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Analgesia overdose due to dental pain requiring acute hospital admissions
Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
P 115 Dental registration of UK OMFS consultants and trainees in 2015 – a significant change? Not ‘ARF’ P. Magennis ∗ , A. Begley, M.S. Dover Aintree University Hospitals NHS Foundation Trust, United Kingdom Introduction: It is a requirement for those entering OMFS training in the UK to have fully registerable qualifications in medicine and dentistry. Guidance from the OMFS SAC recommends OMFS trainees maintain registration with the General Dental Council (GDC) during their training to avoid administrative difficulties when applying for their Certificate of Completion of Training (CCT). For those already on the OMFS specialist list, dual registration may be required by their employer but the GMC does not require dental registration to remain on the OMFS specialist list. In autumn 2014 the GDC almost doubled its Annual Retention Fee (ARF) for the year 2015. The authors felt this price hike may have a significant impact on OMFS surgeons (who may consider themselves the only ‘volunteers’ on the Dental Register). Method: In January 2015, using GDC numbers previously assembled from the Dental Register, the GDC website was interrogated for current registration details of OMFS trainees and consultants. Results: Of 150 current OMFS trainees and 398 current OMFS consultants/specialists, 381 (70%) of 548 were dentally registered with 113 (75%) trainees and 268 (67%) consultants on the Dental Register. 8 consultants had only dental registration. Of those 130 consultants no longer registered with the GDC, 83 (64%) left at the end of December 2015 and of those 37 trainees no longer registered, 12 (32%) left at this time (against advice from the SAC OMFS). Discussion: The risks and benefits of single and dual registration for OMFS specialists in the UK and Europe will be discussed. http://dx.doi.org/10.1016/j.bjoms.2015.08.123 PP 116 Changing first degrees of OMFS trainees and specialists 1996–2020 P. Magennis ∗ , A. Begley, S. Dover SAC OMFS, United Kingdom Introduction: For most of its history, oral and maxillofacial surgery has been a surgical specialty for those who have trained in dentistry. Even when dual medical and dental qualifications became mandated, most trainees undertook medicine as their second degree. In the last decade two major changes in training had a joint impact on OMFS training, availability and access to shortened dental degrees for med-
e79
ical graduates and the training earthquake of the Medical Training Appointment Service (MTAS). MTAS specifically excluded experienced young surgeons from entering higher training, who then looked around and saw the exciting specialty of OMFS and the Kings 3 year dentistry course. Method: Using information from the UK Dental Register, the Medical Register and the General Medical Council Specialist List and information provided by trainees in OMFS, a database of timing of first and second degrees was assembled. The date of entry onto the specialist list or projected end of training date were combined with the first degree data on Excel© and analysed using WinStat© . Results: Year of ‘CCT’ is estimated year of Certificate of Completion of Training, BDS is dental degree first, MB is medical Degree first Year of ‘CCT’
BDS
MB
1996–2000 2001–2005
115 (99%) 83 (98%)
1 (1%) 2 (2%)
2006–2010 2011–2015 2016–2020
87 (88%) 113 (88%) 66 (73%)
12 (12%) 16 (12%) 25 (27%)
Discussion: The changes in first degree of OMFS trainees and specialists will be discussed, and the implications of EU training regulations and the Greenaway report will be reviewed. http://dx.doi.org/10.1016/j.bjoms.2015.08.124 PP 117 Analgesia overdose due to dental pain requiring acute hospital admissions H. Mahmood ∗ , I. Siddique, R. Mohammed-Ali Sheffield Teaching Hospitals NHS Trust, United Kingdom Introduction: There have been serious and lifethreatening cases of paracetamol overdose secondary to dental pain. We aimed to determine what proportion of nonintentional paracetamol overdose cases admitted to an acute Medical Assessment Unit were secondary to dental pain, secondly what proportion of such cases encountered barriers to accessing emergency dental care and finally, what clinical burden such cases placed on the hospital Oral and Maxillofacial service (OMFS). Method: The hospital clinical coding department provided information to allow data collection from patient case notes of all non-intentional paracetamol overdose cases secondary to dental pain over a 24 month period (March 2012 to February 2014). Results: 116 admissions were identified specifically for non-intentional paracetamol overdose. Dental pain accounted
e80
Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
for 48 (41%) of all cases, followed by 22 (19%) due to mental health reasons and 10 (9%) due to back pain. Blood toxicity monitoring was performed in 46 (96%) of patients and 38 (79%) required management with N-acetylcysteine (Parvolex® ). One case experienced new onset acute hepatic failure. 81% of non-dentally registered and all dentally registered patients were unable to access emergency dental care. The majority (97%) of patients referred to the OMFS underwent elective outpatient dental extractions under local anaesthetic. Conclusion: Dental pain was the commonest cause of non-intentional paracetamol overdose. Registered and nonregistered patients had difficulty accessing emergency dental care. All cases referred to the OMFS could have been appropriately accommodated in a primary care setting. Improvements in access to both routine and emergency dental care are required to prevent such admissions. http://dx.doi.org/10.1016/j.bjoms.2015.08.125 PP 118 A novel barbed suture tie-over dressing for skin grafts: a comparison with traditional techniques N. Mahon ∗ , C. Joyce, K. Joyce, P. Dockery, J. Kelly Peterborough City Hospital, United Kingdom Introduction: The unidirectional nature of the barbs facilitates a strong grip on tissues and reduces the need to constantly tension the suture manually. We hypothesized that a barbed suture tie-over suture to secure skin grafts would be quicker to perform than traditional tie-overs and would also exert a greater downward pressure on the skin graft. Methods: Thirty uniform areas of skin were excised from a cadaver. A pressure transducer was placed on the wound bed and covered with the excised skin along with a mineral oil-soaked wool dressing to act as a bolster. Three different sutures were used to secure the graft in place and the pressure was recorded. The tie-over techniques used were the classic silk tie-over, a running Vicryl RapideTM tie-over and a running barbed tie-over. Results: The barbed tie-over exerted the most downward pressure (82.8 ± 7.3 mmHg) compared to the silk (46 ± 4.85 mmHg) and the Vicryl RapideTM (18.6 ± 2.4 mmHg). Furthermore, the barbed tie-over was the quickest to perform (1:45 ± 22 s) when compared to the Vicryl RapideTM (02:57 ± 27 s) and the silk tie-overs (04:26 ± 39 s). Conclusion: Barbed sutures are a viable option for securing skin grafts. They are quick to perform and provide significantly improved downward pressure on the skin graft. We feel that this technique would be especially suited to the sole operator as it can be carried out without the need of an assistant. http://dx.doi.org/10.1016/j.bjoms.2015.08.126
P 119 Perceived impediments to the junior years of oral and maxillofacial training W. Minks Leeds Teaching Hospitals Trust, United Kingdom Introduction: Recent legislative changes in higher and postgraduate medical education have impacted upon Oral and Maxillofacial training. This study sought to expose matters threatening junior trainees, for the purpose of workforce planning and prioritization of issues to be tackled by the committee. Method: An anonymous survey was circulated via the junior trainees’ forum. This elicited the stage and region of training, information regarding second degree funding and career aims. Respondents ranked impediments experienced in order of impact. Results: 63 trainees responded to the survey. ‘Lack of Guaranteed Pay Protection’, ‘Tuition Fees’ and ‘Subscription Costs’ posed the greatest barriers, with trainees in the South East of England significantly more threatened by ‘Relocation’ and ‘Registrar Application Ratios’ than elsewhere in Great Britain. Head and Neck Cancer was the most intended subspecialty (29%) with 48% of respondents considering academic training. All second degree respondents undertook Oral and Maxillofacial clinical shift work and 45% of these trainees were provided with an NHS contract for their employment. 85% of trainees opted out of the European Working Time Directive during their second degree. Respondents volunteered that some universities disallowed employment, rendering cooperation problematic. Trainees were also inhibited by a lack of mentoring, relevant training posts and operating opportunities. Conclusion: It is in the interest of the group that high quality trainees are sufficiently supported, and that training undertaken is relevant and legal. A survey should be distributed annually with relevant issues prioritized each year. The group should consider a format for a consultant led mentoring system. http://dx.doi.org/10.1016/j.bjoms.2015.08.127 P 120 ‘OMFS SHO’ App: clinical guidance at your fingertips! J. Mirza ∗ , A. Abou-foul, V. Ramamoorthy, P. Anand Oxford University Hospitals, United Kingdom Objectives: In August 2013, the specialist surgery rota at our regional, Oral & Maxillofacial surgery (OMFS) centre had been revised. This lead to a shift pattern fragmentation and increased work load on junior doctors out of hours (OOH). Our main objective was to assess the potential ben-
P 115 Dental registration of UK OMFS consultants and trainees in 2015 – a significant change? Not ‘ARF’ P. Magennis ∗ , A. Begley, M.S. Dover Aintree University Hospitals NHS Foundation Trust, United Kingdom Introduction: It is a requirement for those entering OMFS training in the UK to have fully registerable qualifications in medicine and dentistry. Guidance from the OMFS SAC recommends OMFS trainees maintain registration with the General Dental Council (GDC) during their training to avoid administrative difficulties when applying for their Certificate of Completion of Training (CCT). For those already on the OMFS specialist list, dual registration may be required by their employer but the GMC does not require dental registration to remain on the OMFS specialist list. In autumn 2014 the GDC almost doubled its Annual Retention Fee (ARF) for the year 2015. The authors felt this price hike may have a significant impact on OMFS surgeons (who may consider themselves the only ‘volunteers’ on the Dental Register). Method: In January 2015, using GDC numbers previously assembled from the Dental Register, the GDC website was interrogated for current registration details of OMFS trainees and consultants. Results: Of 150 current OMFS trainees and 398 current OMFS consultants/specialists, 381 (70%) of 548 were dentally registered with 113 (75%) trainees and 268 (67%) consultants on the Dental Register. 8 consultants had only dental registration. Of those 130 consultants no longer registered with the GDC, 83 (64%) left at the end of December 2015 and of those 37 trainees no longer registered, 12 (32%) left at this time (against advice from the SAC OMFS). Discussion: The risks and benefits of single and dual registration for OMFS specialists in the UK and Europe will be discussed. http://dx.doi.org/10.1016/j.bjoms.2015.08.123 PP 116 Changing first degrees of OMFS trainees and specialists 1996–2020 P. Magennis ∗ , A. Begley, S. Dover SAC OMFS, United Kingdom Introduction: For most of its history, oral and maxillofacial surgery has been a surgical specialty for those who have trained in dentistry. Even when dual medical and dental qualifications became mandated, most trainees undertook medicine as their second degree. In the last decade two major changes in training had a joint impact on OMFS training, availability and access to shortened dental degrees for med-
e79
ical graduates and the training earthquake of the Medical Training Appointment Service (MTAS). MTAS specifically excluded experienced young surgeons from entering higher training, who then looked around and saw the exciting specialty of OMFS and the Kings 3 year dentistry course. Method: Using information from the UK Dental Register, the Medical Register and the General Medical Council Specialist List and information provided by trainees in OMFS, a database of timing of first and second degrees was assembled. The date of entry onto the specialist list or projected end of training date were combined with the first degree data on Excel© and analysed using WinStat© . Results: Year of ‘CCT’ is estimated year of Certificate of Completion of Training, BDS is dental degree first, MB is medical Degree first Year of ‘CCT’
BDS
MB
1996–2000 2001–2005
115 (99%) 83 (98%)
1 (1%) 2 (2%)
2006–2010 2011–2015 2016–2020
87 (88%) 113 (88%) 66 (73%)
12 (12%) 16 (12%) 25 (27%)
Discussion: The changes in first degree of OMFS trainees and specialists will be discussed, and the implications of EU training regulations and the Greenaway report will be reviewed. http://dx.doi.org/10.1016/j.bjoms.2015.08.124 PP 117 Analgesia overdose due to dental pain requiring acute hospital admissions H. Mahmood ∗ , I. Siddique, R. Mohammed-Ali Sheffield Teaching Hospitals NHS Trust, United Kingdom Introduction: There have been serious and lifethreatening cases of paracetamol overdose secondary to dental pain. We aimed to determine what proportion of nonintentional paracetamol overdose cases admitted to an acute Medical Assessment Unit were secondary to dental pain, secondly what proportion of such cases encountered barriers to accessing emergency dental care and finally, what clinical burden such cases placed on the hospital Oral and Maxillofacial service (OMFS). Method: The hospital clinical coding department provided information to allow data collection from patient case notes of all non-intentional paracetamol overdose cases secondary to dental pain over a 24 month period (March 2012 to February 2014). Results: 116 admissions were identified specifically for non-intentional paracetamol overdose. Dental pain accounted
e80
Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
for 48 (41%) of all cases, followed by 22 (19%) due to mental health reasons and 10 (9%) due to back pain. Blood toxicity monitoring was performed in 46 (96%) of patients and 38 (79%) required management with N-acetylcysteine (Parvolex® ). One case experienced new onset acute hepatic failure. 81% of non-dentally registered and all dentally registered patients were unable to access emergency dental care. The majority (97%) of patients referred to the OMFS underwent elective outpatient dental extractions under local anaesthetic. Conclusion: Dental pain was the commonest cause of non-intentional paracetamol overdose. Registered and nonregistered patients had difficulty accessing emergency dental care. All cases referred to the OMFS could have been appropriately accommodated in a primary care setting. Improvements in access to both routine and emergency dental care are required to prevent such admissions. http://dx.doi.org/10.1016/j.bjoms.2015.08.125 PP 118 A novel barbed suture tie-over dressing for skin grafts: a comparison with traditional techniques N. Mahon ∗ , C. Joyce, K. Joyce, P. Dockery, J. Kelly Peterborough City Hospital, United Kingdom Introduction: The unidirectional nature of the barbs facilitates a strong grip on tissues and reduces the need to constantly tension the suture manually. We hypothesized that a barbed suture tie-over suture to secure skin grafts would be quicker to perform than traditional tie-overs and would also exert a greater downward pressure on the skin graft. Methods: Thirty uniform areas of skin were excised from a cadaver. A pressure transducer was placed on the wound bed and covered with the excised skin along with a mineral oil-soaked wool dressing to act as a bolster. Three different sutures were used to secure the graft in place and the pressure was recorded. The tie-over techniques used were the classic silk tie-over, a running Vicryl RapideTM tie-over and a running barbed tie-over. Results: The barbed tie-over exerted the most downward pressure (82.8 ± 7.3 mmHg) compared to the silk (46 ± 4.85 mmHg) and the Vicryl RapideTM (18.6 ± 2.4 mmHg). Furthermore, the barbed tie-over was the quickest to perform (1:45 ± 22 s) when compared to the Vicryl RapideTM (02:57 ± 27 s) and the silk tie-overs (04:26 ± 39 s). Conclusion: Barbed sutures are a viable option for securing skin grafts. They are quick to perform and provide significantly improved downward pressure on the skin graft. We feel that this technique would be especially suited to the sole operator as it can be carried out without the need of an assistant. http://dx.doi.org/10.1016/j.bjoms.2015.08.126
P 119 Perceived impediments to the junior years of oral and maxillofacial training W. Minks Leeds Teaching Hospitals Trust, United Kingdom Introduction: Recent legislative changes in higher and postgraduate medical education have impacted upon Oral and Maxillofacial training. This study sought to expose matters threatening junior trainees, for the purpose of workforce planning and prioritization of issues to be tackled by the committee. Method: An anonymous survey was circulated via the junior trainees’ forum. This elicited the stage and region of training, information regarding second degree funding and career aims. Respondents ranked impediments experienced in order of impact. Results: 63 trainees responded to the survey. ‘Lack of Guaranteed Pay Protection’, ‘Tuition Fees’ and ‘Subscription Costs’ posed the greatest barriers, with trainees in the South East of England significantly more threatened by ‘Relocation’ and ‘Registrar Application Ratios’ than elsewhere in Great Britain. Head and Neck Cancer was the most intended subspecialty (29%) with 48% of respondents considering academic training. All second degree respondents undertook Oral and Maxillofacial clinical shift work and 45% of these trainees were provided with an NHS contract for their employment. 85% of trainees opted out of the European Working Time Directive during their second degree. Respondents volunteered that some universities disallowed employment, rendering cooperation problematic. Trainees were also inhibited by a lack of mentoring, relevant training posts and operating opportunities. Conclusion: It is in the interest of the group that high quality trainees are sufficiently supported, and that training undertaken is relevant and legal. A survey should be distributed annually with relevant issues prioritized each year. The group should consider a format for a consultant led mentoring system. http://dx.doi.org/10.1016/j.bjoms.2015.08.127 P 120 ‘OMFS SHO’ App: clinical guidance at your fingertips! J. Mirza ∗ , A. Abou-foul, V. Ramamoorthy, P. Anand Oxford University Hospitals, United Kingdom Objectives: In August 2013, the specialist surgery rota at our regional, Oral & Maxillofacial surgery (OMFS) centre had been revised. This lead to a shift pattern fragmentation and increased work load on junior doctors out of hours (OOH). Our main objective was to assess the potential ben-