Oral potentially malignant disorders - An assessment of knowledge and attitude to future education in undergraduate dental students

INTRODUCTION

The aim of this study was to assess the knowledge and clinical experience of oral potentially malignant disorders (OPMDs) in undergraduate dental students in six European countries (Croatia, France, Italy, Portugal, Spain and United Kingdom) and assess student's attitude and preference to future education on the topic. A secondary aim was to identify gaps in student's knowledge and clinical practice. The study was a part of the Erasmus+ project "Oral Potentially Malignant Disorders: Healthcare Professionals Training" (Grant No: 2020-1-UK01-KA202-078917).

MATERIALS AND METHODS

An online questionnaire was distributed to all final-year students in six partner universities. This consisted of four parts assessing: (1) knowledge on OPMDs, (2) clinical experience with this group of patients, (3) self-rated competence in the management of OPMDs and (4) preferences with regard to future education.

RESULTS

Two hundred and sixty final-year dental students from six partner universities responded to the questionnaire. Response rates varied from 12% to 92% between partner universities. Significant differences in clinical experience and knowledge were found between students. Students with more clinical exposure to OPMDs rated their knowledge and competence in the management of OPMDs higher than students with less clinical experience. The majority of students were interested in future education on OPMDs, preferably via short educational videos.

CONCLUSION

The majority of students have received theoretical knowledge of OPMDs during their undergraduate studies, however, not all had clinical exposure to this group of patients. Students were open to further education on OPMDs. Important deficiencies in knowledge were identified that need to be addressed and it is anticipated that the e-learning platform and e-book that are in development by partner institutions will help to improve overall knowledge of OPMDs.

Streptococcus Salivarius: A Potential Salivary Biomarker for Orofacial Granulomatosis and Crohn's Disease?

BACKGROUND

Orofacial granulomatosis (OFG) is a rare disease characterised by chronic, noncaseating, granulomatous inflammation primarily affecting the oral cavity. Histologically, it is similar to Crohn's disease (CD), and a proportion of patients have both OFG and CD. The cause of OFG remains elusive, but it has been suggested that microbial interactions may be involved. The aim of this study was to compare the salivary microbial composition of subjects with OFG and/or CD and healthy controls.

METHODS

Two hundred sixty-one subjects were recruited, of whom 78 had OFG only, 40 had both OFG and CD, 97 had CD only with no oral symptoms, and 46 were healthy controls. Bacterial community profiles were obtained by sequencing the V1-V3 region of the 16S rRNA gene.

RESULTS

There were no differences in richness or diversity of the salivary bacterial communities between patient groups and controls. The relative abundance of the Streptococcus salivarius group was raised in patients with OFG or CD only compared with controls, whereas that of the Streptococcus mitis group was lower in CD compared with both OFG and controls. One S. salivarius oligotype made the major contribution to the increased proportions seen in patients with OFG and CD.

CONCLUSIONS

The salivary microbiome of individuals with OFG and CD was similar to that found in health, although the proportions of S. salivarius, a common oral Streptococcus, were raised. One specific strain-level oligotype was found to be primarily responsible for the increased levels seen.

Oral Medicine for undergraduate dental students in the United Kingdom and Ireland-A curriculum

INTRODUCTION

Oral Medicine focuses on care for patients with chronic, recurrent and medically related disorders of the orofacial region that are distinct from diseases of the periodontal and tooth tissues, with an emphasis on non-surgical management. At present, there are no shared outcomes for Oral Medicine to define the standards to be achieved before new graduates become registered dentists engaged with ongoing professional development.

CURRICULUM

We present a consensus undergraduate curriculum in Oral Medicine agreed by representatives from 18 Dental Schools in the United Kingdom and Republic of Ireland. The scope of Oral Medicine practice includes conditions involving the oral mucosa, salivary glands, neurological system or musculoskeletal tissues that are not directly attributable to dental (tooth and periodontium) pathology. Account is taken of the priorities for practice and learning opportunities needed to support development of relevance to independent clinical practice. The outcomes triangulate with the requirements set out by the respective regulatory bodies in the UK and Republic of Ireland prior to first registration and are consistent with the framework for European undergraduate dental education and greater harmonisation of dental education.

CONCLUSIONS

This curriculum will act as a foundation for an increasingly shared approach between centres with respect to the outcomes to be achieved in Oral Medicine. The curriculum may also be of interest to others, such as those responsible for the training of dental hygienists and dental therapists. It provides a platform for future collective developments with the overarching goal of raising the quality of patient care.

Assessing the application of knowledge in clinical problem-solving: The structured professional reasoning exercise

INTRODUCTION

Clinical reasoning is a fundamental and core clinical competence of healthcare professionals. The study aimed to investigate the utility of the Structured Professional Reasoning Exercise (SPRE), a new competence assessment method designed to measure dental students' clinical reasoning in simulated scenarios, covering the clinical areas of Oral Disease, Primary Dental Care and Restorative Dentistry, Child Dental Health and Dental Practice and Clinical Governance.

MATERIALS AND METHODS

A total of 313 year-5 students sat for the assessment. Students spent 45 minutes assimilating the scenarios, before rotating through four pairs of 39 trained examiners who each independently assessed a single scenario over a ten-minute period, using a structured marking sheet. After the assessment, all students and examiners were invited to complete an anonymous perception questionnaire of the exercise. These questionnaires and the examination scores were statistically analysed.

RESULTS AND DISCUSSION

Oral Disease showed the lowest scores; Dental Practice and Governance the highest. The overall Intraclass Correlation Coefficient (ICC) was 0.770, whilst examiner training helped to increase the ICC from 0.716 in 2013 to 0.835 in 2014. Exploratory factor analysis revealed one major factor with an eigenvalue of 2.75 (68.8% of total variance). The Generalizability coefficient was consistent at 0.806. A total of 295 students and 32 examiners completed the perception questionnaire. Students' lowest examination perceptions were an "Unpleasant" and "Unenjoyable" experience, whilst the highest were "Interesting", "Valuable" and "Important". The majority of students and examiners reported the assessment as acceptable, fair and valid.

CONCLUSION

The SPRE offers a reliable, valid and acceptable assessment method, provided it comprises at least four scenarios with two independently marking and trained assessors. 3.

Fostering Dental Students' Academic Achievements and Reflection Skills Through Clinical Peer Assessment and Feedback

Peer assessment is increasingly being encouraged to enhance dental students' learning. The aim of this study was to evaluate the educational impact in terms of academic achievements and reflective thinking of a formative prospective peer assessment and feedback protocol. Volunteer final-year dental students at King's College London Dental Institute, UK, received training on peer assessment, peer feedback, and self-reflection. At the beginning (baseline) and end (resultant) of the 2012-13 academic year, 86 students (55% of the year group) completed a reflection questionnaire (RQ). Sixty-eight of those students used a modified Direct Observation of Procedural Skills (DOPS) as a framework for peer assessment and peer feedback during a complete academic year. End-of-year, high-stakes examination grades and RQ scores from the participants and nonparticipants were statistically compared. The participants completed 576 peer DOPS. Those 22 students who peer assessed each other ≥10 times exhibited highly statistically significant differences and powerful positive effect sizes in their high-stakes exam grades (p=0.0001, d=0.74) and critical reflection skills (p=0.005, d=1.41) when compared to those who did not assess one another. Furthermore, only the same 22 students showed a statistically significant increase and positive effect size in their critical reflection skills from baseline to resultant (p=0.003, d=1.04). The results of this study suggest that the protocol used has the potential to impact dental students' academic and reflection skills, provided it is practiced in ten or more peer encounters and ensuring peer feedback is provided followed by self-reflection.

Update on Orofacial Granulomatosis

Orofacial granulomatosis (OFG) is a condition manifesting clinically with chronic swelling of the mouth and/or face, notably with swelling of the lips and oral mucosa, a full-thickness, erythematous gingivitis and mucosal ulceration of various clinical types. Some patients may also present with neurological findings, for example facial palsy. Biopsy of affected tissue shows lymphoedema, with or without granulomatous inflammation. The oral lesions in OFG are histologically indistinguishable from the oral lesions in Crohn's disease (CD) and other systemic granulomatous disorders. It is a condition which may respond to the exclusion of certain food-related chemicals from the diet in up to 60% of patients and, as such, is distinct from gastrointestinal CD. CD is a relapsing systemic inflammatory disease which predominantly affects the gut, and patients suffering from this disease frequently present with abdominal pain, fever and altered bowel habit. A proportion of patients with clinical OFG (without other systemic disease) may have asymptomatic gastrointestinal involvement or go on to develop gut CD suggesting an association between the two diseases. It is estimated that 1% of CD sufferers may have a diagnosis of OFG, but the majority of patients in specialist OFG clinics do not have gut symptoms.

A practical guide to the use of thiopurines in oral medicine

Thiopurines are widely used as first-line immunosuppressive therapies in the management of chronic inflammatory oral disease. However, despite over half a century of clinical experience, the evidence base for their use is limited. The aims of this paper were to review the evidence for the use of thiopurines in oral medicine and provide a contemporary model of thiopurine metabolism and mechanism of action and a rationale for clinical use and safe practice.

Student acceptability of high-stakes e-assessment in dental education: using privacy screen filters to control cheating

Acceptability is a required quality for a sound assessment. For students, acceptability of a test is strongly influenced by perception of fairness. Computer-based assessment has been reported to be preferred by students provided that strict controls to prevent cheating are in place. This may be difficult to achieve as e-assessments are often taken in learning environments where computer screens are close together. In this study, 138 Year 5 dental students completed an e-assessment followed by an onscreen post-assessment questionnaire about the acceptability, fairness, and effectiveness of using privacy screen filters installed in front of their monitors to prevent cheating. Ninety-one percent of students in this study considered that taking a summative e-assessment with privacy screen filters was acceptable, 86 percent expressed the view that filters contributed to a fairer test, and 54 percent reported the filters made it easier or did not make any difference to read the screen. In addition, 60 percent gave positive comments and feedback, mainly focused on prevention of cheating. These findings suggest that privacy filters, originally developed for data protection in banks, medicine, and business, have potential in e-assessment in higher education. They provide an effective way of hampering cheating and improve student acceptability and confidence in the fairness of computer-delivered assessments.

Development of a low phenolic acid diet for the management of orofacial granulomatosis

BACKGROUND

Orofacial granulomatosis (OFG) is a rare disease of unknown cause. A cinnamon- and benzoate-free diet is successful in up to 72% of patients. Phenolic acids are among the chemical constituents restricted in this diet, which avoids some but not all of these structurally similar compounds. The present study aimed to: (i) develop a novel diet low in phenolic acids; (ii) implement this in a small clinical trial; and (iii) assess its nutritional adequacy.

METHODS

A literature review identified 10 papers quantifying phenolic acids from which 91 10-mg phenolic acid exchanges were devised. A phenolic acid exclusion diet with precautionary micronutrient supplementation was designed and implemented in 10 patients. Phenolic acids were excluded for 6 weeks and were reintroduced at a rate of one exchange every second day for 6 weeks. Wilcoxon matched pairs tests analysed disease outcomes measured by an oral disease severity scoring tool at weeks 0, 6 and 12. Nutritional adequacy was assessed, excluding micronutrient supplementation, at weeks 0 and 6, and compared intakes with dietary reference values.

RESULTS

The diet was nutritionally inadequate for a range of micronutrients. Seven of 10 patients responded. Mean [standard deviation (SD)] severity scores improved from week 0-6 [20.8 (9.39) and 10.1 (5.72); P = 0.009] and were maintained in five patients who completed the reintroduction [6.6 (3.13) and 7.2 (5.54); P = 0.713].

CONCLUSIONS

A low phenolic acid diet with micronutrient supplementation holds promise of a novel dietary treatment for OFG. Further work is required in larger studies to determine long-term outcomes.

Review article: cinnamon- and benzoate-free diet as a primary treatment for orofacial granulomatosis

BACKGROUND

Orofacial granulomatosis is a rare chronic granulomatous inflammatory disease of the lips, face and mouth. The aetiology remains unclear but may involve an allergic component. Improvements have been reported with cinnamon- and benzoate-free diets.

AIMS

To explore the prevalence of compound and food sensitivity and examine the dietary treatments used in orofacial granulomatosis.

METHODS

A comprehensive literature search was carried out and relevant studies from January 1933 to January 2010 were identified using the electronic database search engines; AGRIS 1991-2008, AMED 1985-2008, British Nursing and Index archive 1985-2008, EMBASE 1980-2008, evidence based medicine review databases (e.g. Cochrane DSR), International Pharmaceutical and Medline 1950-2008.

RESULTS

Common sensitivities identified, predominantly through patch testing, were to benzoic acid (36%) food additives (33%), perfumes and flavourings (28%), cinnamaldehyde (27%), cinnamon (17%), benzoates (17%) and chocolate (11%). The cinnamon- and benzoate-free diet has been shown to provide benefit in 54-78% of patients with 23% requiring no adjunctive therapies. A negative or positive patch test result to cinnamaldehyde, and benzoates did not predict dietary outcome. The most concentrated source of benzoate exposure is from food preservatives. Use of liquid enteral formulas can offer a further dietary therapy, particularly in children with orofacial granulomatosis.

CONCLUSION

Management of orofacial granulomatosis is challenging but cinnamon- and benzoate-free diets appear to have a definite role to play.

Congenital heart block associated with Sjögren syndrome: case report

BACKGROUND

Congenital heart block is a rare complication of pregnancy associated with Sjögren Syndrome that may result in the death of the foetus or infant, or the need for pacing in the newborn or at a later stage.

CASE REPORT

The case is presented of a 64-year-old patient with primary Sjögren Syndrome and a history of having given birth to two sons with congenital heart block, both of whom required pacing several years later.

CONCLUSION

The literature relating to this association is discussed including the suggested mechanism, long-term outcome of mothers of children with congenital heart block and preventive treatment strategies.

Lip impressions: a new method for monitoring morphological changes in orofacial granulomatosis

AIM

To develop and evaluate an objective method for assessing lip size and treatment-related morphological changes in orofacial granulomatosis (OFG) patients.

MATERIALS AND METHODS

Patients with swollen lips because of OFG (n=21) were enrolled. A light-body polyvinylsiloxane material was used to take lip impressions before and after treatment (n=10), or during treatment (n=11). Plaster models were cast from the impressions and the lips were measured using callipers. The intra-examiner and inter-examiner reproducibility of the technique were assessed.

RESULTS

OFG patients had significantly larger lips than controls (P<0.0001). The coefficient of variation on repeated measurements of the same impression was 1.6% and for duplicate impressions was 2.6%. Significant reduction in lip size was shown in all 10 patients after diet restriction (P<0.002). Seven of 11 patients whose impressions were taken at least 3 months after the initiation of cinnamon- and benzoate-free diet also showed reduction in lip size during follow up (P<0.002).

CONCLUSIONS

Serial lip impressions appear to be reliable for routine quantification of morphological changes of the lips in OFG patients. We present a new reproducible and sensitive method for assessing changes in lip size in response to treatment in OFG.

A Revolution in the Management of Obstructive Salivary Gland Disease

Salivary gland obstruction is the commonest cause of salivary gland disease presenting to the general dental practitioner. To date, with the exception of the most surgically accessible stones found within the anterior ducts, there has been little treatment to offer patients except surgical removal of the gland, with the associated risks to the facial and trigeminal nerves. In the last 10 years, more conservative treatment modalities have been developed, opening up a range of treatment options which combine to provide an alternative management of these cases. This paper presents data from one unit in which lithotripsy, which is the destruction of stones (calculi) using shock waves, basket retrieval, a modified minor surgical technique, and balloon dilatation have been used to treat salivary gland obstruction successfully. Over 70% of stones can now be retrieved leaving a functioning gland.

CLINICAL RELEVANCE

Salivary gland obstruction is a clinical problem presenting to the general dental practitioner, and requires an understanding of the range of treatment options available.

Glandular function after intraoral removal of salivary calculi from the hilum of the submandibular gland

We studied 43 patients (25 women and 18 men) who had salivary calculi removed from the hilum of the submandibular gland. Preoperatively they had clinical and radiographic examinations, and glandular function was measured scintigraphically in 38 patients. Postoperative follow-up was based on history, clinical examination, structured questionnaire, and scintigraphy. Stone(s) were removed successfully in 42 patients (97%). During the follow-up of a mean of 24 months (range 4-47), 37 patients were symptom-free and 2 patients had mild obstructive symptoms that did not require intervention. The other 4 patients had repeated infections that necessitated removal of the gland under general anaesthesia. Preoperative and postoperative scintigraphic assessments were made in 37 patients (88%). There was a significant increase in the functional fraction and the excretion rate in the gland after removal of the calculus. We conclude that glandular function improves to varying degrees in most patients after the removal of a salivary calculus.

Modern management of salivary calculi

Background

The aim was to investigate the results of a minimally invasive approach to the management of salivary calculi.

Methods

Four hundred and fifty-five salivary calculi (323 submandibular and 132 parotid) were treated using extracorporeal shock-wave lithotripsy (ECSWL), fluoroscopically guided basket retrieval or intraoral stone removal under general anaesthesia. The techniques were used either alone or in combination.

Results

ECSWL achieved complete success (stone and symptom free) in 87 (39·4 per cent) of 221 patients (84 of 218 primary and all of three secondary procedures; 43 of 131 submandibular, 44 of 90 parotid). Basket retrieval cured 124 (74·7 per cent) of 166 patients (103 of 136 primary and 21 of 30 secondary procedures; 80 of 109 submandibular, 44 of 57 parotid). Intraoral surgical removal was successful in a further 137 (95·8 per cent) of 143 patients with submandibular stones (99 of 101 primary, 36 of 38 secondary and two of four tertiary procedures). The overall success rate for the three techniques was 348 (76·5 per cent) of 455.

Conclusion

A minimally invasive approach to the management of salivary calculi is to be encouraged. All three techniques described have low morbidity and afford the possibility of retaining a functional gland.

Can one predict the likely specific orofacial pain syndrome from a self-completed questionnaire?

To estimate the prevalence of orofacial pain (OFP) by specific diagnostic subgroups in the general population. Cross-sectional population study. General medical practice in South East Cheshire, UK. Participants of baseline investigation who completed the full postal questionnaire (1510, adjusted study participation rate 81%). Clinical examination was attended by 126 (43%) of all the participants who reported OFP in the questionnaire. These individuals were classified as musculoligamentous/soft tissue type, dentoalveolar or neurological/vascular. OFP duration, location, descriptors and statements on OFP were predictors of classification group. The estimated prevalence in the general population of musculoligamentous/soft tissue type of OFP was 7%, dentoalveolar 7% and neurological/vascular 6%. This study has derived a statistical model to classify participants with OFP into three broad groups (musculoligamentous/soft tissue, dentoalveolar and neurological/vascular) based on questionnaire information about OFP (OFP chronicity, location and verbal descriptors of pain). It is potentially useful in large population studies of OFP, where a clinical examination is not possible, however, further validation of its performance in large populations are necessary.

Modern management of obstructive salivary gland disease

AIMS

To investigate the results of a minimally invasive approach to the management of obstructive salivary gland disease.

MATERIALS AND METHODS

Five hundred and thirty-seven patients with symptomatic obstructive salivary gland disease (455 calculi, 82 strictures) consisting of 330 submandibular and 207 parotid cases were treated using minimally invasive techniques. Extra-corporeal shock wave lithotripsy (ECSWL), fluoroscopically guided basket retrieval, or intra-oral stone removal under general anaesthesia, were used for salivary calculi, either alone or in combination. Strictures were treated using fluoroscopically guided balloon dilatation.

RESULTS

ECSWL achieved complete success (stone and symptom free) in 87/221 (39%) of cases (84/218 primary, 3/3 secondary) of which submandibular 43/131, parotid 44/90. Basket retrieval cured 124/166 (75%) cases (103/136 primary, 21/30 secondary) of which submandibular 80/109, parotid 44/57. Intra-oral surgical removal provided a cure in a further 137/143 (96%) submandibular cases (99/101 primary, 36/38 secondary and 2/4 tertiary). The overall success rate for the three techniques was 348/455 (76%). Balloon dilatation resulted in complete elimination of the stricture in 44/82 (54%) and a reduction in the stricture in 32/82 (39%) and no improvement in 6/82 (7%). Review at six months showed resolution 14/32 (44%), improvement 16/32 (50%) and no change 2/32 (6%) of symptoms.

CONCLUSIONS

A minimally invasive approach to the management of obstructive salivary gland disease is to be encouraged. All four techniques described have a low morbidity and afford the possibility of retaining a functional gland.

Serum and salivary IgA antibody responses to Saccharomyces cerevisiae, Candida albicans and Streptococcus mutans in orofacial granulomatosis and Crohn's disease

Orofacial granulomatosis (OFG) is a condition of unknown aetiology with histological and, in some cases, clinical association with Crohn's disease (CD). However, the exact relationship between OFG and CD remains uncertain. The aim of this study was to determine whether OFG could be distinguished immunologically from CD by comparing non-specific and specific aspects of humoral immunity in serum, whole saliva and parotid saliva in three groups of patients: (a) OFG only (n = 14), (b) those with both oral and gut CD (OFG + CD) (n = 12) and (c) CD without oral involvement (n = 22) and in healthy controls (n = 29). Non-specific immunoglobulin (IgA, SigA, IgA subclasses and IgG) levels and antibodies to whole cells of Saccharomyces cerevisiae, Candida albicans and Streptococcus mutans were assayed by enzyme-linked immunosorbent assay (ELISA) in serum, whole saliva and parotid saliva. Serum IgA and IgA1 and IgA2 subclasses were raised in all patient groups (P < 0.01). Salivary IgA (and IgG) levels were raised in OFG and OFG + CD (P < 0.01) but not in the CD group. Parotid IgA was also raised in OFG and OFG + CD but not in CD. The findings suggest that serum IgA changes reflect mucosal inflammation anywhere in the GI tract but that salivary IgA changes reflect involvement of the oral cavity. Furthermore, the elevated levels of IgA in parotid saliva suggest involvement of the salivary glands in OFG. Serum IgA antibodies to S. cerevisiae were raised markedly in the two groups with gut disease while serum IgA (or IgG) antibodies to C. albicans were elevated significantly in all three patient groups (P < 0.02). No differences were found with antibodies to S. mutans. Whole saliva IgA antibodies to S. cerevisiae (and C. albicans) were raised in the groups with oral involvement. These findings suggest that raised serum IgA antibodies to S. cerevisiae may reflect gut inflammation while raised SIgA antibodies to S. cerevisiae or raised IgA or IgA2 levels in saliva reflect oral but not gut disease. Analysis of salivary IgA and IgA antibodies to S. cerevisiae as well as serum antibodies in patients presenting with OFG may allow prediction of gut involvement.

Extracorporeal shockwave lithotripsy in the management of salivary calculi

BACKGROUND

The aim was to investigate the results of extracorporeal shockwave lithotripsy in the management of salivary calculi using a dedicated sialolithotriptor.

METHODS

Some 122 salivary calculi (84 submandibular and 38 parotid) were treated in an experimental study using a sialolithotriptor.

RESULTS

Complete success was achieved in 40 procedures (33 per cent), 27 of 84 submandibular and 13 of 38 parotid calculi. A further 43 patients (35 per cent) were rendered asymptomatic although some stone debris remained in the duct (26 submandibular and 17 parotid). Failure (retention of stone debris and continued symptoms) occurred in 39 patients (32 per cent), 30 submandibular and eight parotid glands. The chance of failure increased with the size of the calculus and increasing duration of symptoms.

CONCLUSION

Extracorporeal shockwave lithotripsy provides a useful option for the management of salivary calculi, particularly for stones less than 7 mm in diameter.

Minimally invasive radiologically guided intervention for the treatment of salivary calculi

PURPOSE

To describe the technique and examine the value of salivary stone extraction using a minimally invasive, radiologically guided approach as an alternative to salivary gland surgery for the treatment of benign salivary gland obstruction.

METHODS

Eighty-six cases of sialolithiasis (83 patients) were treated by stone removal using a Dormia basket under local anesthesia and fluoroscopic guidance. Postoperative assessment was made clinically at review, by sialogram and by questionnaire.

RESULTS

Of 86 cases of sialolithiasis treated, in 55 (64%) it was possible to remove all stones. In 12 cases (14%) part of a stone or some of a number of calculi were removed and in 19 cases (22%) the procedure failed. The commonest reason for failure was fixation of the stone within the duct. Symptoms at review (range 1-49 months, mean 17 months) were relieved in 55 of 67 (82%) of cases where a stone or portion of stone was removed.

CONCLUSIONS

Stone removal from the salivary duct system by radiologically guided, minimally invasive approach is a simple procedure with low morbidity and high patient acceptance when appropriate selection criteria are applied. These criteria are considered and recommendations made.

Balloon dilatation of salivary duct strictures: report on 36 treated glands

PURPOSE

This paper describes the technique for balloon dilatation of salivary duct strictures and evaluates the clinical and radiographic findings in a consecutive series of 36 affected glands.

METHODS

Thirty-four patients (36 glands) had balloon dilatation of their salivary duct strictures performed under fluoroscopic control. They were evaluated immediately afterwards and at review by sialography.

RESULTS

In 36 cases attempted, 33 (92%) strictures were dilated. The immediate post-treatment sialogram was available in 28 cases, of which 23 (82%) demonstrated complete and four (14%) partial elimination of stricture. In one case the appearance was unchanged (4%). Review data (mean 6.8 months) were available on 25 glands: 12 were asymptomatic (48%), 12 (48%) had reduced symptoms and one (4%) failed to improve. Sialographic data were available on 21 glands: in 10 (48%) the duct remained patent, in one (5%) the stricture was partially eliminated, in seven (33%) the strictures had returned and in the remaining three (14%) cases there was complete obstruction.

CONCLUSIONS

Balloon dilatation is an effective treatment of salivary duct stenosis. In half the cases the stricture recurred but symptomatic improvement was achieved and maintained in the majority of cases.

Interventional radiology in the removal of salivary calculi

PURPOSE

To prospectively investigate the efficacy of a wire basket extractor in the retrieval of salivary calculi and establish selection criteria for suitable cases.

MATERIALS AND METHODS

Twenty-five consecutive patients (14 male, 11 female; age range, 13-69 years) with salivary calculi (20 submandibular, five parotid) were treated by using a commercially available wire basket extractor with intermittent fluoroscopic guidance.

RESULTS

Elimination of calculi was accomplished in 10 (40%) cases. In an additional seven (28%) cases, either part of the calculus was removed or whole calculi were removed with others remaining. Failure to retrieve any stone occurred in eight (32%) cases. The most common cause of failure was attachment of the calculus to the duct wall.

CONCLUSION

Interventional radiology provides a useful adjuvant method of calculus removal and complements extracorporeal lithotripsy. Basket retrieval of calculi has low morbidity and is rapid and less invasive than traditional surgery. It is most effective in retrieving mobile stones in the extraglandular parotid and submandibular ducts.

The management of sialolithiasis in 2 children through use of extracorporeal shock wave lithotripsy

The management of salivary calculi in children may prove difficult for a number of reasons. Traditional investigations require ionizing radiation and in cases of sialography may be poorly tolerated. Similarly, any surgical treatment is likely to require general anesthesia and, in a number of cases, removal of the affected gland, which is associated with attendant risks. As an alternative, ultrasound and extracorporeal shock wave lithotripsy therapy offers low morbidity and outpatient procedures that are well tolerated, as illustrated by these 2 cases.

Symptomatic sialoadenitis and sialolithiasis in the English population, an estimate of the cost of hospital treatment

OBJECTIVE

To establish the annual incidence, and cost of treating, symptomatic salivary stones and sialoadenitis.

MATERIALS AND METHODS

Data relating to sialolithiasis and sialoadenitis were obtained from the Department of Health with respect to the 15 health regions in England during the period 1991-1995. These were analysed to obtain the mean incidence per annum. The proportions of each condition treated on an in-patient and out-patient basis were also calculated. A survey of hospital fees was undertaken to determine the national cost for treating these two conditions.

RESULTS

In the period the mean incidence of hospital admission for symptomatic sialoadenitis and sialolithiasis in the 15 health regions in England was 27.5 (19-46) and 31.5 (26-37) per million population per annum respectively. During this time there was a slight shift toward day case treatment.

CONCLUSIONS

Based on hospital admission data for the period 1991-1995 the mean incidence of symptomatic sialolithiasis is relatively low, being at least 27 per million population per annum and possibly as much as 59 per million population per annum. This represents a cost to the National Health Service of up to 4,000,000 Pounds per annum.

The current status and possible future for lithotripsy of salivary calculi

Extracorporeal and intracorporeal shockwave lithotripsy are effective in at least 30% of cases, particularly when combined with adjuvant techniques. Factors that appear to affect outcome adversely are stone size, partial fragmentation with reduced clearance, duct stenosis, and poor gland function.

Intra-oral ultrasound imaging of a submandibular duct calculus

A case is presented showing the first reported use of a small, digitally-guided, intra-oral ultrasound probe to image a calculus in a submandibular salivary duct. This use of intra-oral ultrasound is discussed in the context of the overall current status of intra-oral and extra-oral ultrasound imaging. It is proposed that using a combination of intra-oral and extra-oral probes, the whole of the salivary apparatus may now be examined sonographically for the presence of calculi.

Factors influencing treatment planning of restorative dentistry in general practice: Part 1

Careful treatment planning is vital if examination and treatment of even the most routine cases is to proceed smoothly. This is the first of a short series of articles in which the authors detail the steps that a general dental practitioner should take in order to produce an effective treatment plan for each patient. In this, the first paper, the steps necessary to accurately record the information required in formulation of the plan are outlined. A second article will deal with matters concerning patient management and the examination.