European dental students’ opinions on their local anaesthesia education

Objective: To investigate students’ opinion about theoretical and clinical training in local anaesthesia at different European dental schools. Materials and Methods: A questionnaire was designed to collect information about local anaesthesia teaching. Students’ opinion was quantified with five‐point Likert scales. The web‐based questionnaire was distributed through European Dental Students Association contacts amongst students of 25 different dental schools. Eight hundred and eighteen completed questionnaires from students of 12 dental schools were analyzed statistically. Results: Dental schools showed a wide variation in the beginning of the theoretical teaching of local anaesthesia and the practical teaching. A preclinical training model was used by a small number of students, but these students found it a useful preparation. Many students felt insufficiently prepared when they administered their first injection in a human (17–81%). In dental schools from the UK, Ireland, Sweden and the Netherlands, this first injection is administered to a fellow dental student, whilst in the other countries the first injection is usually performed in a patient. Instruction in mandibular block anaesthesia was frequently reported (81–100%) as well as in infiltration anaesthesia of the upper and lower jaws (78–100% and 30–93% respectively). Many students expressed that they like to receive teaching in intraligamentary anaesthesia (13–70%). Other changes in the curriculum were also frequently suggested (33–100%), especially the introduction of preclinical training models and practical teaching earlier in the curriculum. Conclusion: Local anaesthesia teaching programmes and the rating of this teaching by dental students show a considerable variation across European dental schools. Students considered better preparation highly desirable. The variability in programmes may have implications for mobility of students between European dental schools.     

Quantifying lip‐read‐induced suppression and facilitation of the auditory N1 and P2 reveals peak enhancements and delays

Lip‐read speech suppresses and speeds up the auditory N1 and P2 peaks, but these effects are not always observed or reported. Here, the robustness of lip‐read‐induced N1/P2 suppression and facilitation in phonetically congruent audiovisual speech was assessed by analyzing peak values that were taken from published plots and individual data. To determine whether adhering to the additive model of AV integration (i.e., A+V ≠ AV, or AV?V ≠ A) is critical for correct characterization of lip‐read‐induced effects on the N1 and P2, auditory data was compared to AV and to AV?V. On average, the N1 and P2 were consistently suppressed and sped up by lip‐read information, with no indication that AV integration effects were significantly modulated by whether or not V was subtracted from AV. To assess the possibility that variability in observed N1/P2 amplitudes and latencies may explain why N1/P2 suppression and facilitation are not always found, additional correlations between peak values and size of the AV integration effects were computed. These analyses showed that N1/P2 peak values correlated with the size of AV integration effects. However, it also became apparent that a portion of the AV integration effects was characterized by lip‐read‐induced peak enhancements and delays rather than suppressions and facilitations, which, for the individual data, seemed related to particularly small/early A‐only peaks and large/late AV(?V) peaks.     

Malignant transformation of oral leukoplakia in a well‐defined cohort of 144 patients

Objectives

Oral leukoplakia is a potentially malignant disorder of the oral mucosa. The aim of this retrospective study was to identify the factors that possibly predict malignant transformation in a well‐defined cohort of patients with a long‐term follow‐up. All leukoplakias were staged according to a clinicopathological classification and staging system. Furthermore, a certainty factor has been used with which the diagnosis has been established.

Material and methods

The group consisted of 144 patients. The size, presence and degree of epithelial dysplasia were incorporated into a clinicopathological classification and staging system. Initial management consisted of surgical excision, CO₂ laser vaporisation or observation only. The mean follow‐up period was 51.2 months (s.d. = 39.33, range 12–179 months).

Results

In 16 of 144 patients (11%), malignant transformation occurred between 20 and 94 months (mean 57.0 months) after the first visit, the annual malignant transformation rate being approximately 2.6%. A large size of the lesion (≥ 4 cm) showed to be the only statistically significant predictor of malignant transformation (P = 0.034).

Conclusion

A size of ≥ 4 cm showed to be the only significant predicting factor of malignant transformation in oral leukoplakia. No other epidemiological, aetiological, clinical or histopathological parameters were of statistical significance.     

The relevance of uniform reporting in oral leukoplakia: Definition, certainty factor and staging based on experience with 275 patients

The aim of the present study was to evaluate the definition of oral leukoplakia, proposed by the WHO in 2005 and taking into account a previously reported classification and staging system, including the use of a Certainty factor of four levels with which the diagnosis of leukoplakia can be established. In the period 1997-2012 a hospital-based population of 275 consecutive patients with a provisional diagnosis of oral leukoplakia has been examined. In only 176 patients of these 275 patients a firm diagnosis of leukoplakia has been established based on strict clinicopathological criteria. The 176 patients have subsequently been staged using a classification and staging system based on size and histopathologic features. For use in epidemiological studies it seems acceptable to accept a diagnosis of leukoplakia based on a single oral examination (Certainty level 1). For studies on management and malignant transformation rate the recommendation is made to include the requirement of histopathologic examination of an incisional or excisional biopsy, representing Certainty level 3 and 4, respectively. This recommendation results in the following definition of oral leukoplakia: “A predominantly white lesion or plaque of questionable behaviour having excluded, clinically and histopathologically, any other definable white disease or disorder”. Furthermore, we recommend the use of strict diagnostic criteria for predominantly white lesions for which a causative factor has been identified, e.g. smokers’ lesion, frictional lesion and dental restoration associated lesion. Key words:Oral epithelial dysplasia, oral leukoplakia, potentially malignant oral disorders.     

Decline in prolonged hormone replacement therapy in women aged 45 years or more,and impact of a centralised database tool

Objective Evaluation of discontinuation in prolonged use of menopausal and post‐menopausal hormone replacement therapy (HRT) in The Netherlands after the publication of the Million Women Study in The Lancet of August 9, 2003. Furthermore estimation of the contribution of a centralised database tool on this decline, supplying community pharmacists with their patients on prolonged HRT therapy. Setting Dispensing data of more than 90% of Dutch community pharmacies were collected in a centralised database. Shortly after the publication of the Million Women Study, this database was used to offer community pharmacists online access to a listing of their patients with prolonged HRT use. Methods In August 2003 all women who had used HRT for at least one year were selected as long‐term users. This cohort was followed until April 2004. The proportion of patients who had stopped their prolonged HRT in this cohort was calculated. This decline was also measured according to the use of a database tool. For this purpose community pharmacies were divided into pharmacies who had repeatedly consulted the centralised database tool (T pharmacies; n = 343) and control pharmacies who had evidently not consulted the tool (C pharmacies; n =490). The two groups of pharmacies were compared according to characteristics of the pharmacy on which information was available in the centralised database. They were also compared for patient characteristics that were routinely collected in the database. Differences between the two groups for averages of these parameters were tested with a chi square test and with a chi square test for trend for ordinal variables with more categories. The proportion of patients who stopped their prolonged HRT was calculated for each of the two groups of pharmacies. These proportions were compared with a Z test for proportions. The two groups of pharmacies were compared for cessation of HRT treatment and for ceasing treatment earlier by a Kaplan‐Meier survival curve. Cox survival analyses was used to estimate the chances for discontinuation of HRT for patients within the two pharmacy groups with the possibility to adjust for possible confounders such as patient's age and type of HRT medication. Key findings After publication of the Million Women Study in The Lancet of August 9, 2003, 63% of the women in The Netherlands who had used HRT for more than one year in August 2003 had stopped their prolonged use in April 2004. A centralised database tool supplying community pharmacists with a list of their patients on prolonged HRT therapy caused a significantly higher proportion of cessation in the T group of pharmacies than in the C group (65% versus 62%; P < 0.05). Furthermore, the time needed for halving the number of patients on prolonged HRT was significantly shorter in T pharmacies than in C pharmacies (187 days versus 202 days; P < 0.05). Patients in T pharmacies had a significantly increased chance of 7.6% (95% confidence interval: 1.05–1.10) of discontinuing their HRT and of doing so earlier. Conclusions The results of the Million Women Study had a major impact on prolonged HRT use in The Netherlands. A centralised database tool for prolonged use of HRT could have a modest but significant impact on dispensing patterns.