Dimensions of good work for employees in oral and maxillofacial surgery in Sweden

The aims of this study were to describe how the employees of Oral and Maxillofacial Surgery (OMFS) clinics in Sweden perceive "good work", i.e. their image of the good dimensions that the profession should contain and to investigate if there is a discrepancy between ideal and reality for this group. The study was based on a questionnaire with 67 questions, related to quality management at the clinic, health and the content of good work in two sections, one with the headline "defines good work" and the other "fulfilled 'in my present work' ". Each section was subdivided into 12 parts covering aspects of good work. The maxillo-facial surgeons rated "intellectually stimulating work" as most important (91%), and the "hazard-free work environment" as least important (48%). The nurses rated "stimulating fellowship" as most important (84%), and the "opportunity for career advancement" as least important (27%). The percentage unit differences between the ideal and the reality were largest for the item "the work provides opportunities to have an influence on important decisions". Maxillo-facial surgeons had the greatest differences for that question and nurses had the greatest differences in "the work is well paid". A principal components analysis was performed and three factors explained more than half of the variance (52%). The factors were interpreted as (1) aiming at moral values and possibilities for skill discretion, as (2) career development, and as (3) work environment. The employees of OMFS clinics in Sweden emphasized free, influential, and intellectually stimulating work, but the discrepancy between ideal and reality was rather wide. Three factors of work environment could be established.     

Work environment factors affecting quality work in Swedish oral and maxillofacial surgery

The aim of this study was to investigate how work environment influenced attitudes to and knowledge of quality among employees of Oral and Maxillofacial Surgery (OMFS) clinics in Sweden. Data were collected with a questionnaire of 67 questions, related to quality management at the clinic, working situation, content of "good work", physical environment and health. 22 clinics with 297 employees responded, 65% of the clinics and 86% of the employees. A multiple regression analysis with the dependent variable "Attitude towards quality work" showed that only "work environment" (p = 0.010) revealed a significant association (p < 0.05). The personnel will have a more favourable attitude to quality work if they regard work environment to be important. Dental nurses and assistant nurses had more than four times more knowledge of the used quality management system than had the maxillo-facial surgeons. Women had nearly four times more knowledge of quality management than men. Clinic size was important, with better knowledge of quality management in bigger clinics. Soft demands were defined as demands for "flexibility, creativity, quality, service, engagement/commitment and ability to work together, and competence". Hard demands included economy as important, and emphasis on efficiency and productivity. There was a weak association with knowledge of quality management systems if soft demands increased, but negative if hard demands increased. In conclusion, mainly work environment was of significance for the attitude towards quality work among the employees of OMFS clinics in Sweden. Profession, gender, clinic size, and the hard demands were significantly associated with knowledge of the quality management system used.     

Psychosocial work environment related health in Swedish oral and maxillofacial surgery in comparison with other human service workers

The aims of this study were to describe how the employees of OMFS clinics in Sweden perceive their health, to compare with female unpromoted general practice dentists and other human service groups and to explore the dimensionality of the health measure. Data were collected by way of a questionnaire with 67 questions, related to quality management at the clinic, working situation, questions about the content of "good work", the connection between physical environment and health, emphasis on physical environment. 22 clinics with 297 employees responded, 65% of the clinics and 86% of the employees. The results showed that employees of OMFS clinics in Sweden perceived their health as rather problematic. In comparison, the present study group placed itself between general practice dentists and other human service groups as to their health. Three factors explained more than half of the variance of symptoms. They were interpreted as (1) psychosomatic troubles, (2) somatic troubles, and (3) muscle and joint troubles. These factors were almost the same as previously reported, confirming the basic dimensionality of the question battery. This study has shown that OMFS employees are feeling unhealthy, but no worse than other high-risk-groups in human service working situation and better than female general practice dentists. The women among OMFS employees felt worse than the men. Three factors of symptoms could be established, i.e. psychosomatic troubles, somatic troubles, and muscle and joint troubles.     

Quality assessment of randomised controlled trials in oral and maxillofacial surgery

Randomised controlled trials are the best way to study the evaluation of treatments. We have evaluated the quantity and quality of clinical trials in three of the main journals in the specialty of oral and maxillofacial surgery between January 2010 and December 2016, using a scientometric analysis, and evaluation by the Jadad scale. In this period, 303 randomised controlled trials (5% of the total) were identified; the largest number of studies were from Asia (45%) followed by Europe (32%). The subgroup that concerned most studies was oral surgery. The mean score on the Jadad scale was 3.06 points, which means that 32% of the total studies had a low risk of bias. Studies that declared funding and adherence to Consolidated Standards of Reporting Trials (CONSORT) were given significantly higher scores (p < 0.001) than studies that did not. We conclude that randomised controlled trials in oral maxillofacial surgery have evolved in both quality and quantity since previous surveys were published. The quality of trials was related to the presence of funding and adherence to CONSORT.     

Piezosurgery in oral and maxillofacial surgery

This review summarizes current knowledge and experience with piezosurgery, a promising, meticulous and soft tissue-sparing system for bone cutting, based on ultrasonic microvibrations. The main advantages of piezosurgery include soft tissue protection, optimal visibility in the surgical field, decreased blood loss, less vibration and noise, increased comfort for the patient and protection of tooth structure. To date it has been indicationed for use in oral and maxillofacial surgery, otorhinolaryngology, neurosurgery, ophthalmology, traumatology and orthopaedics. The main indications in oral surgery are sinus lift, bone graft harvesting, osteogenic distraction, ridge expansion, endodontic surgery, periodontal surgery, inferior alveolar nerve decompression, cyst removal, dental extraction and impacted tooth removal. In conclusion, piezosurgery is a promising technical modality for different aspects of bone surgery with a rapidly increasing number of indications throughout the whole field of surgery.     

Lasers in oral and maxillofacial surgery

Because of their many advantages, lasers have become indispensable in OMS as a modality for soft tissue surgery. Based on manufacturer estimates, approximately 10% to 20% of all oral and maxillofacial surgeons have one or more lasers in their offices, and most surgeons have access to lasers in the hospital. Lasers not only enhance the current surgical options for treatment, but also have expanded the scope of practice. There are many uses for lasers in OMS, and the advent of new wavelengths will undoubtedly lead to new procedures that can be performed with them. One [figure: see text] elusive use is hard tissue surgery. Although the Er:YAG has been approved for hard tissue use in the United States and currently is being used in general dentistry, it is still not yet practical or proven for large-volume osseous or extraction surgery, in which the greatest opportunity for innovation and clinical use exists. With future research, it is possible that the right wavelength laser will be developed for this purpose, allowing an increased base of procedures performed with lasers in OMS.     

Cosmetic oral and maxillofacial surgery

The dental specialty of oral and maxillofacial surgery over the last fifteen years has been intimately involved in not only altering the bony facial skeleton, but also the esthetic defects of the facial soft tissue drape. These procedures are currently being taught, in many of our residency programs, along side the art and science of dentoalveolar surgery. When one combines the modification of both the skeletal and soft tissues, the resultant effect can be greater than the sum of its parts. Should one take this a step further and add to the list, proper arch form as prepared by the orthodontist along with cosmetic shape and appearance of the dentition by the restorative dentist using the latest in cosmetic dental techniques, what transforms is a result that has never been seen heretofore in the annals of dentofacial care. To follow are a number of case reports illustrating some salient points.     

Quality assessment of clinical practice guidelines used in oral and maxillofacial surgery

An assessment of the quality of oral and maxillofacial surgery clinical practice guidelines is lacking. The aim of this investigation was to assess the quality of guidelines using the RIGHT (Reporting Items for practice Guidelines in HealThcare) checklist. The primary outcome was to assess the score (quality) of guidelines based on the RIGHT checklist and to identify predictors (region, type, single or multi-centre, and speciality/non-speciality) influencing the quality score. In this review, following a search of electronic databases and national society websites, a total of 25 guidelines were independently assessed by two assessors against the 22-item RIGHT checklist. Inter-assessor reliability was assessed. Deficiencies in the reporting of items relating to limitations, funding, declaration and management of interests, healthcare questions, and quality assurance were evident. The median overall score for the guidelines was 28 (range 14–66). Guidelines produced by multiple centres (β = 57.15, 95% confidence interval −26.62 to 87.68, P =  0.001, multivariate analysis) and non-speciality societies (β = 20, 95% confidence interval −0.03 to 40.03, P = 0.05, univariate analysis) tended to have higher quality scores. Overall, the quality of clinical practice guidelines used in oral and maxillofacial surgery was deemed suboptimal. If clinical practice guidelines are to be used in making treatment decisions for patients, clinicians should be aware of their possible limitations.     

Image-guided navigation in oral and maxillofacial surgery

Image-guided surgery is the logical extension of imaging as it integrates previously acquired radiological or nuclear medicine images with the operative field. In conventional image-guided surgery, a surgeon uses a surgical instrument or a pointer to establish correspondence between features in the preoperative images and the surgical scene. This is not ideal because the surgeon has to look away from the operative field to view the data. Augmented reality guidance systems offer a solution to this problem but are limited by deformation of soft tissues. Real-time intraoperative imaging offers a potential solution but is currently only experimental. The additional precision and confidence that this technology provides make it a useful tool, and recent advances in image-guided surgery offer new opportunities in the field of oral and maxillofacial surgery. Here, we review the development, current technologies, and applications of image-guided surgery and illustrate them with two case reports.     

Lasers in contemporary oral and maxillofacial surgery

The practice of oral and maxillofacial surgery has included the use of lasers since the 1960s. Over the past few decades, the use of lasers among oral and maxillofacial surgeons has grown dramatically. Their evolution within the specialty not only has enhanced current surgical options for treatment, but also contributed to a variety of new procedures that are now commonplace in oral and maxillofacial surgery. The management of patients with sleep apnea, temporomandibular joint derangements, dental implants, premalignant lesions, and posttraumatic facial scarring has improved significantly with the advent of laser surgery. As the number of laser systems grows and their technology becomes more advanced, a thorough understanding regarding the principles of their use is paramount to providing safe and effective patient care.     

Amniotic membrane in oral and maxillofacial surgery

Purpose

Following its renaissance in ophthalmology during the 1990s, preserved human amniotic membrane (HAM) has become an attractive biomaterial for all surgical disciplines. This article reviews the current and potential use of HAM in oral and maxillofacial surgery, its postulated properties and common preservation techniques.

Methods

Literature was identified by an electronic search of PubMed in July 2012; this was supplemented from the reference lists of the consulted papers.

Results

HAM has been used in the field of oral and maxillofacial surgery from 1969 onwards because of its immunological preference and its pain-reducing, antimicrobial, mechanical and side-dependent adhesive or anti-adhesive properties. The effects of HAM on dermal and mucosal re-epithelialisation have been highlighted. Typically, HAM is applied after being banked in a glycerol-preserved, DMSO-preserved or freeze-dried and irradiated state. Whereas the use of HAM in flap surgery and in intra-oral and extra-oral lining is reported frequently, novel HAM applications in post-traumatic orbital surgery and temporomandibular joint surgery have been added since 2010. Tissue engineering with HAM is a fast-expanding field with a high variety of future options.

Conclusions

Preserved HAM is considered to be a safe and sufficient biomaterial in all fields of oral and maxillofacial wound healing. Recently published novel indications for HAM application lack a high level of evidence and need to be studied further.     

Stereotactic navigation in oral and maxillofacial surgery

Navigation is an adjunct to existing surgical procedures. It is potentially useful in any procedure where it is possible to make a three-dimensional surgical plan from computed tomography (CT) or magnetic resonance imaging (MRI) data, but is not easy to translate this plan into surgical reality because of absolute limitations of access or lack of anatomical landmarks.     

Computed tomography in oral and maxillofacial surgery

The use of computed tomography (CT) in oral and maxillofacial surgery is discussed. The CT scan delineates lesions in the oral and maxillofacial complex to aid in planning of surgical treatment. Case examples are presented, and the indications for the use of CT scanning are discussed.