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Osteoradionecrosis; management of at risk patients by general dental practitioners and oral & maxillofacial surgery units in the United Kingdom
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Abstracts / British Journal of Oral and Maxillofacial Surgery 46 (2008) e5–e31
Clinical Relevance: It is vital that students and staff performing extractions are fully compliant with HTAct in order to maintain the appropriate licence for use of teeth for research purposes. doi:10.1016/j.bjoms.2008.07.128 P 27 Referrals to OMFS for simple exodontia: are patients happy with their lack of treatment in primary care? Jonathan Collier ∗ , M. Lessani, N. Clifford, R. Bhandari Barts and The London NHS Trust Introduction: Referrals from GDPs form the mainstay of OMFS referrals. Since the introduction of the New Dental Contract our department has seen a significant increase in referrals for simple exodontia. The aim of this study was to quantify this and to determine what treatment patients were being offered in primary care. Methods: All outpatient referrals made to our department over the period of one month were analysed. The reason for referral and any additional clinical information were recorded. At their first outpatient visit a subset of these patients were given a questionnaire asking about the duration of their symptoms, their treatment in primary care and their degree of satisfaction with this using a visual analogue scale. Results: A total of 357 referrals were received in the month studied of which 91% were from GDPs. Threequarters of referrals were for exodontia, 60% of which involved a single tooth. The questionnaire in clinic was completed by 208 patients: the median duration of symptoms was 6 months (range 4 weeks to 12 years) and most patients had waited 3 months before attending their GDP. Over half of the patients received no initial treatment and 80% had had no treatment while waiting to be seen by OMFS. Despite this the median satisfaction rating for GDPs was 8/10 (range 1–10). Conclusions: These results clearly demonstrate that a large number of patients are referred by GDPs for simple exodontia without any attempt at treatment in primary care. This has significant implications for resource allocation and training. doi:10.1016/j.bjoms.2008.07.129 P 28 Osteoradionecrosis; management of at risk patients by general dental practitioners and oral & maxillofacial surgery units in the United Kingdom Niall M.H. McLeod ∗ , P.A. Brennan Portsmouth Hospital NHS Trust Aim: To examine how GDP might identify patients at risk of ORN and their use of antibiotic prophylaxis in patients at risk To establish how oral & maxillofacial surgery units are managing patients at risk of and previously diagnosed with
osteoradionecrosis of the jaws, who require dental extractions. Method: Questionnaire survey of GDP in Portsmouth. Questionnaire survey of MF Units in the UK Results: Over 50% of GDP do not ask about previous head and neck cancer or about radiotherapy as part of medical history. Less than 20% of GDP recommend ABC when treating patients who have previously undergone radiotherapy. Less than 10% of MFU had a written protocol on the management of patients who have had radiotherapy or were known to have osteonecrosis. 60% of MFU use Chlorhexidene mouthrinse. 80% recommend pre-operative and 90% recommend post-operative antibiotics. Discussion: Osteoradionecrosis of the jaws is a significant problem in patients who have had radiotherapy which affects the mandible or maxilla. Many cases arise after dental treatment. The difficulty in treating ORN and significant morbidity to the patient make preventative measures important. We urge GDP and MFU to take certain precautions in managing patients who require extractions, and have previously had radiotherapy affecting the jawbones. doi:10.1016/j.bjoms.2008.07.130 P 29 Frequent intermittent blood pressure monitoring during surgical removal of third molars under local anesthesia and intravenous sedation Robert Jackson Banks ∗ , M. Abu-Serriah, R.O. Hobman Sunderland Royal Hospital Introduction: Intravenous sedation is commonly used as adjunct to local anasthesia in maxillofacial surgery. The current guidelines recommend that “contemporary standards of monitoring must be adopted. . . and patients who have received conscious sedation should be appropriately monitored”. Whilst measurement of blood pressure (BP) is an essential part of preoperative assessment there is a move, based on “best practice” toward frequent intermittent measurement of BP throughout the procedure. This move has clear equipment and staffing implications impacting on both the hospital and high street practitioner wanting to offer a sedation service. Aim: To assess perioperative changes in BP and whether such changes warrant the need for frequent monitoring. Material/methods: 450 consecutive patients undergoing single agent (Midazolam) IV sedation in a titrated dose for the removal of symptomatic lower wisdom teeth in the out patient setting had a range of peri-operative parameters including BP prospectively recorded and analysied. Results/Statistics: There was no significant change in blood pressure during the course of the procedure.
Abstracts / British Journal of Oral and Maxillofacial Surgery 46 (2008) e5–e31
Clinical Relevance: It is vital that students and staff performing extractions are fully compliant with HTAct in order to maintain the appropriate licence for use of teeth for research purposes. doi:10.1016/j.bjoms.2008.07.128 P 27 Referrals to OMFS for simple exodontia: are patients happy with their lack of treatment in primary care? Jonathan Collier ∗ , M. Lessani, N. Clifford, R. Bhandari Barts and The London NHS Trust Introduction: Referrals from GDPs form the mainstay of OMFS referrals. Since the introduction of the New Dental Contract our department has seen a significant increase in referrals for simple exodontia. The aim of this study was to quantify this and to determine what treatment patients were being offered in primary care. Methods: All outpatient referrals made to our department over the period of one month were analysed. The reason for referral and any additional clinical information were recorded. At their first outpatient visit a subset of these patients were given a questionnaire asking about the duration of their symptoms, their treatment in primary care and their degree of satisfaction with this using a visual analogue scale. Results: A total of 357 referrals were received in the month studied of which 91% were from GDPs. Threequarters of referrals were for exodontia, 60% of which involved a single tooth. The questionnaire in clinic was completed by 208 patients: the median duration of symptoms was 6 months (range 4 weeks to 12 years) and most patients had waited 3 months before attending their GDP. Over half of the patients received no initial treatment and 80% had had no treatment while waiting to be seen by OMFS. Despite this the median satisfaction rating for GDPs was 8/10 (range 1–10). Conclusions: These results clearly demonstrate that a large number of patients are referred by GDPs for simple exodontia without any attempt at treatment in primary care. This has significant implications for resource allocation and training. doi:10.1016/j.bjoms.2008.07.129 P 28 Osteoradionecrosis; management of at risk patients by general dental practitioners and oral & maxillofacial surgery units in the United Kingdom Niall M.H. McLeod ∗ , P.A. Brennan Portsmouth Hospital NHS Trust Aim: To examine how GDP might identify patients at risk of ORN and their use of antibiotic prophylaxis in patients at risk To establish how oral & maxillofacial surgery units are managing patients at risk of and previously diagnosed with
osteoradionecrosis of the jaws, who require dental extractions. Method: Questionnaire survey of GDP in Portsmouth. Questionnaire survey of MF Units in the UK Results: Over 50% of GDP do not ask about previous head and neck cancer or about radiotherapy as part of medical history. Less than 20% of GDP recommend ABC when treating patients who have previously undergone radiotherapy. Less than 10% of MFU had a written protocol on the management of patients who have had radiotherapy or were known to have osteonecrosis. 60% of MFU use Chlorhexidene mouthrinse. 80% recommend pre-operative and 90% recommend post-operative antibiotics. Discussion: Osteoradionecrosis of the jaws is a significant problem in patients who have had radiotherapy which affects the mandible or maxilla. Many cases arise after dental treatment. The difficulty in treating ORN and significant morbidity to the patient make preventative measures important. We urge GDP and MFU to take certain precautions in managing patients who require extractions, and have previously had radiotherapy affecting the jawbones. doi:10.1016/j.bjoms.2008.07.130 P 29 Frequent intermittent blood pressure monitoring during surgical removal of third molars under local anesthesia and intravenous sedation Robert Jackson Banks ∗ , M. Abu-Serriah, R.O. Hobman Sunderland Royal Hospital Introduction: Intravenous sedation is commonly used as adjunct to local anasthesia in maxillofacial surgery. The current guidelines recommend that “contemporary standards of monitoring must be adopted. . . and patients who have received conscious sedation should be appropriately monitored”. Whilst measurement of blood pressure (BP) is an essential part of preoperative assessment there is a move, based on “best practice” toward frequent intermittent measurement of BP throughout the procedure. This move has clear equipment and staffing implications impacting on both the hospital and high street practitioner wanting to offer a sedation service. Aim: To assess perioperative changes in BP and whether such changes warrant the need for frequent monitoring. Material/methods: 450 consecutive patients undergoing single agent (Midazolam) IV sedation in a titrated dose for the removal of symptomatic lower wisdom teeth in the out patient setting had a range of peri-operative parameters including BP prospectively recorded and analysied. Results/Statistics: There was no significant change in blood pressure during the course of the procedure.