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Giant cell arteritis (GCA) is a rare condition that causes inflammation of blood vessels. Early diagnosis and treatment is essential to prevent ischaemic complications, including blindness, tongue necrosis and stroke. GCA can present with orofacial symptoms, such as toothache and pain/difficulty in chewing, which may cause individuals with GCA to first present to the dentist. This has important patient safety and medicolegal implications. Dental practitioners should be alert to the possibility of GCA and should direct suspected cases to their general medical practitioner or a hospital specialist. Increased awareness of GCA should minimize the risk of blindness and stroke. CPD/Clinical Relevance: Early recognition and treatment of GCA is key to prevent complications, such as blindness, tongue necrosis and stroke.

Alloplastic malar onlays have been used by surgeons to correct or enhance the midfacial skeleton for over 40 years. Case series have shown respectable results using different alloplastic materials in various maxillofacial subsites. However, these articles include small numbers of patients with limited follow up. We present a literature review specifically concentrating on porous polyethylene (Medpor, Stryker) and polyethyl ether ketone (PEEK) malar onlays. We illustrate the technique used by a single oral and maxillofacial surgeon for placement of 119 implants in 61 patients over a 14-year period, and show the results of this work with long-term follow up. A complication rate of 2.5% in this cohort was reported, with follow up of three years, demonstrating that this technique for midfacial correction is successful in both the short and the long term.

Introduction\ud Patient safety within dental education is paramount. Wrong‐site surgery (WSS) tooth extraction is not uncommon and is a significant never event (NE) in dentistry. This study aimed to explore dental schools’ undergraduate experience of NEs, safety interventions implemented and the impact on student experience.\ud \ud Methods\ud All 16 UK dental schools were surveyed via email.\ud \ud Results\ud The response rate was 100%. A modified World Health Organization (WHO) checklist was used within institutions (94%) including pre‐operative briefings and recording teeth on whiteboards (81%, respectively). Students were directly supervised performing extractions (63%) utilising a 1:4 staff: student ratio. WSS by students was reported in 69% of schools, with student experience being impacted by an increased patient safety focus.\ud \ud Discussion\ud This study demonstrated an increased utilisation of an adapted WHO checklist. Modification of practices to ensure patient safety was demonstrated at all schools, irrespective of student WSS occurrences. Institutions experiencing student NEs commonly implemented WHO checklists and recording teeth for extraction on whiteboards. Other strategies included direct staff supervision and pre‐operative briefings.\ud \ud Conclusion\ud UK dental schools have increased the emphasis on patient safety by the implementation of national healthcare models, for example WHO checklists and pre‐operative briefings. These strategies both aim to improve communication and teamwork. Increased levels of staff supervision foster greater quality of teaching; however, this has resulted in reduced student clinical experience. A proposed minimum standard for undergraduate surgery is suggested to ensure safe and competent dental practitioners of the future.

Introduction: This 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.Methods: A 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.Results: Six 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 speciality curriculum, including more leadership and management training to ensure trainees are well prepared for senior posts.Conclusion: Overall, this survey demonstrates the broad and diverse skillsof 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.

Background Following graduation, training costs for an individual trainee to achieve completion of specialist surgical training has been estimated to be between £20,000 to £71,431, and is expected to rise. Furthermore, there are other non-monetary costs to consider, including poor work-life balance and the burden of training on home life.Methods A 22-question online survey using SurveyGizmo was developed and emailed to all current UK and Ireland oral surgery trainees from 2016-2019. The survey consisted of open free text, binomial and variable scale responses related to the cost of training.Results A total of 43 (96%) oral surgery trainees responded to the survey. Sixty-eight percent had enrolled on a postgraduate degree, or other higher qualification, during their training. Of these, only 4.5% were fully funded and nearly half received no funding at all. Trainees reported vast disparities in financial support across deaneries, with an overall average study budget of £687. Annual obligatory costs of up to £4,142 and a mean average spend of £9,240 on courses and £2,830 on conferences were reported. Childcare, relocating and textbooks were listed as additional costs incurred.Conclusion A standardised, transparent and more substantial financial support system is required for dental specialty trainees.

AimTo give the surgeon an overview of Primary Sjögren's syndrome, its pathophysiology, diagnosis and management thus giving insight into why labial gland biopsies are required. The authors also aim to make the operating surgeon aware of their role, responsibility and medicolegal factors to be considered prior to undertaking a labial gland biopsy (LgBx).Materials and methodsA literature search of PubMed (MEDLINE), Cochrane and EMBASE electronic databases using the search terms ‘Primary Sjӧgren's Syndrome’, ‘Diagnostic Criteria for Sjӧgren's Syndrome’, ‘Labial Gland Biopsy’, ‘Labial Gland Biopsy Complications’, ‘Diagnostic Imaging for Sjӧgren's Syndrome’ and ‘Medicolegal Responsibility of Surgeons’. Title and then abstract were reviewed to determine relevance. Widely used guidelines were identified, indications for biopsy and the risks posed by surgery considered. Medicolegal advice was formally sought via a medical/dental defence union.ResultsThe authors considered the available evidence and medicolegal advice and applied this knowledge to the clinical setting. A preoperative checklist for consideration prior to LgBx was developed.ConclusionsLabial gland biopsy is an invasive procedure with potential to cause post‐operative complications. The operator assumes ultimate responsibility for the procedure. Every surgeon aims to ensure safe surgical practice, in the best interest of the patient. Here, we consolidate recent evidence and propose a checklist to facilitate the process for oral surgeons.

Background Extra-oral drainage of odontogenic abscesses is commonly performed by oral and maxillofacial surgeons. It is a potentially hazardous and expensive procedure, but in selected cases can be carried out under local anaesthetic, avoiding some of the risks and costs associated with general anaesthesia. Aim To evaluate the management options for odontogenic abscesses. Method A review of the literature with respect to radiological, anaesthetic and surgical techniques that facilitate extra-oral incision and drainage under local anaesthetic. Results A case series demonstrates the value of imaging, the Vazirani–Akinosi mandibular nerve block, a specific forcep technique and local anaesthetic extra-oral drainage of the submandibular space. Conclusions Oral surgeons can utilise their specialist knowledge of head and neck anatomy, local anaesthetic technique, surgical skills and specialist equipment to deliver quick and definitive treatment for odontogenic abscesses. To our knowledge, extra-oral incision and drainage of dental abscesses is not regularly carried out under local anaesthetic. However, if removal of the causative tooth and abscess drainage can be undertaken under local anaesthetic, the risks and costs of general anaesthesia can be avoided.

Implanting biomaterials such as surgical sutures leads to wound inflammation and a Foreign Body Response (FBR), which can result in scarring and ultimately biomaterial rejection. To investigate the cell and signalling events that underlie FBR, we use live imaging of zebrafish reporter lines to observe how inflammation and angiogenesis differ between a healthy acute wound versus suture implantation. We observe inflammation extending from the suture margins and correlates with subsequent avascular and fibrotic encapsulation zones: sutures that induce more inflammation result in increased zones of avascularity and fibrosis. Moreover, we capture macrophages as they fuse to become multinucleate foreign body giant cells (FBGCs) adjacent to the most pro-inflammatory sutures. Both genetic and pharmacological dampening of the inflammatory response minimises the FBR (including FBGC generation) and normalises the status of the tissue surrounding these sutures. This new model of FBR in adult zebrafish allows us, for the first time, to live image the process and to modulate it in ways that may lead us towards new strategies to ameliorate and circumvent FBR in humans.