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Introduction: Online reputation is misattributed in France in academic publications. However, this phenomenon is growing. The objective of this study was to establish an inventory of the e-reputation of French maxillofacial surgeons through the opinions posted on their professional Google® account., Material and Methods: A descriptive study included all the surgeons registered on the list of the French National Medical Council in "maxillofacial surgery and stomatology". Data collection was carried out from February to April 2022., Results: Among the 483 surgeons included, 61.1% had received at least one opinion, the number of per surgeon was 22.2. The average was 4.3/5. Among the 4433 written comments completing the review, 85% were positive. The average response rate of surgeons was 10% and was all the more important as the rating of the opinion was lower. Stomatology (65.3%), aesthetic surgery of the face (15.1%) and orthognathic surgery (14.5%) were the most commented maxillofacial procedures., Discussion: The online image of French maxillofacial surgeons was very positive. However, faced with a defamatory or insulting comment, the surgeon found in an unbalanced situation where he could not respond without risking betraying medical. We recall some common-sense recommendations for managing one's e-reputation and some legislative adjustments for better regulation of these platforms, also considering legal and ethical aspects., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: In this comprehensive evaluation, ten experienced oral surgeon experts posed a total of twenty oral surgery-related questions, including dental implant and tooth extractions, to three distinct Natural Language Processing (NLP)-based chatbot platforms: ChatGPT, Microsoft Bing, and Google Bard. The study aimed to assess the effectiveness of these chatbots in responding to specialized medical questions., Materials and Methods: Two primary evaluation metrics were employed: a Likert Scale (LS) for measuring the accuracy and completeness of responses and a Global Quality Scale (GQS) for evaluating the clarity of responses. Statistical analyses, including one-way analysis of variance (ANOVA) and Post Hoc Tukey, were conducted to assess and compare the performance of the chatbots as rated by the experts., Results: The results of the study revealed significant differences in the performance of the chatbots. ChatGPT statistically achieved a better mean LS score of 1.4000±0.15986 than Microsoft Bing (1.8750±0.18143) and Google Bards (2.0500±0.12472) (P < 0.001). Additionally, ChatGPT statistically achieved a higher GQS score of 4.4200±0.30111 than Microsoft Bing (3.7550±0.28621) and Google Bards (3.5250±0.22392) (P < 0.001)., Conclusions: These findings showed the substantial advantage of ChatGPT in effectively addressing oral surgery-related questions with superior accuracy, completeness, and clarity. The study highlights the potential of advanced NLP platforms to enhance information retrieval and communication within the field of oral surgery, reinforcing the utility of such technologies in medical and surgical domains., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: To study the actual state of the organization of medical care for patients with the profile of «maxillofacial surgery» in the Southern Federal District of the Russian Federation in order to develop proposals for its optimization within the framework of a three-level system of medical care., Material and Methods: We analyzed accounting and reporting materials characterizing the organization of medical care in the field of «Oral and maxillofacial surgery» to the population in the Southern Federal District of the Russian Federation., Results: The population of the Southern Federal District of the Russian Federation is currently provided with accessible round-the-clock medical care in the field of maxillofacial surgery. The forces and means at the disposal of the district government allow this to be implemented. However, the article describes a number of obstacles to the provision of high-quality medical care in the field of maxillofacial surgery and suggests ways to eliminate them., Conclusion: Preparation of an Order defining the functioning of a three-level system of medical care for adults and children with maxillofacial pathology in the Southern Federal District of the Russian Federation, as well as more effective use of telemedicine consultations will significantly improve the availability and quality of medical care.

The impact on the provision of care within the NHS due to COVID-19 can not be understated. It has created various challenges for Oral and Maxillofacial Surgeons due to the high-risk nature of working within this specialty. The aims of this study were to identify the ongoing clinical activities at the height of pandemic, the guidance issued to staff regarding the use of personal protective equipment and the changes to maxillofacial practice. A prospective analysis was commenced within six Oral and Maxillofacial Surgery units in the East Midlands, UK with data being collected by means of a 10-item questionnaire relating to changes in patient care during this time. The responses were analysed to identify compliance with the national guidance produced by the British Association of Oral and Maxillofacial Surgeons. An 87% response rate was obtained (26 respondents from 30 invitations). 73.1% of participants confirmed all surgical members of staff were offered fit tests for FFP3 masks. All units reported a continuation of Head and Neck cancer and emergency operations with a complete reduction in TMJ and orthognathic surgery. FFP3 masks were the most popular masks used for theatre activity whilst FFP2 and surgical masks were more widely used for examining patients and performing procedures in the emergency department. Changes in maxillofacial practice included the use of local flaps compared to free flaps, use of intermaxillary fixation (IMF) where appropriate for craniofacial trauma and routine COVID-19 testing for all inpatients., Competing Interests: Declaration of competing interest None., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

The rise of the COVID-19 pandemic has posed new challenges for health care institutions. Restrictions imposed by local governments worldwide have compromised the mobility of patients and decreased the number of physicians in hospitals. Additional requirements in terms of medical staff security further limited the physical contact of doctors with their patients, thereby questioning the traditional methods of clinical examination. Our institution has developed an organization model to translate the essential clinical services into virtual consultation rooms using a telemedicine interface which is commonly available to patients. We provide examples of clinical activity for a maxillofacial surgery department based on teleconsultation. Our experience is summarized and an organization model is drafted in which outpatient consultation offices are translated into virtual room environments. Clinical examples are provided, demonstrating how each subspecialty of oral and maxillofacial surgery can benefit from virtual examinations. The concept of "telesemeiology" is introduced and a checklist is presented to guide clinicians to perform teleconsultations. This paper is intended to provide an organization model based on telemedicine for maxillofacial surgeons and aims to represent an aid for colleagues who are facing the pandemic in areas where lockdown limits the possibility of a physical examination.

Several uncertainties exist regarding how we will conduct our clinical, didactic, business, and social activities as the coronavirus disease 2019 (COVID-19) global pandemic abates and social distancing guidelines are relaxed. We anticipate changes in how we interact with our patients and other providers, how patient workflow is designed, the methods used to conduct our teaching sessions, and how we perform procedures in different clinical settings. The objective of the present report is to review some of the changes to consider in the clinical and academic oral and maxillofacial surgery workflow and, allow for a smoother transition, with less risk to our patients and healthcare personnel. New infection control policies should be strictly enforced and monitored in all clinical and nonclinical settings, with an overall goal to decrease the risk of exposure and transmission. Screening for COVID-19 symptoms, testing when indicated, and establishing the epidemiologic linkage will be crucial to containing and preventing new COVID-19 cases until a vaccine or an alternate solution is available. Additionally, the shortage of essential supplies such as drugs and personal protective equipment, the design and ventilation of workspaces and waiting areas, the increase in overhead costs, and the possible absence of staff, if quarantine is necessary, must be considered. This shift in our workflow and patient care paths will likely continue in the short-term at least through 2021 or the next 12 to 24 months. Thus, we must prioritize surgery, balancing patient preferences and healthcare personnel risks. We have an opportunity now to make changes and embrace telemedicine and other collaborative virtual platforms for teaching and clinical care. It is crucial that we maintain COVID-19 awareness, proper surveillance in our microenvironments, good clinical judgment, and ethical values to continue to deliver high-quality, economical, and accessible patient care., (Copyright © 2020 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

The emergence of coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 (SC2) virus, in late December 2019 has placed an overwhelming strain on healthcare institutions nationwide. The modern healthcare system has never managed a pandemic of this magnitude, the ramifications of which will undoubtedly lead to lasting changes in policy and protocol development for viral testing guidelines, personal protective equipment (PPE), surgical scheduling, and residency education and training. The State of Washington had the first reported case and death related to COVID-19 in the United States. Oral and maxillofacial surgeons have a unique risk of exposure to SC2 and developing COVID-19 because of our proximity of working in and around the oropharynx and nasopharynx. The present report has summarized the evolution of COVID-19 guidelines in 4 key areas: 1) preoperative SC2 testing; 2) PPE stewardship; 3) surgical scheduling guidelines; and 4) resident education and training for oral and maxillofacial surgery at the University of Washington, Seattle, Washington., (Copyright © 2020 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: Smartphones have become very popular among oral and maxillofacial surgeons. WhatsApp is an application that enables users to send voice, text, and multimedia messages using the group communication feature. The purpose of this study was to evaluate the efficiency of WhatsApp messaging as a mode of consultation within an oral and maxillofacial surgery team., Materials and Methods: A retrospective study on WhatsApp group conversations amongst oral and maxillofacial surgeons was performed between July 2015 and July 2016. A WhatsApp group consisting of senior and junior surgeons was created, and many consultations were recorded. Seven hundred fifty-six consultations were included in the study. In this study, the arrival and response times of messages, types of cases, timing of consultation's end, consultant locations, contents of multimedia messages, and the categories/types of messages were evaluated. During consultations, some cases were discussed with text messages via WhatsApp, and some cases with voice and image messages via WhatsApp, with or without WhatsApp text messages. In addition, several cases were discussed with video messages via WhatsApp. Thus, a total of 1747 messages reflecting four different message types were included in this study: 754 (43%) were text messages, 752 (43%) were photographic images, 213 (12%) were videos, and 28 (nearly 2%) were voice messages., Results: The most frequent consultations concerned impacted teeth (n = 363, 48.01%). Most consultations were resolved using WhatsApp (n = 306, 64.4%), and consultants were often not in the hospital during these consultations (n = 411, 54.3%). Most messages sent by consultants were conclusive (n = 306, 74.4%)., Conclusion: We conclude that WhatsApp is a simple, free, and practical application, which allows efficient consultation when consultants are not in the hospital., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Managing an oral and maxillofacial surgery (OMS) practice has undergone dramatic changes. Electronic health records, privacy laws, revenue cycle management, online marketing, and the rise of dental service organizations (DSOs) present increased daily complexity for oral and maxillofacial surgeons in private practice, hospital-based employees, and academic surgeons. This article is structured to discuss the role of DSOs, private equity in OMS, online practice marketing, accounting and tax considerations, and modern essentials of practice management., (Copyright © 2019 Elsevier Inc. All rights reserved.)

A busy head and neck or oral and maxillofacial (OMFS) National Health Service (NHS) clinic treats patients with many different conditions. A large proportion will have cancer of the head and neck, and they will be at different stages of their treatment. Their clinical needs may be different from a larger group of patients who have been referred through the "two-week wait" referral pathway, and who are present in the same clinic for their biopsy results. We present our early experience of "fast-track" referrals and their potential effect on the overall volume of work. They are only a small number of the patients who are typically seen in a nurse-led clinic., (Copyright © 2018 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

China is currently in the process of establishing formal residency training programs in oral and maxillofacial surgery and other medical and dental specialties. Regulatory agencies, and educational and academic institutions in China are exploring mechanisms, goals and standards of residency training that meet the needs of the Chinese healthcare system. This article provides an introduction of residency training in oral and maxillofacial surgery in the United States, with emphasis on the accreditation standard by the Commission on Dental Accreditation. As there are fundamental differences in the medical and dental education systems between China and United States, the training standards in the United States may not be entirely applicable in China. A competency-based training model that focus on overall competencies in medical knowledge, clinical skills and values at the time of graduation should be taken into consideration in a Chinese residency training program in oral and maxillofacial surgery.

Purpose: Clinical pathways have become an important and simple method of improving patient outcomes and decreasing health care resource usage. The purpose of this study was to evaluate early outcomes associated with the implementation of a clinical pathway in a maxillofacial head and neck surgery unit., Materials and Methods: This investigation is a retrospective cohort study of patients who underwent microvascular reconstruction of the head and neck from January 1, 2014 through December 31, 2014. Continuous variables were compared among 4 groups using analysis of variance or Kruskal-Wallis test, and categorical variables were compared using χ 2 test or Fisher exact test where appropriate. The primary predictor variable was use of the clinical pathway. Groups included patients treated by surgeon A during periods before and after implementation of a postoperative clinical pathway. Two groups treated by surgeon B also were evaluated during the same periods and served as external controls. Each period covered a span of 6 months. Outcome variables across groups were evaluated, including length-of-stay metrics, infection rates, transfers to the intensive care unit, and unplanned return to the operating room., Results: Sixty-six patients who underwent microvascular head and neck reconstruction were included. There was a significant decrease in the average length of stay (P = .0364) and an increase in the rate of discharge within 7 days (P = .0416) in the group treated with the clinical pathway. Other outcomes, including infection rate, transfer to the intensive care unit, and unanticipated return to the operating room, showed no relevant difference among groups., Conclusions: The results of this study suggest that implementation of a clinical pathway can be beneficial for efficient management of postoperative care in the setting of microvascular head and neck reconstruction. More predictable and shorter lengths of stay are achievable and the clinical pathway serves as a valuable means of improving communication of the clinical care team., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Spain is the second largest EU Member State with an area of 504,645 km(2) and is the fifth most populated one with a total of 46.5 million inhabitants. The number of dentists working in Spain has grown rapidly in the last 20 years. In December 2014, there were 33,346 practising dentists with a ratio of one dentist for every 1394 inhabitants. Oral health of children has improved; with a fall in the national mean DMFT index (decayed, missing and filled permanent teeth) among 12-year-olds, from 4.20 in 1984 to 1.12 in 2010. The percentage of the population that has visited a dentist within the last three months has risen from 13.5% (1987) to 16.9% (2011-2012). Forty-three percent of the Spanish population visited a dentist in the last year in 2009. The Spanish National Health System (SNS) provides comprehensive cover for general health, but very little oral healthcare for adults. Only emergency care and oral surgery (dental extractions) for adults are provided in publicly funded clinics. The vast majority of oral health care is provided in the private sector and over 90% of dental professionals work in the private sector. Nevertherless, children aged 7-15 years are covered (with some restrictions) by publicly funded oral healthcare with different care models, depending on the local health authority, and some of them are funded by a capitation system which was introduced 25 years ago.

Objectives: The authors explored consistency of the observed running order in operating sequence compared with prior scheduled listing. We analysed potential variables felt to be predictive in the chances of a patient having their procedure as previously scheduled., Methods: Data were retrospectively collected for a consecutive group of patients who underwent elective maxillofacial procedures over a four week period. The consistency of scheduled and observed running order was documented. We considered four independent variables (original list position, day of week, morning or afternoon list, seniority of surgeon) and analysed their relationship to the probability of a patient undergoing their operation as per listing. Logistic regression analysis was used to determine significant associations between predictor variables with an altered list order., Results: Data were available for 35 lists (n = 133). 49% of lists were found to run according to prior given order, the remainder subject to some alteration. Logistic regression analysis showed a statistically significant association between original scheduled position and day of week, with list position consistency. Patients listed first were twelve times more likely to have their operation as listed compared to those placed fourth (OR 12.7, 95% CI 3.7-43, p < 0.05). Operating lists at the start of a week were subject to less alteration (p < 0.05). There was no demonstrated relationship between the grade of surgeon operating and alteration in operating sequence., Conclusion: Approximately half of lists showed some alteration to the previously printed order. It appears that being first on an elective list offers the greatest guarantee that a patient will have their operation as per prior schedule. It may be reasonable for clinicians to be mindful of potential operating list alterations when preparing their patients for elective surgery., (Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Objective: To report the findings of an evaluation of an NHS dental practice-based minor oral surgery service., Basic Research Design: Service evaluation., Clinical Setting: NHS specialist practice in England., Participants: Patients and referring practitioners., Interventions: analysis of activity, patient and referring practitioner satisfaction data., Main Outcome Measures: Numbers and case-mix treated; non-attendance; antibiotic prescribing; complication rates; patients and referring practitioner satisfaction., Results: 5,796 treatment appointments were arranged, with a median waiting time from receipt of referral to treatment of 35 days. Treatment provided included: surgical removal of third molars and non-third molars, surgical endodontics and other surgical and oral medicine cases (28.3%, 53.3%, 3.5%, and 15.0% of cases, respectively). Antibiotics were prescribed at 13.1% of all treatment appointments and 2.5% required appointments for post-operativecomplications. All but one patient reported overall satisfaction and over 98% strongly agreed/agreed with positive attitudinal statements about the oral surgeon's communication/information giving, technical competence and understanding/acceptance. 70.1% of patients were seen on time and under 1% were seen more than 15 minutes late. Some 83.1% felt the standard of service was better than expected from a hospital and none felt it was worse. More than 85% of referring practitioners agreed that: waiting times were shorter than at the hospital; urgent problems were seen quickly; and, the referral process was easy and understandable. Over 98% either strongly agreed or agreed that they were happy with the service provided., Conclusions: A range of minor oral surgery procedures can be provided with low complication rates, short waiting times, acceptable accessibility and high levels of patient and referring practitioner satisfaction from a specialist NHS dental practice-based service.

Orthognathic surgery is a frequent procedure at Swedish Oral and Maxillofacial Surgery Departments.The number of clinical and radiographic postoperative follow-up examinations and the choice of radiographic methods seem to vary.The intention with this study was to find out when postoperative clinical and radiographic follow-up was performed following orthognathic surgery and the type of radiographic examinations that were used. In 2009, all Swedish Oral and Maxillofacial Surgery Departments in the Public Health Service (25 centres) were given a form containing standardized questions on the time for clinical follow-up after orthognathic surgery and the radiographic examinations used. A pilot study on 49 consecutive patients at one of the centres was performed to determine if the postoperative radiographic examinations added additional information, leading to further procedures compared to the clinical observations only. A one-year follow-up was the most frequently used clinical control reported by 15 centres, and a six-month follow-up, the next most frequent. At 14 of the 15 centres, radiographic examinations were included at the one-year follow-up. A five-year clinical and radiographic follow-up was reported by two centres. One or, at the most, two postoperative radiographic follow-up sessions were reported by 68% of the centres. Profile and panoramic imaging were most often used. In the evaluation of the postoperative handling of the 49 consecutive patients in the pilot study, a radiolucency around a fixation screw noted radiographically was the only additional postoperative radiological finding that resulted in a surgical procedure. Postoperative clinical and radiographic follow-up routines following orthognathic surgery vary considerably between the Swedish Oral and Maxillofacial Surgery Departments.There appears to be a need for studies on the value of the information,which repeated postoperative clinical and radiographic follow-up controls add in routine medical attendance.

Objective: To understand the current status of the discipline and work out the developmental tactics of oral and maxillofacial surgery in China., Methods: A questionnaire on the status of oral and maxillofacial surgery was designed and dispatched to the departments of stomatology in general hospitals at the level of prefecture or higher, stomatological hospitals and schools of stomatology. The contents of the questionnaire included the scale, manpower, professional extent, amount of clinical work and professional training of oral and maxillofacial surgery. The current status was compared with the previous status 5 and 10 years ago., Results: In the most institutions which were surveyed, the number of oral and maxillofacial surgeons, beds and out-patients increased, the professional extent enlarged, and the clinical level improved. However, the above-mentioned clinical parameters decreased in some basic level institutions. The number of graduate students and trainees of oral and maxillofacial surgery decreased in one-third of institutions., Conclusions: The discipline of oral and maxillofacial surgery is continuously developing, but it is weakened in some basic level institutions. An effective developmental tactics should be carried on to improve the competition capability of the discipline.

Objective: The purpose of this study was to determine an epidemiologic profile of the patients hospitalized and/or operated on by an oral and maxillofacial surgery service in Brazil., Materials and Methods: A retrospective and descriptive epidemiologic survey of the Oral and Maxillofacial Surgery Service from Saint Lucas Hospital at the Pontifical Catholic University, Porto Alegre, Brazil, from January 2000 to December 2005, was performed. Data related to the number, sex, age, service year, as well as surgical modalities performed, instituted treatments, and length of stay, were collected from the hospital's handbooks., Results: A total of 1117 patients were attended during the 6 years of study, with a decreasing tendency throughout the years (P = 0.022). There was female predominance (54%), between 10 and 40 years old, and attended via public health system (56%). Among surgical modalities performed, dentoalveolar surgery was the most prevalent (22.9%), followed by the orthognathic surgeries (21.4%), facial fractures (18%), pathologic condition surgeries (16.7%), and dental implants and grafts (13.7%). Surgeries of patients with cleft lip and/or palate (3.4%), treatment of maxillofacial infections (2.95%), and temporomandibular joint surgeries (1%) were less frequent., Conclusions: The information presented in this research elicited data to clarify the type of attendance performed by the service, being a cornerstone for planning, organization, and attention improvement of these patients. In addition, this information can compare with data among services, specialty acting fields, as well as, its impact in hospital activities.

Aims: This study surveyed members of the Oral Surgery (OS) register and requested a self assessment of their surgical competencies with regard to both core and extended procedures, as defined by the OS curriculum. Details of education, training backgrounds and working patterns were also requested., Methods: Members of the OS register were identified on the General Dental Council website and mailed a questionnaire. Replies were anonymous., Results: Three hundred and seventy-three valid replies were received. Seventy-five percent of respondents were on the OS specialist list only (single registrants) and 25% of respondents were on both the OS and oral and maxillofacial surgery (OMFS) specialist lists (dual-registrants). Sixty-two percent of single registrants did not feel comfortable performing all core procedures compared to 13% of dual-registrants. Fifty-one percent of OS single registrants felt comfortable performing some extended procedures, as did 99% of dual-registrants. Fifty percent of single registrants and 100% of dual-registrants had a higher qualification. Thirty-seven percent of single registrants had undergone some formally-approved registrar-level training; 98% of dual-registrants had done likewise. Twenty-one percent of single registrants practised exclusively in the private sector compared to 8% of dual-registrants., Conclusion: Extended competencies are being practised by members of the OS register with wide-ranging educational and training backgrounds.

Objective: To determine whether alveolar bone graft outcomes improved with reorganization of Scottish cleft services following the Clinical Services Advisory Group United Kingdom finding of 58% success and to determine the accuracy of results from CLEFTSiS (national managed clinical network for Scottish cleft services) annual audits., Design: Retrospective random analysis of electronic radiographs by two observers., Setting: Surgical-orthodontic care provided through National Health Service., Patients, Participants: Sixty-three of 261 patients eligible for alveolar bone grafting by cleft type did not undergo surgery. Nine surgeons operated on 198 patients (2 regrafts). Radiographs were available for 115 subjects (one was excluded)., Interventions: A standard protocol involved presurgical maxillary expansion (where necessary) and bone harvesting from the iliac crest., Main Outcome Measure(s): The Kindelan Bone-Fill Index evaluated radiographic success with weighted kappa statistics for intraobserver and interobserver reproducibility. Two-sample t-tests were used to determine whether outcomes for ilateral and unilateral cleft lip and palate patients differed and to examine the effects of operator volume, presurgical expansion, and age at the time of grafting., Results: Intraobserver (0.93 to 0.97) and interobserver (0.83 to 0.85) reproducibility were almost perfect. Grafts were successful in 76% of patients, while 23% were partial failures and 1% of cases were total failures. Patients who underwent presurgical expansion (n = 64) had statistically significantly better results (p = .046). However, there was no statistically significant effect for unilateral versus bilateral patients (p = .77), patients treated by the highest volume operator (p = .78), and patients under 11 years of age (p = .29)., Conclusions: CLEFTSiS alveolar bone graft results between 2000 and 2004 were improved on the Clinical Services Advisory Group study and annual CLEFTSiS audits. Patients who underwent maxillary expansion prior to surgery were more successful.

This paper describes the innovative use of National Health Service (NHS) dental commissioning powers to develop specialist primary care based oral surgery services. The outcomes, after one full year of the scheme, have been substantial improvement in access and reduced waiting times for patients, further development of NHS primary care dental services through commissioning processes, increased use and engagement of oral surgery specialists outside of a hospital setting, and considerable ongoing savings to the NHS. Collaborative working between hospital consultants and managers, Primary Care Trust dental commissioners, general dental practice providers, specialist oral surgeons and a dental public health consultant has resulted in sustainable benefits to patients and the NHS within the World Class Commissioning framework.