operational challenges, and only a small proportion of patients had changes to their treatment. The lessons learnt from the first wave, combined with adequate resources and preoperative testing of patients, should allow those facial injuries in the second wave to receive best-practice care.