First Bite Syndrome (FBS) is a painful condition which classically presents as severe pain in the pre‐auricular region, initiated on the first bite of a meal. It is usually associated with a history of upper neck surgery or tumour of the parotid salivary gland or parapharyngeal space (PPS). Some propose that FBS arises from damage to, or resection of, the cervical sympathetic trunk resulting in loss of sympathetic innervation to the parotid salivary gland. Idiopathic FBS has been reported only a handful of times in the literature. We present the case of a 51‐year‐old male, urgently referred to the Department of Oral Medicine, with a 3‐week history of severe, sharp, unilateral pain from the right angle of mandible, intensity described as ‘20/10', occurring only on the first bite of eating. This would diminish over 2 min. Clinical examination revealed tenderness over the right condylar neck and angle of mandible only. FBS was suspected and the patient immediately started on carbamazepine. An urgent MRI displayed no abnormalities of the temporomandibular joints, PPS, trigeminal nerve or parotid gland. Restorative Dentistry review confirmed no odontogenic or occlusal cause and on review, 4 months later the patient reported complete resolution of symptoms on 200 mg of carbamazepine three times daily. This case highlights the importance of taking a thorough pain history. Patients with symptoms of FBS and no history of surgery to the neck should have an MRI to rule out parotid gland or PPS tumour. Carbamazepine can be successful in treating idiopathic FBS and can resolve symptoms completely.
Background Due to the COVID-19 pandemic orthognathic surgery was suspended in the UK. The effect this had on patients, to date, is unknown. Aim: A multi-centre, cross-sectional survey was conducted in the UK to investigate the health-related impact for patients on the orthognathic surgery pathway, including those on the waiting list for surgery . Method : A structured questionnaire was designed to explore the impact of the pandemic on the patients whose orthognathic treatment was temporarily cancelled. Results: Ninety-five questionnaires were returned giving a response rate of 65%. When asked if the delay due to the pandemic had caused emotional distress, 63% (51/81) agreed. Respondents experienced more distress, in relation to dental appearance (60%, 51/83), self-confidence (52% 50/83), facial appearance (53%, 44/83) and ability to eat and chew (59%, 50/83) during the pandemic. One hundred percent of patients would have had appliances fitted or their appliances adjusted during the pandemic and 93% percent of patients stated that they would attend for surgery if they were offered this during the pandemic. In conclusion, patients appear to have experienced emotional distress in relation to the delay with their orthognathic treatment. The patients should be given greater priority, during the remobilisation of elective surgery. They should have access to ongoing psychological support, where delays affect their treatment. The “surgery-first” approach may be considered, for suitable patients, to minimise the duration of the treatment journey.
Completion of an elective project at the University of Glasgow Dental School is a progression requirement that entails a period of self-directed and enquiry-led learning. This study sought to uncover students’ expectations and perspectives of their elective experience as there is a scarcity of supporting literature to determine if this activity has significant educational value. This qualitative study utilised a participatory research methodology,ensuring that students were at the centre of the enquiry process. Three student co-researchers analysed data collected from their peers, using a questionnaire and a focus group meeting. The findings support maintaining autonomous, enquiry-led, independent learning-focused electives and also highlight aspects of the elective which students particularly valued. This has allowed a deeper understanding of students’ perceptions of, and motivations for, particular elective projects, enabling the elective programme to respond to changing environments in education and global health. The outcomes of this study have informed the redesign of the dental elective study programme and the associated quality assurance process.
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