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Introduction Trismus has been identified as a red flag sign that may lead to an early identification of a malignant lesion. A simple checklist was devised to allow clinicians to identify patients who may be at risk.Methods The implementation of this checklist at the temporomandibular disorder clinic of the University Dental Hospital of Manchester has been audited through ten annual cycles, each examining a sample of 50 clinical records of patients referred to the clinic. The standards set were that the presence of the trismus checklist in new patient examination notes should be 100%, the recording of mouth opening should be 100% and that the trismus checklist should be correctly filled in 100% of the time.Results The incidence of trismus ranged from 0-20%. The presence of the trismus checklist in new patient examination notes ranged from 78-100% compliance. The recording of mouth opening ranged from 80-100% compliance. The trismus checklist was not always filled in correctly: it ranged from 50-100%.Conclusion The use of audit has led to the evolution of the checklist and to improvements in its implementation. The trismus checklist has aided the early identification of malignancy. Future work should look at its implementation in a wider range of settings., (© 2022. The Author(s), under exclusive licence to the British Dental Association.)

Aim To identify glove usage within UK and Ireland dental hospitals as well as the use of latex- and non-latex-containing dental equipment.Method A self-completed questionnaire was disseminated to 16 dental hospitals in the summer of 2017. The survey concerned their current use of latex and non-latex gloves and dental equipment. In addition, information was sought regarding any problems associated with non-latex and latex gloves.Results The questionnaire response rate was 13/16 (81%), of which 100% reported the use of non-latex examination gloves. The majority were using nitrile gloves. Twelve of the 13 dental hospitals would use examination gloves for simple extractions and 11 would use sterile gloves for minor oral surgery. In ten hospitals (77%), the sterile gloves were always non-latex, and again, the majority were nitrile. Latex-containing dental equipment including orthodontic bands, prophylactic polishing cups and dental dam was still being used within some dental hospitals, but to a much lesser extent than non-latex.Conclusion All dental hospitals were using latex-free examination gloves and were showing a move towards latex-free dental equipment. This usage is comparable to what has been seen in general dental practice and follows the trend towards latex-free dentistry., (© 2021. The Author(s), under exclusive licence to British Dental Association.)

Oral cancer is a significant cause of morbidity and mortality worldwide. In this article we present two cases of potentially innocuous looking lesions, initially thought to be traumatic in origin, but later diagnosed as cancer. The first patient presented with a persistent laceration thought to be caused by an accidental shaving injury, which was subsequently diagnosed as squamous cell carcinoma. The second patient presented with a hyperplastic mucosal lesion, suspected as forming due to denture-clasp irritation, which was subsequently diagnosed as proliferative verrucous carcinoma. The importance of early detection and palpation of suspicious lesions is emphasised in this article.

Objectives: To evaluate the current routine use of latex gloves and latex containing dental dam in UK general dental practice., Methods: A questionnaire was disseminated to 89 general dental practitioners (GDPs) in June 2017. The survey concerned their current, routine use of latex gloves and latex-containing dental dam in general dental practice. In addition, monthly sales figures of gloves classified by material, were obtained from a UK dental supply company, for 2015-2017., Results: The questionnaire response rate was 84 (94%), of whom 90% reported using non-latex (non-sterile examination) gloves for their routine dentistry. The majority were using nitrile gloves. All GDPs surveyed would use examination gloves for routine extractions, and 76% would use examination gloves for surgical extractions. The majority (75%) reported using non-latex dental dam. Sales of nitrile gloves were significantly higher than for latex gloves, with a continuing trend in the reduction in volume of sales of latex gloves., Conclusion: The majority of GDP's now routinely use non-latex containing gloves and dental dam in their clinical dentistry. Nitrile gloves are predominantly used. Examination gloves are used for straightforward extractions, with many practitioners also using them for minor oral surgery. Sales of latex containing gloves are continuing to decrease., Clinical Significance: The routine use of latex-containing products in UK dental practice is low and likely to reduce further, with on-going benefit for the dental practitioner, latex allergic patients and prevalence of latex allergy in the general population., (© 2020 Published by Elsevier Ltd.)

The NHS in England requires the reporting of defined "never events" that are directly related to patients' safety. Analysis of data from 2012-2015 has been published previously in this journal. An examination of continuing data from 2015-2019 shows that "wrong tooth/teeth removed" has not reduced in frequency and it still remains a common "wrong-site surgery" event accounting for between 16% and 24% of wrong-site surgery never events and 7%-10% of all never events reported. Hospitals and community Trusts remain the main source of such reports, although some now originate from primary-care-based dental settings. Further efforts have focused on prevention, and the implementation of existing measures to reduce the risk of wrong tooth extraction, is warranted., (Copyright © 2019 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Oral squamous cell carcinoma is associated with the use of tobacco products. The predominant addictive substance in tobacco is nicotine, however, the major carcinogenic substances are in the other components of the tobacco leaf. The highest risk from tobacco use arises from combustion in the form of cigarettes. While cigarette consumption remains prevalent in the developing world, in the UK the rates of smoking are falling. In Sweden, modified smokeless tobacco in the form of snus has been available for many years and has contributed to reduced levels of smoking. In high income countries, new forms of tobacco consumption and nicotine delivery products have been developed over the last few years. These include heat-not-burn cigarettes and electronic cigarettes, and these products are now being actively marketed by many companies, including the tobacco industry. This paper reviews this changing pattern of tobacco and nicotine consumption and the current evidence regarding the risk of these products causing oral cancer.

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., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Oral candidiasis is a frequently encountered oral fungal infection which can be treated with systemic and topical antifungal agents. Warfarin is a widely used oral anticoagulant. The interaction of miconazole oral gel and warfarin, causing potentiation of anticoagulant activity, has been documented over many years with evidence of occurrence in multiple settings and is a significant patient safety risk. This dangerous interaction remains underappreciated by dentists, doctors, pharmacists and patients, with resulting significant morbidity and mortality still occurring. This paper reports on recent developments concerning this interaction, and the important patient safety issues involved. In situations where topical treatment for oral candidiasis is indicated, nystatin should be prescribed instead of miconazole oral gel in patients taking warfarin, unless close monitoring and titration of the anticoagulant effect is undertaken.

The present study was conducted to assess the applicability of liquid-based cytology (LBC) using an innovative oral brush, Orcellex. Fifty healthy volunteers were recruited. From each subject, four samples were collected using "Orcellex" from apparently normal oral mucosal sites. A plastic spatula was also used to obtain an additional sample. Data on the tolerability and acceptability of the Orcellex were collected from the subjects, together with assessments of the adequacy of LBC slide preparations for cellularity, preparation quality, and the types of cells observed. The Orcellex brush was well accepted by the volunteers, who reported relatively little pain. Orcellex brush LBC preparations were of good quality in terms of cell morphology and staining, with a clean background. Only two smears (2/200; 1%) were found to be inadequate due to low cellularity. All of the plastic spatula LBC preparations were inadequate. Representative cells from all layers of the different oral epithelia examined were documented. Oral liquid-based cytology using the Orcellex brush may have considerable potential for early detection of oral cancer and precancer.

The presence of short dental roots can present challenges to the orthodontist both in terms of identifying its aetiology and in subsequent treatment planning. Uncommon causes include hypoparathyroidism and pseudohypoparathyroidism, where short roots may be seen in combination with other oral manifestations including enamel hypoplasia secondary to low calcium levels. This case report highlights these features and the orthodontic treatment proposed.

All clinicians in medicine and dentistry aim to deliver evidence-based practice; however, it is widely recognised that the current evidence base for interventions in oral medicine, as with many other specialties, is of a low quality. The highest level of evidence is considered to be the systematic review and meta-analysis. The Cochrane Collaboration and the Cochrane Oral Health group produce high quality systematic reviews, however, despite the large number of trials carried out for treatments in oral medicine, the results are often not able to be utilised to guide clinical care due to the various methodological limitations of the trials including the heterogeneity of outcome measures used. To improve the strength of the evidence base this will need to change. The Comet initiative aims to support the development of core outcome sets which are used to allow homogeneity of outcome measures in trials and therefore will allow pooling of data for meta-analysis in future systematic reviews. This paper explores the complexities involved in producing evidence for oral medicine interventions and introduces an approach for developing core outcome sets in oral medicine.

Aim To identify the types of dental notation systems used in dental hospitals, and their perceived advantages and disadvantages. In addition, to record the dental notation used in patient referral letters.Method A self-completed questionnaire survey asking about the use of dental notation systems was distributed to 16 dental hospitals in the UK and Ireland in the summer of 2016. In addition, dentist referrals to the Restorative Dentistry department of the University Dental Hospital of Manchester were sequentially assessed for the dental notation used.Results Twelve hospitals replied. In order of frequency, the notation systems in use were the Alphanumeric, the Palmer, and the Federation Dentaire Internationale system. No hospital used the Universal system. Perceived advantages and disadvantages of each of the different systems were volunteered. One hundred and twenty-four referral letters were assessed and 100 were identified where dental notation was used. The majority used Alphanumeric notation.Conclusion A variety of dental notation systems remain in use in dental hospitals. The move to electronic recording and communication of information regarding teeth is encouraging the use of the Alphanumeric system. General dental practitioners are predominantly using the Alphanumeric system as their notation of choice in referral letters to the Restorative Dentistry department in Manchester.

Over recent years there has been an increased emphasis on improving patient safety in all branches of medicine, with reducing wrong tooth extraction being a priority in dentistry. The true incidence of wrong tooth extraction is unknown but it is considered an avoidable harm and is a significant source of dental litigation. Interventions to reduce wrong tooth extraction include educational programmes encompassing human factor training, patient assisted identification, the use of checklists, marking of surgical sites and implementation of patient safety guidelines. Identified risk factors which make wrong tooth extraction more likely include; suboptimal checks and/or cross checking of relevant clinical information, unclear diagnosis, unclear documentation, ambiguity regarding notation of molar teeth, orthodontic extractions, and extractions where there are multiple carious teeth and extractions in the mixed dentition. Accurate and timely reporting of wrong tooth extraction incidents followed by analysis and sharing of findings together with implementation of improved practice will help to minimise risks of wrong tooth extraction.

The NHS in England has identified several adverse incidents that involve patients, including operations done at the wrong site, as "never" events. We examined published data from the period April 2012 to October 2015 and found that "wrong tooth/teeth removed" is the most common "wrong site" event, and accounted for between 20% and 25% of wrong site surgery never events, and 6% - 9% of all "never" events. All "wrong tooth/teeth removed" events seem to have been reported only by hospitals or Community Trusts. It is important to find out how these events are recorded and to find ways to prevent them., (Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.)

Aim To identify the procedures in dental hospitals where a surgical safety checklist is used and in addition, in England, to identify the understanding of hospitals regarding patient safety incidents requiring reporting as Never Events to NHS England.Method A self-completed questionnaire survey asking about the use of checklists was distributed to 16 dental hospitals associated with undergraduate dental schools in the UK and Ireland in the summer of 2015. For hospitals in England (10), additional questions regarding their understanding of incidents to be reported as Never Events were asked.Results Thirteen hospitals replied (8 in England). All use a surgical safety checklist in an operating theatre setting. Ten use a surgical safety checklist in an outpatient setting for the extraction of teeth. There is variable use of checklists for other procedures. The majority of English hospitals thought that the reporting of a 'Never Event' was required following wrong tooth extraction in whatever setting it occurred, including general dental practice.Conclusion Surgical safety checklists are increasingly used in dental hospitals, especially for oral surgery procedures. Beyond 'wrong tooth extraction', English dental hospitals have different understandings of what other oral and dental procedures require reporting as Never Events to NHS England.

Chlorhexidine is an effective antiseptic which is widely used in dentistry. Over recent years, it has also been used in other healthcare products as well as in cosmetics. Anaphylaxis to chlorhexidine has been increasingly reported throughout the world, including two incidents in the UK where chlorhexidine-containing mouthwash had been used to wash tooth sockets following recent tooth extraction. Chlorhexidine is under-recognized as a cause of anaphylaxis and dentists should be aware of its potential for serious adverse effects. Dentists need to consider whether the washing out of a tooth socket with chlorhexidine solution should be avoided in the treatment of established dry socket. On current evidence the potential risks of using chlorhexidine as irrigation solution for treating an established dry socket appears to outweigh any known benefit. CPD/Clinical Relevance: Chlorhexidine has the potential to cause anaphylaxis in the dental surgery.

Objectives: Role substitution between primary care dentists (PCDs) and dental hygienists and therapists is increasingly being used in a number of different countries. Opponents to this development argue that it is unsafe and frequently cite the potential for missing oral malignancy as an inherent danger. The aim of the present study was to determine the comparative diagnostic test accuracy of different members of the dental team when differentiating between standardised photographs of mouth cancer, potentially malignant disorders and benign oral lesions., Methods: A total of 192 dental professionals, comprising 96 PCDs, 63 DH-Ts, nine hospital-based dental staff and 24 other dental professionals were sampled purposively. Following orientation, participants were asked to score 90 clinical photographs that depicted cases of oral squamous cell carcinoma, potentially malignant disorders and non-malignant lesions of the oral mucosa. For each photograph participants were asked to determine whether they felt the lesion was representative of carcinoma, a potentially malignant disorder (test positive), or whether the lesion was benign (test negative). They were also asked to record their confidence in their decision on a 0-10 scale. Judgement decisions were compared against the known histopathological diagnosis of each lesion. Sensitivity and specificity were calculated for each participant and clinical group., Results: The diagnostic test accuracy of PCDs and DH-Ts was similar. There was a median sensitivity of 81% Interquartile range (IQR) 19%) for PCDs and 77% (IQR 19%) for DH-T, with specificity of 73% (IQR 16%) and 69% (IQR 17%) respectively. DH-Ts missed fewer frank malignant lesions compared to PCDs., Conclusion: The performance of PCDs and DH-Ts when differentiating between mouth cancer, potentially malignant disorders and benign lesions is comparable. DH-Ts should be regarded as being as competent as PCDs as front-line healthcare workers with regard to detection of mouth cancer. However, considerable heterogeneity in detection was found within both clinical groups, suggesting that training remains paramount.

Oral mucosal disease has a variety of causes, some of which are due to dysfunction of the immune system. Recurrent aphthous stomatitis and oral lichen planus are the mucosal diseases of unknown cause seen most frequently in dental practice, and the most likely mucosal diseases for which a dentist will prescribe. This paper briefly reviews the clinical features of these conditions, their causation and pertinent information for managing them in a primary care setting. The prescribing of appropriate medications to treat the conditions in a general dental practice is described and discussed.

Patient safety is an important marker of quality for any healthcare organisation. In 2008, the British Government white paper entitled High quality care for all, resulting from a review led by Lord Darzi, identified patient safety as a key component of quality and discussed how it might be measured, analysed and acted upon. National and local clinically curated metrics were suggested, which could be displayed via a 'clinical dashboard'. This paper explains the development of a clinical effectiveness dashboard focused on patient safety in an English dental hospital and how it has helped us identify relevant patient safety issues in secondary dental care.

Extraction of the wrong tooth or teeth is a serious and avoidable clinical error causing harm to the patient. All NHS Trusts in England are required to use a surgical safety checklist in operating theatres to prevent incorrect site surgery and ensure safe management of patients. However, the majority of patients have dental extractions and other oral surgical procedures undertaken on an outpatient basis and these patients are also at risk of having an incorrect site surgical procedure such as a wrong tooth extraction. We describe our experience in developing, introducing and refining a surgical safety checklist for outpatient oral surgery along with the key strategic actions needed to ensure effective cultural change and optimum patient safety in the outpatient setting.

The improvement of patient safety has been a long-term aim of healthcare organisations and following recent negative events within the UK, the focus on safety has rightly increased. For over twenty years, clinical audit has been the tool most frequently used to measure safety-related aspects of healthcare and when done so correctly, can lead to sustained improvements. This paper explains how clinical audit is used as a safety improvement tool in an English dental hospital and gives several examples of projects that have resulted in long-term improvements in secondary dental care.

Trismus is a restriction in the ability to open the mouth. Trismus can occur following trauma, surgery, radiation therapy, infection, inflammatory diseases, temporomandibular disorders (TMD) or less commonly as a result of malignancy. Following two cases of delayed diagnosis of carcinoma presenting with features of TMD to a specialist clinic, a checklist was developed for completion in cases of trismus, to alert the clinician to suspicious features suggesting a possible non-TMD cause. The use of this checklist, together with an increased awareness, has improved early recognition of atypical features in patients presenting with trismus and has contributed to the early diagnosis of a further case of malignancy presenting to this clinic. This article discusses the presentation of malignancy with trismus, the relevance of imaging in these cases, and the implementation of a checklist to reduce the risk of future misdiagnosis.

Patient safety has always been important and is a source of public concern. Recent high profile scandals and subsequent reports, such as the Francis report into the failings at Mid Staffordshire, have raised those concerns even higher. Mortality and significant morbidity associated with the practice of medicine has led to many strategies to help improve patient safety, however, with its lack of associated mortality and lower associated morbidity, dentistry has been slower at systematically considering how patient safety can be improved. Recently, several organisations, researchers and clinicians have discussed the need for a patient safety culture in dentistry. Strategies are available to help improve patient safety in healthcare and deserve further consideration in dentistry.

Background: Behçet's disease is a chronic inflammatory vasculitis that can affect multiple systems. Mucocutaneous involvement is common, as is the involvement of many other systems such as the central nervous system and skin. Behç̧et's disease can cause significant morbidity, such as loss of sight, and can be life threatening. The frequency of oral ulceration in Behçet's disease is thought to be 97% to 100%. The presence of mouth ulcers can cause difficulties in eating, drinking, and speaking leading to a reduction in quality of life. There is no cure for Behçet's disease and therefore treatment of the oral ulcers that are associated with Behçet's disease is palliative., Objectives: To determine the clinical effectiveness and safety of interventions on the pain, episode duration, and episode frequency of oral ulcers and on quality of life for patients with recurrent aphthous stomatitis (RAS)-type ulceration associated with Behçet's disease., Search Methods: We undertook electronic searches of the Cochrane Oral Health Group Trials Register (to 4 October 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9); MEDLINE via Ovid (1946 to 4 October 2013); EMBASE via Ovid (1980 to 4 October 2013); CINAHL via EBSCO (1980 to 4 October 2013); and AMED via Ovid (1985 to 4 October 2013). We searched the US National Institutes of Health trials register (http://clinicaltrials.gov) and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. There were no restrictions on language or date of publication in the searches of the electronic databases. We contacted authors when necessary to obtain additional information., Selection Criteria: We included randomised controlled trials (RCTs) that looked at pre-specified oral outcome measures to assess the efficacy of interventions for mouth ulcers in Behçet's disease. The oral outcome measures included pain, episode duration, episode frequency, safety, and quality of life. Trials were not restricted by outcomes alone., Data Collection and Analysis: All studies meeting the inclusion criteria underwent data extraction and an assessment of risk of bias, independently by two review authors and using a pre-standardised data extraction form. We used standard methodological procedures expected by The Cochrane Collaboration., Main Results: A total of 15 trials (n = 888 randomised participants) were included, 13 were placebo controlled and three were head to head (two trials had more than two treatment arms). Eleven of the trials were conducted in Turkey, two in Japan, one in Iran and one in the UK. Most trials used the International Study Group criteria for Behçet's disease. Eleven different interventions were assessed. The interventions were grouped into two categories, topical and systemic. Only one study was assessed as being at low risk of bias. It was not possible to carry out a meta-analysis. The quality of the evidence ranged from moderate to very low and there was insufficient evidence to support or refute the use of any included intervention with regard to pain, episode duration, or episode frequency associated with oral ulcers, or safety of the interventions., Authors' Conclusions: Due to the heterogeneity of trials including trial design, choice of intervention, choice and timing of outcome measures, it was not possible to carry out a meta-analysis. Several interventions show promise and future trials should be planned and reported according to the CONSORT guidelines. Whilst the primary aim of many trials for Behç̧et's disease is not necessarily reduction of oral ulceration, reporting of oral ulcers in these studies should be standardised and pre-specified in the methodology. The use of a core outcome set for oral ulcer trials would be beneficial.

Many dental practitioners will be aware of patients using electronic cigarettes over the last few years. These products are now widely used, but are they of help in tobacco control? And what are the implications of their use? The regulatory framework concerning these products is evolving rapidly with many opinions on what their final legal status should be. This paper explains their origin, explores some of the arguments and looks at possible future developments.

Immunological reactions to chlorhexidine, including allergy (Type I hypersensitivity) and allergic contact dermatitis/stomatitis (Type IV hypersensitivity), have been recognised for many years. This potential safety issue, however, is not well known within dentistry. The purpose of this paper is to alert dentists and dental care professionals to the potential of chlorhexidine in causing hypersensitivity reactions and to consider this possibility if unexplained hypersensitivity reactions occur.

Background: Recurrent aphthous stomatitis (RAS) is the most frequent form of oral ulceration, characterised by recurrent oral mucosal ulceration in an otherwise healthy individual. At its worst RAS can cause significant difficulties in eating and drinking. Treatment is primarily aimed at pain relief and the promotion of healing to reduce the duration of the disease or reduce the rate of recurrence. A variety of topical and systemic therapies have been utilised., Objectives: To determine the clinical effect of systemic interventions in the reduction of pain associated with RAS, a reduction in episode duration or frequency., Search Methods: We undertook electronic searches of: Cochrane Oral Health Group and PaPaS Trials Registers (to 6 June 2012); CENTRAL via The Cochrane Library (to Issue 4, 2012); MEDLINE via OVID (1950 to 6 June 2012); EMBASE via OVID (1980 to 6 June 2012); CINAHL via EBSCO (1980 to 6 June 2012); and AMED via PubMed (1950 to 6 June 2012). We searched reference lists from relevant articles and contacted the authors of eligible trials to identify further trials and obtain additional information., Selection Criteria: We included randomised controlled trials (RCTs) in which the primary outcome measures assess a reduction of pain associated with RAS, a reduction in episode duration or a reduction in episode frequency. Trials were not restricted by outcome alone. We also included RCTs of a cross-over design., Data Collection and Analysis: Two review authors independently extracted data in duplicate. We contacted trial authors for details of randomisation, blindness and withdrawals. We carried out risk of bias assessment on six domains. We followed The Cochrane Collaboration statistical guidelines and risk ratio (RR) values were to be calculated using fixed-effect models (if two or three trials in each meta-analysis) or random-effects models (if four or more trials in each meta-analysis)., Main Results: A total of 25 trials were included, 22 of which were placebo controlled and eight made head-to-head comparisons (five trials had more than two treatment arms). Twenty-one different interventions were assessed. The interventions were grouped into two categories: immunomodulatory/anti-inflammatory and uncertain. Only one study was assessed as being at low risk of bias. There was insufficient evidence to support or refute the use of any intervention., Authors' Conclusions: No single treatment was found to be effective and therefore the results remain inconclusive in regard to the best systemic intervention for RAS. This is likely to reflect the poor methodological rigour of trials, and lack of studies for certain drugs, rather than the true effect of the intervention. It is also recognised that in clinical practice, individual drugs appear to work for individual patients and so the interventions are likely to be complex in nature. In addition, it is acknowledged that systemic interventions are often reserved for those patients who have been unresponsive to topical treatments, and therefore may represent a select group of patients.

The aim of this paper is to highlight a change in guidance relating to possible interactions between antibiotics and oral contraceptives. Until recently, dentists have been advised to warn women taking the combined oral contraceptive pill of the routine need to use additional contraceptive measures while taking courses of broad spectrum antibiotics. Recent guidance relating to this issue has changed and dentists may not be aware of this. This paper reminds dentists of the previous guidelines and related evidence, reviews the pharmacokinetics of hormonal contraception and presents them with the latest evidence-based guidance. This should change their clinical practice.

The technical aspects of dentistry need to be practised with insight into the spectrum of human diseases and illnesses and how these impact upon individuals and society. Application of this insight is critical to decision-making related to the planning and delivery of safe and appropriate patient-centred healthcare tailored to the needs of the individual. Provision for the necessary training is included in undergraduate programmes, but in the United Kingdom and Ireland there is considerable variation between centres without common outcomes. In 2009 representatives from 17 undergraduate dental schools in the United Kingdom and Ireland agreed to move towards a common, shared approach to meet their own immediate needs and that might also be of value to others in keeping with the Bologna Process. To provide a clear identity the term 'Clinical Medical Sciences in Dentistry' was agreed in preference to other names such as 'Human Disease' or 'Medicine and Surgery'. The group was challenged to define consensus outcomes. Contemporary dental education documents informed, but did not drive the process. The consensus curriculum for undergraduate Clinical Medical Sciences in Dentistry teaching agreed by the participating centres is reported. Many of the issues are generic and it includes elements that are likely to be applicable to others. This document will act as a focus for a more unified approach to the outcomes required by graduates of the participating centres and act as a catalyst for future developments that ultimately aim to enhance the quality of patient care., (© 2011 John Wiley & Sons A/S.)

We present a case of an epidermoid cyst in contact with the inferior and lateral aspects of the left trigeminal nerve, which resulted in secondary trigeminal neuralgia of the left mandibular branch of the trigeminal nerve. The symptoms were typical of trigeminal neuralgia, with no other neurological signs and symptoms. If patients present with trigeminal neuralgia, consideration should be given to routine visualisation of the entire course of the trigeminal nerve by magnetic resonance imaging (MRI) to identify cases of secondary trigeminal neuralgia.

Angiotensin converting enzyme (ACE) inhibitors are a commonly prescribed, effective medication in the treatment of hypertension and heart failure. Several side-effects of dental relevance can occur including angioedema of the lips, mouth and throat. This adverse effect is well reported and can be fatal, but it is not always recognised by clinicians, as the angioedema does not always have a clear relationship with the commencement of the medication. The cases of angioedema reported here all presented in a dental setting and highlight both the delayed onset and the chronic recurrent nature of ACE inhibitor induced angioedema.

Solitary fixed drug eruptions involving the lips and mouth are known to occur but are rarely seen in oral medicine clinical practice. Various drugs have been implicated as causative agents. We present a case of a fixed drug eruption on the lip caused by oxybutynin, a relationship not previously described.

Objective: To evaluate pentoxifylline for the treatment of recurrent aphthous stomatitis., Design: A 60-day, randomized, double-blind, placebo-controlled trial with a 60-day no treatment follow-up., Setting: An oral medicine specialist referral center in Manchester., Participants: Forty-nine volunteers who passed the initial assessment for recurrent aphthous stomatitis entered a pretrial phase in which their eligibility for the trial phase of the study was assessed. Sixteen subjects were deemed ineligible, and 7 failed to attend or withdrew. The remaining 26 subjects were randomized to placebo or treatment. Six subjects withdrew because of adverse effects, and 1 was unavailable for follow-up., Intervention: Pentoxifylline (also called oxpentifylline), 400 mg 3 times daily, or matching placebo., Main Outcome Measure: A reduction in the median pain score, ulcer size, number of ulcers, or total number of ulcer episodes., Results: Patients taking pentoxifylline had less pain and reported smaller and fewer ulcers compared with baseline. Patients taking placebo reported no improvement in these variables. Patients taking pentoxifylline also reported more ulcer-free days than those taking placebo. However, the differences were small and, with the exception of median ulcer size (P = .05), did not reach statistical significance. Adverse effects were common with pentoxifylline, but not significantly different from those experienced by patients taking placebo., Conclusions: Although pentoxifylline may have some benefit in the treatment of recurrent aphthous stomatitis, the benefit is limited. It may have a role in the treatment of patients unresponsive to other treatments, but cannot yet be recommended as a first-line treatment.

This report presents an unusual case of spontaneous salivary otorrhoea in which advanced imaging was used to identify a developmental defect in the anterior wall of the bony external auditory meatus. This defect, the so-called foramen of Huschke, was subsequently found to be the source of the fistula. A review of the literature highlights the diagnostic dilemmas that such cases pose for the clinician.