Chemical constituents, viable micro-organism and malignant cell content in ultrasonic scalpel plume: A literature review

PURPOSE

To identify all published data on the chemical, micro-organism and malignant cell contents of ultrasonic scalpel plume, if any, and on any clinical implications of the contents on patients and operating staff.

METHODS

Searches were conducted aiming to identify all published evidence on the chemical constituents, presence/absence of viable micro-organisms and malignant cells in ultrasonic scalpel plume. Attempts were made to source unpublished industry data.

RESULTS

There is evidence from human and in vitro studies of the presence of a range of harmful, and some human carcinogenic, chemicals within ultrasonic plume, mostly at very low concentrations. Any clinical relevance of this has not been studied. There is evidence from experimental studies of the presence of hepatitis virus, human coronavirus and human papillomavirus material within ultrasonic plume. Any clinical effect of this has not been studied. There is conflicting evidence from combined in vitro and mouse model studies of the presence of viable malignant cells within ultrasonic plume. Any clinical relevance of this has also not been studied.

CONCLUSION

Overall, relatively little research into the plume has been published, and further study is required to more clearly delineate any potential risk to patients, surgeons and other theatre staff. Current safety recommendations are discussed.

Utility of preoperative colour flow Doppler assessment of perforator anatomy in medial sural artery perforator (MSAP) free flaps

PURPOSE

It is known that the vascular perforators upon which the medial sural artery perforator (MSAP) flap is based are subject to considerable variation. This study seeks to evaluate the use of colour flow Doppler (CFD) as an imaging technique to establish the presence of suitable vessels, the discriminatory findings from that imaging, the rate of flap abandonment and flap complications.

METHODS

All patients undergoing MSAP in our institution since 2015 had a pre-operative CFD using a standardised technique. A prior group of 22 patients not having CFD acted as a control group. Data were  collected prospectively.

RESULTS

Fourteen patients had CFD. In one patient, no suitable vessels were found. In 13 patients, vessels of suitable size and position were identified, which then correlated precisely with operative findings. Three had suitable vessels in one leg only. No flaps in the CFD group were abandoned. One flap in the CFD group was partially lost. One flap in the prior control group was abandoned.

CONCLUSIONS

CFD provided reliable discriminatory information to decide on flap suitability/which leg and correlated precisely with operative findings, with no flap abandonment. Flap survival rate was very high.

Current thinking in lower third molar surgery

The removal of lower third molar teeth is one of the most common surgical procedures performed worldwide, but many concepts in this surgery have been unclear and have engendered different opinions. This paper aims to review current thinking in certain pertinent aspects of this surgery to update the reader on the most current research and synthesise it to make clinical recommendations. Topics covered include preoperative imaging, timing of removal, flap design, lingual retraction, coronectomy, lingual split, closure techniques, and use of antibiotics, steroids, and drains.

4 A Cross-Sectional Study of the Oral Health and Oral-Health-Related Quality of Life of Older Adults Admitted to An Acute Hospital in the North East of England

Introduction

Oral health has a strong relationship with general health, wellbeing and quality of life. The importance of establishing and protecting oral health in older adults is increasingly recognised. Admission to an acute hospital can be a good opportunity to assess and intervene with oral health, however data on the oral health of this population are very sparse.

Methods

A cross-sectional study of adults aged over 65 admitted to the acute medical ward within the Northumbria Specialist Emergency Care Hospital, Northumberland. Ethical approval was granted and all participants gave written consent. Data were obtained via verbal questions and a bedside visual examination by a dentist. Recorded were—gender, age, time since last dental visit, current oral symptoms, number of teeth present, number of decayed teeth, requirement for dental treatment, global oral health including health of hard and soft tissues and oral hygiene using the Oral Health Assessment Tool (OHAT) and oral-health-related quality of life using the Gohai scale.

Results

32 participants took part, 16 male and 16 female, of average age 81.9 (range 69–94). Time since last dental visit ranged from a few months to 30+ years. 14 complained of oral dryness and 7 of loose dentures. 15 had no current oral symptoms. 18 participants had no teeth. The remainder had an average of 13.3 teeth of which 5.8 were restored. 22 had dentures. 9 had active dental disease requiring treatment. OHAT score (with 0 indicating perfect health and 14 the worst score) mean 3.6. Gohai score (scored from 12 indicating best to 60 indicating worst quality of life) mean 19.4 and range 14–33.

Conclusions

The dental status of this group is variable but this study indicates the presence of troublesome oral symptoms and active dental disease requiring treatment, with a significant number not having seen a dentist for some time.

Management of Medication-related Osteonecrosis of the Jaw (MRONJ) risk in patients due to commence anti-resorptive/anti-angiogenic drugs - how should pre-drug-treatment dental preventive care be organised?

BACKGROUND

Medication-related osteonecrosis of the jaw (MRONJ) can be difficult to treat and causes significant morbidity, but is largely preventable. Published guidelines strongly recommend dental assessment and necessary remedial treatment before such drugs are commenced. Specific guidance on who should provide or arrange this care is lacking, and it may often be delegated to the patient arranging it with their own dentist. However, numerous factors can make this difficult.

AIMS

To review published strategies for organising timely and effective dental preventive care in patients due to be prescribed MRONJ-associated drugs.

RESULTS

13 studies were identified giving some detail of formal dental assessment setup. Two comprised a primary care dentist-led service, one a hospital assessment with most treatment in primary care and the remainder a hospital-based service from dental staff with or without dental specialists and input from medical and allied professionals. Follow-up varied from none to the period of drug use. Most studies reported the effectiveness of the service in reducing MRONJ incidence.

DISCUSSION

Details of the organisation of dental assessment/treatment are incomplete in most studies. Direct comparison is difficult. However, promising strategies to prevent MRONJ have been demonstrated.

CONCLUSION

There exists a large and growing group at risk of MRONJ who have significant amounts of oral disease. However, the risk of the condition is largely preventable. Promise is shown in several methods to organise timely dental care before treatment.

Oral hygiene and mouth care for older people in acute hospitals: part 2

Acute hospital admission provides an excellent opportunity to address poor oral health in older people, a group rarely seen by dental professionals and for who oral health activity in hospital is inconsistent and generally suboptimal. This two-part article explores oral hygiene and mouth care provision for older adults in acute hospitals. The first article presented the findings of a literature review exploring oral and dental disease in older adults, the importance of good oral health and mouth care, and the current situation. The second article explores clinical recommendations. A change in philosophy is needed to embed oral care as an essential component of holistic practice. More research is needed to determine the best ways to assess and treat oro-dental problems in older people, and promote and restore their oral health in hospitals. Great potential exists to innovate and develop new ways of providing care to this group.

Oral hygiene and mouth care for older people in acute hospitals: part 1

The oral health of older people in acute hospitals has rarely been studied. Hospital admission provides a prime opportunity for identification and rectification of problems, and oral health promotion. This two-part article explores oral hygiene and mouth care provision for older adults in acute hospitals. The first article presents the findings of a literature review exploring oral and dental disease in older adults, the importance of good oral health and mouth care, and the current situation. Searches of electronic databases and the websites of relevant professional health service bodies in the UK were undertaken to identify articles and guidelines. The literature shows a high prevalence of oro-dental disease in this population, with many known detrimental effects, combined with suboptimal oral hygiene and mouth care provision in acute hospitals. Several guidelines exist, although the emphasis on oral health is weaker than other aspects of hospital care. Older adults admitted to acute hospitals have a high burden of oro-dental disease and oral and mouth care needs, but care provision tends to be suboptimal. The literature is growing, but this area is still relatively neglected. Great potential exists to develop oral and mouth care in this context. The second part of this article explores clinical recommendations.

Skin cancer - an overview for dentists

Skin cancer is common and an increasing problem in the UK. It frequently occurs on the head and neck skin. A significant proportion of the adult population in the UK visits the dentist each year, thus making dental practitioners ideally placed to identify suspicious lesions, which could be skin cancer, as part of their routine extra-oral examination. These patients can then be referred on to hospital or their GP for further management. The dentist can also give advice on risk factors and self-monitoring to patients. This paper aims to describe the risk factors, pathology, presentation and treatments for the three most common forms of skin cancer - basal and squamous cell carcinomas, and malignant melanoma, to give the dental practitioner the knowledge and confidence to examine for and identify these skin cancers.

Pharmacy counter assistants and oral health promotion: an exploratory study

BACKGROUND

The involvement of community pharmacists in oral health promotion is being increasingly recognised and studied. However, a large proportion of interactions in community pharmacies take place with pharmacy counter assistants rather than the pharmacist, and the role of pharmacy counter assistants in oral health promotion has received little or no attention until now.

AIMS

To clarify the current state of affairs on pharmacy counter assistants' involvement with oral health promotion.

DESIGN AND METHODS

A postal-questionnaire-based survey of pharmacy counter assistants across East Yorkshire, North Lincolnshire and the Doncaster area. One hundred addresses were included and 35 responses were received.

RESULTS

Pharmacy counter assistants are infrequently approached by the public for advice on matters of oral health and advice is not often volunteered despite a reasonable knowledge of the subject. Respondents identified a role for themselves in educating patients/customers, which they are keen to expand.

CONCLUSIONS

The expansion of the pharmacy counter assistant's role in oral health promotion would be of value to patients/customers. This should include increased opportunistic education and a more integrated position of pharmacy within a holistic health promotion strategy.

14N Nuclear Magnetic Resonance Relaxation of the Nitrate Ion and Ion Pairing in Aqueous Solution

14 N n.m.r. spin-lattice relaxation times of four metal nitrate salts were measured as a function of concentration in aqueous solution. The concentration dependence of T1 was attributed to the formation of ion pairs with increasing concentration in these solutions. The T1 data, allowing for viscosity corrections, were treated by a two-state model of 'free' and 'bound' nitrate ions and to both possibilities of slow and fast exchange between the two states. In the equilibrium expressions estimates of the relevant activity coefficients were included. The slow nitrate exchange mechanism was favoured and the values obtained for this particular mechanism compared well with those derived from alternative measurements.

Nitrate Selectivity of Ion-Exchange Resins and of Their Model Compounds. I. Conductance Measurements on Benzyltrialkylammonium Salts

The concentration dependence of the conductance in aqueous solution of a series of benzyltrialkylammonium chlorides, nitrates and sulfates was measured. The n-alkyl substituents in this series were methyl, ethyl, propyl , butyl and pentyl. The conductances of the chlorides, nitrates and sulfates fit satisfactorily the electrostatic ion pairing models relevant to 1 : 1 and 1 : 2 electrolytes. The extent of ion pairing is small in all the solutions studied but consistently larger for nitrates and sulfates compared with chlorides. The dependence of the association constants on the alkyl substitutents shows different trends for the monovalent anions compared with the sulfate salts.

Is human hair a dosimeter for endogenous zinc and other trace elements?

This work incorporates an assessment of the potential of human hair to monitor ingestion of trace elements from the environment. Included is a report of a study of Zn levels in the facial hair of one of the authors, who was dosed with ZnSO4. Daily doses increasing from 100 to 300 mg Zn were taken for 57 days. Analysis was by differential pulse anodic stripping voltammetry. No significant increase in beard Zn was found. Cd, Pb and Cu were measured simultaneously. Studies of dosing with other elements are reviewed and a generalized pool model for the deposition of ingested trace elements in hair is presented. It is suggested that the concept of hair as a monitor of endogenous elements is a simplistic one which is better modified by the pool model, the precise form of which varies with the element under consideration.