Introduction: A number of patients are routinely prescribed antiresorptive drugs that can be associated with developing medicationrelated osteonecrosis of the jaw (MRONJ). When presenting to a dental setting, the majority are unaware of the small but relative risk of developing MRONJ. Prevention is currently the only evidence-based method of reducing the incidence of MRONJ. Raising awareness of MRONJ could encourage GMPs to liaise with dental clinicians for premedication screening, preventative advice and specialist referrals. Methods: An electronic survey consisting of 16 multiple-choice questions, targeting GMPs and GMP trainees in Birmingham was conducted to evaluate their knowledge and awareness of MRONJ. A section for open comments was available. This was conducted between March and May 2016. Results: 71% of the 49 participants surveyed, were aware of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and 6% were aware of the change in terminology to MRONJ. 56% of participants were aware of associated medications and 11% always mentioned the risk when prescribing relevant medications. 67% would not consider seeking a dental opinion prior to commencing these medications. 75% were unaware of the clinical presentation of MRONJ and 92% were unaware of associated guidelines. Encouragingly, 78% of the participants were interested in receiving further information and training. Conclusions: This survey highlights the limited knowledge and training that GMPs and trainees in the West Midlands have regarding MRONJ. By raising awareness of this condition through leaflets and teaching, we can educate our colleagues and also encourage a more holistic management approach to this patient cohort.
Clinical RelevanceScientific rationale for study A number of patients are routinely prescribed antiresorptive medications that can be associated with developing medication related osteonecrosis of the jaw (MRONJ). These patients may be unaware of the small risk of developing MRONJ. Prevention is currently the only evidence-based method of reducing the incidence of MRONJ. This article evaluates the awareness of MRONJ amongst the Birmingham general medical practitioner community.
Principal findings77% of participants were aware of bisphosphonaterelated osteonecrosis of the jaw (BRONJ) and 6% were aware of the change in terminology to MRONJ. 56% were aware of associated medications and 11%Oral Surgery 12 (2019) 22--29.
This study examined the ways in which the meaning of 'sexual problems' is constructed and defined in undergraduate human sexuality textbooks. Drawing on feminist and critical discourse frameworks, the dominant as well as the absent/marginalized discourses were identified using critical discourse analysis. Sexual difficulties were largely framed by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. Thus, medical discourse was privileged. Alternative conceptualizations and frameworks, such as the New View of Women's Sexual Problems, were included marginally and peripherally. We argue that current constructions of sexuality knowledge reinforce, rather than challenge, existing hegemonic discourses of sexuality.
Objective
To gather patients’ and primary care physicians’ (PCP) opinions on trauma-informed Care (TIC) and to investigate the acceptability of recommendations developed by patient, family, and physician advisors.
Design
Cross-sectional research survey design and patient engagement.
Setting
Canada, 2017 to 2019.
Participants
English-speaking adults and licensed PCPs residing in Canada.
Main outcome measures
Participants were given a series of questionnaires including a list of physician actions and a list of recommendations consistent with TIC.
Results
Patients and PCPs viewed TIC as important. Both patients and PCPs rated the following recommendations as helpful and likely to positively impact patient care: physician training, online trauma resource centres, information pamphlets, the ability to extend appointment times, and clinical pathways for responding to trauma. PCPs’ responses were significantly more positive than patients’ responses.
Conclusion
TIC is important to patients and PCPs. Patients and PCPs believe changes to physician training, patient engagement, and systemic factors would be helpful and likely to positively impact patient care. Future research needs to be conducted to investigate whether these recommendations improve patient care.
Introduction
Gorlin Goltz syndrome (GGS) is a rare, hereditary, AD condition with multiple BCCs, odontogenic keratocysts (Jaw cysts), calcification of falx cerebri, skeletal anomalies & a predisposition to neoplasms like medulloblastomas, fibromas and rhabdomyosarcomas.
Aim
We present a rare case of a Squamous cell carcinoma (SCC) developing in a Maxillary odontogenic keratocyst in a 32-year male with GGS.
Discussion
This patient was referred to the OMFS unit with a non-healing UL3 extraction socket and exophytic growth. Initial biopsies suggested an atypical squamo-proliferative lesion, however a repeat biopsy demonstrated an invasive SCC arising from a background odontogenic keratocyst of the maxilla. He was initially reluctant to undergo a staging CT scan to avoid risks of developing further BCCs due to IR exposure. This was eventually performed as per H&N MDT recommendation & showed a T4aN0M0 SCC of the left maxilla and bilateral multiple mandibular odontogenic keratocysts. He underwent a left maxillectomy, left neck dissection & reconstruction with a DCIA free flap, but did not want his mandibular keratocysts treated at the same time. Complete tumour clearance was achieved with no involved neck nodes & he remains disease-free at 4 months postoperatively. Although for a T4 tumour he would have needed postoperative radiotherapy, in view of the GGS, no adjuvant treatment was indicated.
Conclusions
SCC developing in a maxillary OKC is exceedingly rare with only two previous cases reported in GG syndrome. This is the first reported case of a GGS patient with oral SCC undergoing a complex free flap reconstruction.
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