After odontogenic pain, temporomandibular disorders (TMDs) are one of the most common causes of pain in the mouth and face and also have the potential to produce persisting (chronic) pain. 1 2 Chronic or persistent (myogenous) TMDs can be associated with other chronic pain conditions, 3 including migraine, fibromyalgia, and widespread pain. [4][5][6][7][8] They are also known to be comorbid with bruxism, depression, irritable bowel syndrome, and chronic fatigue. 6 9 10 With or without these comorbidities, TMDs are recognised to have a considerable impact on quality of life. [11][12][13][14][15][16][17] Early diagnosis and explanation followed by management is likely to be key to improving prognosis and reducing the impact of this group of conditions on quality of life. 11 18 The purpose of this review is to give non-specialists an overview of the diagnosis and management of TMDs.
Objectives: Patient safety is an important issue in health care. In the United Kingdom, wrong site tooth extraction contributes to a significant proportion of adverse or harmful events, coined "never events." Therefore, patient safety within the field of dentistry is of paramount importance. This novel study aims to explore the teaching of patient safety to undergraduate dental students and their current attitudes to the subject. Methods: Focus groups were held at Barts' and The London School of Medicine andDentistry, QMUL in 2018 to ascertain the views and opinions of thirteen third-year dental undergraduate students.Results: Thematic analysis was performed on verbatim transcripts. Key themes were highlighted. All students could provide a complete definition of patient safety and of "never events," with examples. There was a strong emphasis upon awareness of one's own competence and the need for effective communication to maintain patient safety. Small group teaching and the requirement for standardization of teaching were encouraged. The challenge of incorporation of the patient safety concept into the clinical routine without causing repetition during teaching was highlighted. Conclusion:The results show a positive attitude towards the concept and the teaching of patient safety. All students understood patient safety concepts and techniques used to prevent adverse or harmful events. This study proves that teaching on the subject was thought to be of value. It is crucial that the teaching of patient safety is introduced and built upon within the early years of dental undergraduate training so that its practice becomes second nature.
There has been a rise in nonsurgical cosmetic procedures seen within the UK population in the past decade. A change in legislation has placed restrictions on the distribution and provision of such treatments. Therefore, patients may seek alternative methods to bring about a change to their appearance, such as self-injection of a filler. Complications may include oral ulceration, foreign body tissue reaction, and infection due to a lack in sterility during injection. Such presentations may mimic that of oral cancer and can lead to misdiagnoses and undue cost to the National Health Service. This case highlights the common features leading to correct identification of patients self-injecting with facial fillers and discusses the controversy surrounding the economic aspects of their care. We would like to report one such case presenting to our oral and maxillofacial surgical unit.
Temporomandibular disorders (TMDs) are a group of conditions which affect the temporomandibular joint and its associated musculature. 1 TMDs are the most common type of non-odontogenic orofacial pain and have the potential to produce persistent pain. 2 It is known that the majority of TMD cases respond well to simple, reversible therapies. [3][4][5] One such therapy is supported self-management (SSM) (also termed 'self-care' within the literature). SSM programmes are often complex, multimodal interventions which include several different techniques aimed at changing the behaviour of the patient. Due to the number of different SSM programmes available within the literature, it is still unknown which intervention or components are the most effective and no gold standard for treatment exists.A previous systematic review 6 undertaken by one of the authors used multiple sources 7-10 to define SSM interventions in respect of TMD: Supported self-management programmes in TMD encompass a range of activities that, after some limited guidance from health care professionals,
Temporomandibular disorders (TMD) are a common chronic pain problem within the population. 1 These disorders can be classified using the Diagnostic criteria for Temporomandibular Disorders (DC/TMD) into three broad groups; muscle disorders; disc displacements and other common joint disorders. 2,3 These criteria are used worldwide and are known to be actuated. Pain associated with TMD affects not only the temporomandibular joint itself but also other structures including the head, neck, ear, back and teeth. [4][5][6] Further to this, TMD can have a significant impact on the quality of a patient's life such as sleep deprivation, difficulty in function and psychosocial aspects associated with chronic pain. 7,8 The literature reports the prevalence of TMD in children to be varied from 1% to 50%. [9][10][11][12] In recent years, there has been a reported increase in children presenting with myofascial pain, as diagnosed using the DC/TMD criteria, to their general dental practitioners, to community dental services and secondary care providers.
Patients with persistent orofacial pain (POFP) can go through complex care pathways to receive a diagnosis and management, which can negatively affect their pain. This study aimed to describe 44-y trends in attendances at Welsh medical practices for POFP and establish the number of attendances per patient and referrals associated with orofacial pain and factors that may predict whether a patient is referred. A retrospective observational study was completed using the nationwide Secure Anonymised Information Linkage Databank of visits to general medical practices in Wales (UK). Data were extracted using diagnostic codes (“Read codes”). Orofacial and migraine Read codes were extracted between 1974 and 2017. Data were analyzed using descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 468,827 POFP and migraine diagnostic codes, accounting for 468,137 patient attendances, or 301,832 patients. The overall attendance rate was 4.22 attendances per 1,000 patient-years (95% confidence interval [CI], 4.21–4.23). The attendance rate increased over the study period. Almost one-third of patients ( n = 92,192, 30.54%) attended more than once over the study period, and 15.83% attended more than once within a 12-mo period. There were 20,103 referral codes that were associated with 8,183 patients, with over half these patients being referred more than once. Odds of receiving a referral were highest in females (odds ratio [OR], 1.23; 95% CI, 1.17–1.29), in those living in rural locations (OR, 1.17; 95% CI, 1.12–1.22), and in the least deprived quintile (OR, 1.39; 95% CI, 1.29–1.48). Odds also increased with increasing age (OR, 1.03; 95% CI, 1.03–1.03). The increasing attendance may be explained by the increasing incidence of POFP within the population. These patients can attend on a repeated basis, and very few are referred, but when they are, this may occur multiple times; therefore, current care pathways could be improved.
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