- Email: [email protected]
Is there any clinical benefit in routinely sending off pus swabs following drainage of dental abscesses?
Poster Presentations / British Journal of Oral and Maxillofacial Surgery 50S (2012) S42–S66
P51 Meeting the educational needs of our trainees: facebook as an access platform to training material—a review of the impact of this new method of delivering continuing education J. Parmar Yorkshire and the Humber Deanery, United Kingdom Facebook was founded in February 2004 as a social networking site. At its last count, it had over 750 million users worldwide. The opportunity has opened up to provide multimedia information targeted to specific groups through “pages” created under the domain of Facebook. At the Yorkshire & Humber School of Surgery, and under the supervision of Professor Michael Gough and Mr James McCaul, we have been running a number of pages beginning with the prefix “School of..”. I would like bring to attention to readers the “School of Oral & Maxillofacial Surgery” (www.facebook.com/maxfaxschool). We believe that the “School of Oral & Maxillofacial Surgery” (www.facebook.com/maxfaxschool) has set the president in the delivery of educational needs for our trainees at all training grades via a social networking medium. It does however have pitfalls in accessibility restrictions in most NHS trusts. Through editorial review, and the ability of the administrators to filter through the available material to find appropriate web links we hope to bring our trainees to the forefront of evidence based care. This poster illustrates the number of users regularly visiting our sites, reading our articles and “sharing” links that have been posted on a weekly basis since June 2011. http://dx.doi.org/10.1016/j.bjoms.2012.04.130 P52 Paracetamol overdose cases secondary to dental pain requiring acute medical admissions: a retrospective case series I. Siddique ∗ , K.K. Patel St Lukes Hospital, Bradford, United Kingdom Aims: The aims of the present study were to determine what proportion of paracetamol overdose cases presenting to the Medical Admissions Unit of a teaching hospital were secondary to acute dental pain and to reveal what proportion of such cases had dental access problems. Finally, we wanted to determine the clinical burden of these cases on the hospital Oral and Maxillofacial Service (OMFS). Setting: Medical Admissions Unit (MAU), Bradford Royal Infirmary. Methods: Cases of paracetamol overdose were identified using clinical coding of patient discharges between 1st of June 2010 and 31st December 2010. Patient discharge sum-
S61
maries and case notes were used to identify the paracetamol overdose cases secondary to dental pain and to obtain data on dental registration, access to the emergency dental service and referral to the OMFS. Results: Dental pain accounted for just 9 out of 535 total paracetamol overdose cases. 7 cases were unable to access emergency dental care despite 4 being registered. 3 cases experienced new onset acute liver dysfunction and 4 cases required treatment to reverse blood drug toxicity. All 3 of the cases referred to the OMFS were treated with either dental extractions under local anaesthetic or outpatient referral. Conclusion: 3% of the total paracetamol overdose cases were secondary to dental pain. Registered and non-registered patients had difficulty accessing timely emergency dental appointments. All cases referred to the OMFS department could have been appropriately accommodated in a primary care setting. Keywords: Paracetamol; Overdose; Dental pain; Acute; Medical admissions http://dx.doi.org/10.1016/j.bjoms.2012.04.131 RP53 Is there any clinical benefit in routinely sending off pus swabs following drainage of dental abscesses? N. Vig ∗ , S. Bhupal, S. Shah, L. Cascarini Northwick Park Hospital, North West London Hospitals Trust, United Kingdom Introduction: Currently, pus swabs are sent off routinely for culture and sensitivity following incision and drainage of odontogenic abscesses. Is there evidence to support this practice? Method: A retrospective analysis of all patients admitted to Northwick Park Hospital over a 6 year period was carried out. 200 patients had pus swabs sent for MC&S following drainage. The EPR was used to determine results of culture, if any. Results: Of these 200 patients, the majority (145, 72.5%) had no significant bacterial growth, or grew ‘oral flora’. 24% (48) of total swabs grew specific bacteria (incl Staphylococci sp. 9% of total, Streptococci sp. 8%, anaerobes 5%), with candidal growth in 3.5%. Of 48 with growth, 43 (89.6%) had antibiotic sensitivities available. All of these were antibiotics routinely used to treat odontogenic infection (e.g. penicillins, metronidazole) and patient management did not change with availability of results. Discussion: Only a quarter of swabs gave rise to identifiable bacteria, and these were entirely in keeping with the literature. Antibiotic sensitivities were predictable: broadspectrum penicillins and metronidazole are still extremely effective as first-line, with resistance only high for drugs rarely prescribed initially (clarithromycin, tetracyclines).
S62
Poster Presentations / British Journal of Oral and Maxillofacial Surgery 50S (2012) S42–S66
Investigations are requested to aid diagnosis, and to effect an improvement in patient care. This was not evident here. There are significant cost implications (up to £30 per swab) too. Given our findings, we argue that it is hard to justify sending off pus swabs routinely for dental infections in the otherwise fit and well patient.
P55
http://dx.doi.org/10.1016/j.bjoms.2012.04.132
University Hospitals of Leicester, Leicester Royal Infirmary, United Kingdom
P54 Sialendoscopy—a patient satisfaction survey R.I. Mohammed-Ali ∗ , C. Blore, R. Crosher Rotherham General Hospital NHS Foundation Trust, United Kingdom Introduction: Sialendoscopy is a minimally invasive technique for the diagnosis and treatment of obstructive and inflammatory disorders of the salivary glands. Diagnostic sialendoscopy allows examination of the duct system. Interventional sialendoscopy can treat obstructions caused by calculi or stenoses and preserve gland function. Advances in optical technology and are responsible for progress in salivary gland endoscopy. From the surgeon’s perspective, sialendoscopy is an effective treatment for obstructive salivary gland disorders with reported resolution of obstruction in the order of 82–87%. The complication rate is low and major complications are rare. There are no publications on patient satisfaction surveys following sialendoscopy. We wish to present our findings of such a survey. Methods: A patient satisfaction questionnaire was sent to 82 of 85 patients who had undergone sialendoscopy at Rotherham NHS Foundation Trust between 2005 and 2011. Three patients were excluded. Two of these were children and a third patient was known to be unable to respond. The questionnaire included Visual Analogue Scales to record responses to questions on the severity of their symptoms before and after treatment and on their global satisfaction with the procedure. Patients were also asked: “Was the procedure explained to you?” and “Were you happy with the type of anaesthetic/sedation you had?” Results: The results indicate that sialendoscopy is well tolerated by patients. We present the details of the full study, including patients’ free text feedback. Conclusion: A patient satisfaction survey is a useful tool for assessing aspects of clinical practice. http://dx.doi.org/10.1016/j.bjoms.2012.04.133
Comparison of temporomandibular joint dysfunction following wisdom tooth extraction under general anaesthesia (GA) to local anaesthesia (LA) V. Jasani ∗ , S. Ahmed, C. Avery
Background: Third molar surgery is a risk factor for Temporomandibular Joint Dysfunction (TMJD). The incidence of TMJD following wisdom teeth extraction under GA against LA is not well reported. Aim: To compare the incidence of TMJD after third molar surgery under GA and LA. Methods: 120 patients were randomly selected; 60 underwent third molar surgery under GA and 60 under LA. None had TMJD prior to surgery. They were interviewed by telephone at 6 months following the surgery. A standardised questionnaire was used to record jaw joint symptoms at intervals of 1 week, 1 month and 3 months after surgery. Other factors such as seniority of surgeon, difficulty of impaction were considered. Result: There was an increased incidence of TMJD following GA procedures; particularly at 1 week and 1 month, which subsequently settled and was not statistically significant by 6 months. Conclusion: The increased incidence of TMJD under GA may be because of: a) Procedural trauma, b) Improper or forceful placement of mouth-prop, and c) Intubation tubes or LMAs (Laryngeal Mask Anaesthesia). Although the incidence of TMJD after GA is relatively low, it may on rare occasions result in significant adverse effects. We advise informing the patients of these potential complications and to allow informed decision to be made regarding preference for GA or LA procedures. This information will be included into our departmental leaflet. http://dx.doi.org/10.1016/j.bjoms.2012.04.134 P56 Retrospective study of survival of Christensen fossa hemiarthroplasty of the TMJ C. Perez Turriaf ∗ , S. Kaura, P. Korczak The Royal Derby Hospital, United Kingdom Introduction: The replacement of diseased TMJ discs is a contentious issue with many suggesting that if the disc is irreparably damaged the only solutions are to leave the joint as is, try various autologous grafts and risk more rapid development of osteoarthrosis or to progress to a total TMJ reconstruction. However, this is often performed on
P51 Meeting the educational needs of our trainees: facebook as an access platform to training material—a review of the impact of this new method of delivering continuing education J. Parmar Yorkshire and the Humber Deanery, United Kingdom Facebook was founded in February 2004 as a social networking site. At its last count, it had over 750 million users worldwide. The opportunity has opened up to provide multimedia information targeted to specific groups through “pages” created under the domain of Facebook. At the Yorkshire & Humber School of Surgery, and under the supervision of Professor Michael Gough and Mr James McCaul, we have been running a number of pages beginning with the prefix “School of..”. I would like bring to attention to readers the “School of Oral & Maxillofacial Surgery” (www.facebook.com/maxfaxschool). We believe that the “School of Oral & Maxillofacial Surgery” (www.facebook.com/maxfaxschool) has set the president in the delivery of educational needs for our trainees at all training grades via a social networking medium. It does however have pitfalls in accessibility restrictions in most NHS trusts. Through editorial review, and the ability of the administrators to filter through the available material to find appropriate web links we hope to bring our trainees to the forefront of evidence based care. This poster illustrates the number of users regularly visiting our sites, reading our articles and “sharing” links that have been posted on a weekly basis since June 2011. http://dx.doi.org/10.1016/j.bjoms.2012.04.130 P52 Paracetamol overdose cases secondary to dental pain requiring acute medical admissions: a retrospective case series I. Siddique ∗ , K.K. Patel St Lukes Hospital, Bradford, United Kingdom Aims: The aims of the present study were to determine what proportion of paracetamol overdose cases presenting to the Medical Admissions Unit of a teaching hospital were secondary to acute dental pain and to reveal what proportion of such cases had dental access problems. Finally, we wanted to determine the clinical burden of these cases on the hospital Oral and Maxillofacial Service (OMFS). Setting: Medical Admissions Unit (MAU), Bradford Royal Infirmary. Methods: Cases of paracetamol overdose were identified using clinical coding of patient discharges between 1st of June 2010 and 31st December 2010. Patient discharge sum-
S61
maries and case notes were used to identify the paracetamol overdose cases secondary to dental pain and to obtain data on dental registration, access to the emergency dental service and referral to the OMFS. Results: Dental pain accounted for just 9 out of 535 total paracetamol overdose cases. 7 cases were unable to access emergency dental care despite 4 being registered. 3 cases experienced new onset acute liver dysfunction and 4 cases required treatment to reverse blood drug toxicity. All 3 of the cases referred to the OMFS were treated with either dental extractions under local anaesthetic or outpatient referral. Conclusion: 3% of the total paracetamol overdose cases were secondary to dental pain. Registered and non-registered patients had difficulty accessing timely emergency dental appointments. All cases referred to the OMFS department could have been appropriately accommodated in a primary care setting. Keywords: Paracetamol; Overdose; Dental pain; Acute; Medical admissions http://dx.doi.org/10.1016/j.bjoms.2012.04.131 RP53 Is there any clinical benefit in routinely sending off pus swabs following drainage of dental abscesses? N. Vig ∗ , S. Bhupal, S. Shah, L. Cascarini Northwick Park Hospital, North West London Hospitals Trust, United Kingdom Introduction: Currently, pus swabs are sent off routinely for culture and sensitivity following incision and drainage of odontogenic abscesses. Is there evidence to support this practice? Method: A retrospective analysis of all patients admitted to Northwick Park Hospital over a 6 year period was carried out. 200 patients had pus swabs sent for MC&S following drainage. The EPR was used to determine results of culture, if any. Results: Of these 200 patients, the majority (145, 72.5%) had no significant bacterial growth, or grew ‘oral flora’. 24% (48) of total swabs grew specific bacteria (incl Staphylococci sp. 9% of total, Streptococci sp. 8%, anaerobes 5%), with candidal growth in 3.5%. Of 48 with growth, 43 (89.6%) had antibiotic sensitivities available. All of these were antibiotics routinely used to treat odontogenic infection (e.g. penicillins, metronidazole) and patient management did not change with availability of results. Discussion: Only a quarter of swabs gave rise to identifiable bacteria, and these were entirely in keeping with the literature. Antibiotic sensitivities were predictable: broadspectrum penicillins and metronidazole are still extremely effective as first-line, with resistance only high for drugs rarely prescribed initially (clarithromycin, tetracyclines).
S62
Poster Presentations / British Journal of Oral and Maxillofacial Surgery 50S (2012) S42–S66
Investigations are requested to aid diagnosis, and to effect an improvement in patient care. This was not evident here. There are significant cost implications (up to £30 per swab) too. Given our findings, we argue that it is hard to justify sending off pus swabs routinely for dental infections in the otherwise fit and well patient.
P55
http://dx.doi.org/10.1016/j.bjoms.2012.04.132
University Hospitals of Leicester, Leicester Royal Infirmary, United Kingdom
P54 Sialendoscopy—a patient satisfaction survey R.I. Mohammed-Ali ∗ , C. Blore, R. Crosher Rotherham General Hospital NHS Foundation Trust, United Kingdom Introduction: Sialendoscopy is a minimally invasive technique for the diagnosis and treatment of obstructive and inflammatory disorders of the salivary glands. Diagnostic sialendoscopy allows examination of the duct system. Interventional sialendoscopy can treat obstructions caused by calculi or stenoses and preserve gland function. Advances in optical technology and are responsible for progress in salivary gland endoscopy. From the surgeon’s perspective, sialendoscopy is an effective treatment for obstructive salivary gland disorders with reported resolution of obstruction in the order of 82–87%. The complication rate is low and major complications are rare. There are no publications on patient satisfaction surveys following sialendoscopy. We wish to present our findings of such a survey. Methods: A patient satisfaction questionnaire was sent to 82 of 85 patients who had undergone sialendoscopy at Rotherham NHS Foundation Trust between 2005 and 2011. Three patients were excluded. Two of these were children and a third patient was known to be unable to respond. The questionnaire included Visual Analogue Scales to record responses to questions on the severity of their symptoms before and after treatment and on their global satisfaction with the procedure. Patients were also asked: “Was the procedure explained to you?” and “Were you happy with the type of anaesthetic/sedation you had?” Results: The results indicate that sialendoscopy is well tolerated by patients. We present the details of the full study, including patients’ free text feedback. Conclusion: A patient satisfaction survey is a useful tool for assessing aspects of clinical practice. http://dx.doi.org/10.1016/j.bjoms.2012.04.133
Comparison of temporomandibular joint dysfunction following wisdom tooth extraction under general anaesthesia (GA) to local anaesthesia (LA) V. Jasani ∗ , S. Ahmed, C. Avery
Background: Third molar surgery is a risk factor for Temporomandibular Joint Dysfunction (TMJD). The incidence of TMJD following wisdom teeth extraction under GA against LA is not well reported. Aim: To compare the incidence of TMJD after third molar surgery under GA and LA. Methods: 120 patients were randomly selected; 60 underwent third molar surgery under GA and 60 under LA. None had TMJD prior to surgery. They were interviewed by telephone at 6 months following the surgery. A standardised questionnaire was used to record jaw joint symptoms at intervals of 1 week, 1 month and 3 months after surgery. Other factors such as seniority of surgeon, difficulty of impaction were considered. Result: There was an increased incidence of TMJD following GA procedures; particularly at 1 week and 1 month, which subsequently settled and was not statistically significant by 6 months. Conclusion: The increased incidence of TMJD under GA may be because of: a) Procedural trauma, b) Improper or forceful placement of mouth-prop, and c) Intubation tubes or LMAs (Laryngeal Mask Anaesthesia). Although the incidence of TMJD after GA is relatively low, it may on rare occasions result in significant adverse effects. We advise informing the patients of these potential complications and to allow informed decision to be made regarding preference for GA or LA procedures. This information will be included into our departmental leaflet. http://dx.doi.org/10.1016/j.bjoms.2012.04.134 P56 Retrospective study of survival of Christensen fossa hemiarthroplasty of the TMJ C. Perez Turriaf ∗ , S. Kaura, P. Korczak The Royal Derby Hospital, United Kingdom Introduction: The replacement of diseased TMJ discs is a contentious issue with many suggesting that if the disc is irreparably damaged the only solutions are to leave the joint as is, try various autologous grafts and risk more rapid development of osteoarthrosis or to progress to a total TMJ reconstruction. However, this is often performed on