Oral submucous fibrosis (OSF) is a chronic progressive condition affecting the oral cavity, oropharynx and upper third of the oesophagus. It is a potentially malignant disorder. The authors collated and analysed the existing literature to establish the overall malignant transformation rate (MTR). A retrospective analysis of medical and dental scientific literature using online indexed databases was conducted for the period 1956 to 2021. The quality of the enrolled studies was assessed by the Newcastle-Ottawa Scale (NOS). A meta-analysis using a random effects model of a single proportion was performed along with statistical tests for heterogeneity. The overall proportion of malignancy across all studies was 0.06 (95% CI, 0.02–0.10), indicating an overall 6% risk of malignant transformation across all studies and cohorts. Sub-group analyses revealed strong differences in proportion of malignancy according to ethnicity/cohort; Chinese = 0.02 (95% CI 0.01–0.02), Taiwanese = 0.06 (95% CI, 0.03–0.10), Indian = 0.08 (95% CI, 0.03–0.14) and Pakistani = 0.27 (95% CI 0.25–0.29). Overall, the MTR was 6%; however, wide heterogeneity of the included studies was noted. Geographic variations in MTR were noted but were not statistically significant. Further studies are required to analyse the difference between cohort groups.

In this commentary, we discuss the short‐term and long‐term implications of COVID‐19 on postgraduate dental training in the UK, specifically Dental Core Training (DCT) and Specialty Training. Although this commentary focuses on the authors’ experiences within Guy's and St Thomas’ NHS Foundation Trust (GSTT) in London, we hope that our viewpoint will resonate with dental postgraduate trainees across Europe and may guide further discussion in this area. We also reflect on adaptations that may be required if there are any future disruptions to dental postgraduate training in the UK.

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Haematuria is a common feature of haemophilia and von Willebrand's disease, as many as 90% of severely affected patients having at least one episode in their lifetime.' The clinical course is well documented, usually arising and resolving spontaneously even before the advent of specific treatment.2 It has been shown not to be associated with progressive loss of renal function and is generally believed to be benign. Two months later a similar episode occurred and was complicated by bladder outflow obstruction secondary to clot. Results of urine bacteriology and of biochemical investigations were again normal. Haemoglobin concentration had fallen to 12-7 g/dl, blood film showed early iron deficient changes, and white cell count was normal. An intravenous urogram showed a normal kidney and collecting system on the left, while on the right a large dense nephrogram was apparent with delayed excretion of dye (fig 1). The right ureter was not visualised at any stage in the examination, and the dense nephrogram was still present on the two hour film. These appearances were compatible with obstruction, probably secondary to blood clot in the ureter. Again the haematuria settled with cryoprecipitate and fluids. A further admission was required one month later for haematuria and renal colic. The patient denied any other symptoms and his general health was otherwise good. There were no abnormal findings on physical examination. Biochemical and bacteriological investigations again showed no abnormalities, haemoglobin was 13-2 g/dl, and blood film and white cell count were normal. An isotope renogram showed reduced function and obstruction on the right, and the differential function was 80% (left) to 20%/o (right). function and obstruction and showed good perfusion to the upper pole ofthe right kidney with normal excretion; differential function was within normal limits. Two months later the haematuria and renal colic recurred: there were no other symptoms, and results of physical examination and bacteriological and biochemical investigations were once again normal. Haemoglobin concentration had fallen to 11 -8 g/dl, with an iron deficient film and normal white cell count. Cystoscopy and right sided retrograde pyelography showed no abnormality, apart from slight blunting of the calices, which was considered to be due to the infusion pressure of the dye. We therefore thought that this was a coagulation rather than a structural renal problem and prophylactic treatment with cryoprecipitate was continued. After a further episode of haematuria treatment was augmented with the anti--1648

Background Biologic agents are rapidly emerging as an effective therapy to treat autoimmune and other chronic diseases. The use of these agents is poorly characterized, resulting in a lack of guidance for dental practitioners. Case reports of oral adverse events have begun to emerge. However, their scope and frequency have not been summarized and analysed to date. The objective of this review was to characterize the literature on oral adverse effects associated with biological therapy when used for autoimmune and inflammatory disorders. Methods This review was developed in accordance with scoping review recommendations. Search strategies were developed and employed for six databases. Studies were selected using a systematic search process but with broad inclusion of study types given the paucity of information available. Reports of oral adverse events were analysed descriptively according to agent, mechanism of action, underlying disease, and oral adverse effect observed. Results Our search returned 2080 articles and 51 met our inclusion criteria, of which most were case reports. The most frequent adverse effects included angioedema, oral lichenoid lesions, osteonecrosis of the jaw, and oral infections. There were also cases of oral malignancies associated with use of biologic agents. Less common effects such as pigmentation were also described. Conclusions Oral adverse events have been reported in patients on biologic therapy, albeit in small numbers to date. This limits the generalizability of these results, which should not be used to generate a clinical guideline as they are based primarily on case reports. However, this study presents the first review characterizing the adverse effects observed. Large multi‐center studies will be necessary to further define the oral and dental complications caused by biologic agents.

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Type 1 hereditary angioedema (HAE) is a rare genetic condition characterized by recurrent episodes of oedema caused by a deficiency of C1-esterase inhibitor (C1-INH). A 29-year-old male presented to the oral medicine department at Guy's Hospital, London, with lip swelling following crown preparation and impressions. Haematological investigations showed reduced levels of complement C4 (0.02 g/L; reference range 0.1–0.4 g/L) and C1-INH function was <31% (reference range 85–99%). Immunology confirmed the diagnosis of type 1 HAE, with a de novo mutation. This case highlights how a detailed medical history and multidisciplinary teamwork ensure the correct diagnosis and management. CPD/Clinical Relevance: To demonstrate the various dental triggers, relevant signs and symptoms, and management options for patients diagnosed with hereditary angioedema to allow for effective decision-making in a primary dental setting.

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