Labial Frenectomy: Current Clinical Practice Among a Sample of Oral Surgeons and Oral and Maxillofacial Surgeons in the United Kingdom

Recruitment of Future Maxillofacial Surgeons

Changing the Oral and Maxillofacial Surgery (OMFS) training pathway in the United Kingdom - an illustrative retrospective.

IntroductionCoronavirus disease (COVID‐19) was declared a global pandemic on 11 March 2020, and all routine dental care in England was suspended on 25 March 2020. Oral surgeons typically continued their roles due to the requirement of surgical expertise in the management of urgent care.AimsTo survey the British Association of Oral Surgeons' membership of 654 exploring the impact and response of the speciality in the early phase of the pandemic.MethodsBritish Association of Oral Surgeons members were invited to participate in a weekly online survey commencing 30th March 2020 for 4 weeks. Themes explored included demographics, Personal Protective Equipment (PPE), clinical role and care provided, and financial impact.Results400 responses were received over the 4‐week period. Telephone advice was rapidly introduced ahead of clinical examinations. Few oral surgeons were initially able to provide emergency oral surgery procedures or clinical examinations due to PPE shortage. Only a small proportion of oral surgeons were required themselves to isolate and only a small proportion were redeployed.ConclusionThe COVID‐19 pandemic severely disrupted UK oral surgery services particularly in the early stage and highlight the lack of preparedness. As availability of PPE and evidence on aerosol‐generating procedures and infection control became more readily accessible, surgeons became more confident to provide emergency surgical treatment rather than just phone consultations. The impact on patients' oral health is likely to have been profound.

ObjectiveThe aim of this survey was to evaluate current practice in mandibular third molar (M3M) surgery within the British Association of Oral Surgeons (BAOS) membership against current evidence and relevant guidelines.MethodAn online questionnaire survey was active from March to June 2015.ResultsA total of 250 BAOS members (48%) responded to the survey. About 52% were registered Oral Surgery specialists. Exactly, 36% stated that M3M surgery comprised 50–75% and 17% stated that M3M surgery comprised over 75% of their workload. About 73% would recommend coronectomy for high‐risk M3Ms; however, 53% had difficulty in accessing cone beam CT (CBCT) scanning. Most practitioners undertook a two‐stage written consent informing patients of the possibility of numbness, altered sensation or pain as a result of inferior alveolar or lingual nerve injury; however, there were significant variations in how this was communicated. Most surgeons operated mainly under local anaesthesia, using a triangular buccal flap access; 27% routinely used lingual retraction. Buccal and distal bone removal followed by sectioning of the tooth was the most common approach, although 1% routinely used the lingual split technique. Over the last 5 years, each responder reported an average of 2 temporary and 0.4 permanent inferior alveolar nerve injuries (IANI), 1 temporary and 0.1 permanent lingual nerve injuries (LNI).ConclusionThis survey has highlighted the lack of access to CBCT scanning and the differences in approach to consent and surgical technique. The reported rates of nerve injury caused by M3M surgery were low; however, this may be due to a lack of post‐operative follow up.

Langerhan's Cell Histiocytosis (LCH) refers collectively to a group of diseases previously known as Histiocytosis X, eosinophilic granuloma, Abt-Letterer-Siwe syndrome, Hand-Schueller-Christian syndrome, and others. LCH is rare with an estimated annual incidence of 1–7 cases per million of the population. It has a 2:1 preponderance for presentation in males, usually in childhood, however literature suggests increasing numbers of later presentations.
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\nThe aetiology of LCH is unknown though there is evidence to suggest that LCH may be a more neoplastic disease than a reactive disorder but pathogenesis is still unclear. The disease can affect any organ or system but more frequently bones, skin and pituitary gland. Skeletal involvement is one of the most common features with a reported incidence in the jaws of 7.9%. Involvement of the maxillary sinus is rare. Diverse clinical presentation can lead to outcomes ranging from spontaneous remission of a single bony lesion to rapidly progressive systemic disease that leads to multi organ failure and death.
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\nWe report an unexpected presentation of LCH in a 34 year old male presenting with a large oro-antral fistula (OAF) following extraction of the upper right first molar some months previously. The OAF was successfully repaired using a buccal fat pad/advancement flap. At time of surgery an unusually large volume of bone loss was noted extending to the apices of adjacent teeth, with what appeared to be chronic granulation tissue at the base of the socket extending into the maxillary sinus. This tissue was sampled and histopathology confirmed a diagnosis of LCH. The post-operative recovery was uneventful, but given the diagnosis the patient was sent for further assessment by our haematology colleagues.
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\nThis report reviews current literature and highlights the importance of sampling tissue in seemingly routine procedures particularly when little is known of the history of the presenting clinical complaint.

To obtain views of orthodontists in the United Kingdom on frenectomy in terms of its indications and timing and a recommended retention regimen after correction of median diastema. A 14-item online questionnaire was sent to orthodontic specialists for completion. The questionnaire covered demographics and orthodontists' experience and views on frenectomy. Three hundred and fifty-three orthodontists with various background and experience responded to the survey. Three-quarters of respondents routinely performed a blanche test to aid diagnosis of the abnormal frenum; however, only 15% carried out radiographic investigation. Three-quarters of the orthodontists would consider frenectomy as a part of orthodontic treatment, and variation existed among the clinicians in terms of its timing. Frenectomy without orthodontic treatment was not preferred. There was much variation in the retention regimen after diastema closure regardless of frenectomy. Complete consensus among the orthodontists was not obtained; however, some agreement was found regarding the development of a logical diagnosis and treatment approach. High-quality studies are required to produce national protocols or UK guidelines.

Three changes to reduce the loss of dual degree trainees from OMFS national specialty selection in the UK: evidence based proposals

Aim To investigate the current scope of clinical practice and involvement in postgraduate education and training of UK oral surgeons. Materials and methods Electronic survey via ‘Survey Monkey ™’ of members of British Association of Oral Surgeons. Results Response rate of 39% (208) with margin of error 5.29% at 95% level of confidence. Fifty-nine per cent (122) regularly operated under general anaesthesia; 39% (47) regularly undertook trauma surgery. A wide range of conditions (including mucosal) were managed and surgical procedures undertaken for paediatric and adult patients. Conclusions UK oral surgeons are currently undertaking a wide range of procedures as described by the General Dental Council, the Career Development Framework for Consultant Appointments and EU directives and well beyond the limits of minor oral surgery. They also make a significant contribution to education and training in the UK.

Junior Trainees Group (JTG) of the British Association of Oral and Maxillofacial Surgeons (BAOMS) conference 2018: overview of the conference and analysis of delegates’ feedback

Oral SurgeryVolume 11, Issue 1 p. 92-92 ErratumFree Access Erratum This article corrects the following: British Association of Oral Surgeons Volume 8Issue 2Oral Surgery pages: 111-125 First Published online: April 23, 2015 First published: 26 January 2018 https://doi.org/10.1111/ors.12334AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Erratum The following abstract was omitted in error from the published abstracts of the British Association of Oral Surgeons (BAOS) 2014 Open Papers1. An Audit of Post-operative Complications Wisdom Tooth Removal, Employing the Use of Aseptic Versus Sterile “Scrubbing-up” technique Nikita Patel Abstract Aim: To identify if the method of scrubbing up is significant in the post-operative outcome following the surgical extraction of third molars by comparing the general anaesthetic clinic where a sterile technique is employed compared with local anaesthetic where an aseptic technique is used.Method: A retrospective audit of all patients requiring surgical removal of third molars with local and general anaesthetic over a 6-month period. A gold standard of <8% post-operative complication rate and <2% infection rate was set with no difference between the GA and LA clinics. Patients were identified using the telephone review system and procedure logbooks. Patients who attended for unplanned appointments were then identified and a data capture sheet was used to record information from patient clinical notes regarding the post-operative complication.Results: Data were collected for 352 patients. A total of 31 (9%) patients were found to have returned to Cardiff University Dental Hospital for post-operative complications. Of these, nine patients (29%) were treated with GA and 22 (71%) under LA. Therefore, the complication rate from GA was 8% and for LA 9%. A post-operative infection rate of 2% (eight patients) was identified in this audit. Of the eight patients, 2 (2%) had their wisdom tooth extracted on GA and 6 (3%) had their wisdom tooth extracted on LA.Conclusion: The gold standard for the rate of post-operative complication was not met but the infective rate was met and there was a 1% difference between the GA and LA clinics. Therefore, there is no clear advantage of either scrubbing-up method in association with patients returning with post-operative complications. So the extra cost may not be justified. The Publisher, Editor and the BAOS would like to apologise for this oversight. Reference 1British association of oral surgeons. Oral Surgery 2015; 8: 111– 125. https://doi.org/10.1111/ors.12156 Volume11, Issue1February 2018Pages 92-92 ReferencesRelatedInformation

IntroductionThis study aimed to gather demographic data from the oral surgery workforce who have experienced a formal training pathway, their current roles, commitments, competencies and how they believe oral surgery training could be improved.MethodsA 22‐question online survey was developed and distributed to 70 former oral surgery trainees. Trainee details were retrospectively obtained using the British Association of Oral Surgeons (BAOS) Consultants and Senior Trainers (CAST) group mailing list and the oral surgery trainee mailing list and potential participants were invited via email.ResultsSix participants reported not having had formal training and were excluded, resulting in a 47% response rate. The majority (78%) of former oral surgery trainees appear to spend most of their working week in hospital practice, with 63% in oral surgery consultant or honorary consultant positions. Participants reported a mean average of five WTE oral surgery sessions working for the NHS and one WTE private session. Oral surgeons have a broad remit of roles and responsibilities including teaching and training, policy making, research, leadership and management. Respondents suggested improvements for any future oral surgery specialty curriculum, including more leadership and management training to ensure trainees are well prepared for senior posts.ConclusionOverall, this survey demonstrates the broad and diverse skills of the oral surgery workforce. The majority of former oral surgery trainees currently hold consultant level positions and are mainly based in hospital practice. This study also demonstrated that a large proportion of the oral surgery workforce commitment is to the public sector and education.

Infinite cornucopia: The future of education and training in oral and maxillofacial surgery

Oral SurgeryVolume 1, Issue 4 p. 230-235 The Annual Scientific Conference of British Association of Oral Surgeons 2008 First published: 31 March 2009 https://doi.org/10.1111/j.1752-248X.2008.00046.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume1, Issue4November 2008Pages 230-235 RelatedInformation

Oral SurgeryVolume 7, Issue 2 p. 118-128 2013 BAOS Conference Cardiff Open Paper & Poster Abstracts Booklet British Association of Oral Surgeons 2013 Conference First published: 01 April 2014 https://doi.org/10.1111/ors.12091Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume7, Issue2May 2014Pages 118-128 RelatedInformation

Oral SurgeryVolume 3, Issue 4 p. 155-173 Joint Meeting of the British Association of Oral Surgeons and the European Federation of Oral Surgery Societies, Edinburgh 2010 Keith G. Smith, Keith G. Smith Editor-in-ChiefSearch for more papers by this author Keith G. Smith, Keith G. Smith Editor-in-ChiefSearch for more papers by this author First published: 20 October 2010 https://doi.org/10.1111/j.1752-248X.2010.01103.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume3, Issue4November 2010Pages 155-173 RelatedInformation