Westhbeatty9008

Objectives Dental assessment remains a key intervention for head and neck cancer (HNC) patients pre-radiotherapy (RT). The purpose of this study was to identify the variation in dental status of patients pre-treatment, with respect to population and oncological demographics.Materials and methods The study reviewed dental panoramic radiographs of HNC patients seen on a dedicated pre-RT dental clinic from 2011-2017. Only patients who had undergone intensity-modulated radiotherapy treatment were included within this study. Relevant dental and oncological data were collected.Results A total of 886 patients were included in this study, with oropharyngeal cancer constituting 36% of the cohort. The average number of teeth in HNC patients was less then 21 at the pre-RT phase, which is below the recognised threshold for a functional dentition. Smoking status has a significant impact on overall DMFT (decay/missing/filled teeth), severity of horizontal bone loss and the number of third molars present (p less then 0.001). In the latter, males had a higher mean number of third molars compared to females (p less then 0.005). Comparing dental status of patients based on their tumour sub-site identified significant (p less then 0.0005) variation in all aforementioned categories.Conclusion There are distinct differences in the dental health of HNC patients due to commence RT, compared to the general population. It varies by cancer sub-site and this should be taken into consideration at dental assessment to tailor a dental care plan to the needs of the individual. Consideration should be given to balancing masticatory function against the risks of osteoradionecrosis on the background of increasingly extended survivorship.Aim To assess the habits of tooth wear risk assessment and charting using a tooth wear index, by UK and non-UK dental practitioners.Design A questionnaire-based evaluation.Methods Three hundred and two completed questionnaires were returned and the outcomes analysed using descriptives, Chi-squared test and Fisher's exact test in SPSS. Significance was inferred at p less then 0.05.Results Based on a sample of 297 responses, 81% agreed to the need to undertake risk assessment for all dental patients attending for a first-time consultation. Fifty-nine percent undertook risk assessments for 'new patients' previously identified with signs of severe tooth wear. The routine use of a clinical index to perform tooth wear charting was described by 13.5%, with 5% documenting the frequent use of the BEWE tool. While specialist dental practitioners or those with further post-graduate training were more likely to use a tooth wear index (p less then 0.05), there were no other significant relationships between any of the variables in the sample and the practising habits assessed.Conclusion This investigation alludes to good levels of professional awareness of tooth wear. However, the need for improvement with the actual undertaking of risk assessments for tooth wear and consistency with tooth wear assessment and charting was determined. The need for appropriate professional guidance for the undertaking of tooth wear assessments is supported by the outcomes of this investigation.Aim To evaluate currently available methods for assessing and monitoring tooth wear in a general dental practice environment.Method A questionnaire was developed and used to obtain data. Models were used to test the dentists' assessment of tooth wear. Ethical permission was obtained.Results Twenty general dental practitioners were interviewed and 100% were aware of the use of study models, 50% about the use of photographs and 45% of the BEWE. Methods used to assess and monitor tooth wear were study models (75%), photographs (65%), BEWE (10%), Smith & Knight index (0%) and no method (15%). Sixty-five percent of dentists were unaware of any guidelines on monitoring tooth wear. In comparing serial photographs, no participant correctly identified all the wear changes and 25% thought a change had occurred when one hadn't. Statistical analysis showed a sensitivity of only 73% with a specificity of 75%. In comparing serial study models (same cases as used in the photographs), 55% of participants identified a change when no change occurred and 50-60% of participants were able to correctly identify if wear had or had not occurred. Participants graded the models according to BEWE. Calcitriol manufacturer Statistical analysis of these results shows a sensitivity of just 69% with a specificity of only 55%. The inter-operator agreement (Fliess' Kappa) showed an even lower degree of agreement was found with only 0.12, which suggests only a slight level of agreement, less than that with photographs.Conclusion Dentists do not seem to be aware of the current guidelines but do make reasonable attempts to monitor tooth wear. None of the currently available methods are ideal and even the use of serial study models is open to much inter-operator variability.In the last few decades, the number of targeted chemotherapies approved for cancer treatment and undergoing clinical trials has risen. In comparison to conventional chemotherapy, targeted therapies (TTs) act on specific molecular targets involved in cancer development and progression, with reduced detrimental effects to normal tissues. TTs have now been recognised as key treatments in a number of common cancers, including solid tumours and haematological malignancies. The number of patients undergoing novel cancer treatment will continue to increase, and a significant population will likely present to the dental environment. This paper aims to provide an insight into TTs currently available, including monoclonal antibodies, fusion proteins, tyrosine kinase inhibitors, histone deacetylase inhibitors, mammalian target of rapamycin inhibitors, phosphoinositide 3-kinase inhibitors, proteasome inhibitors and hedgehog pathway inhibitors. The mechanisms of action, indications for use and how to identify the medications will be summarised. Dental implications of these novel therapies include medication-related osteonecrosis of the jaw, delayed healing, immunosuppression and thrombocytopenia. These will be discussed to ensure oral healthcare providers are aware of their impact in a dental setting.