The use of cone beam computed tomographic imaging in a paediatric dentistry department

Abstract Cone beam computed tomography (CBCT) is an emerging radiographic imaging modality. The diagnostic benefit must exceed the individual detriment that its generally higher radiation exposure may cause. Since limited studies exist on the use and impact of CBCT in paediatric dentistry, a service evaluation was carried out to explore the reasons for CBCT referral and to identify its impact on the treatment plan and/or management in a paediatric dentistry department. Clinical records for all paediatric patients who underwent a CBCT were reviewed, to identify the reason for referral and its influence on diagnosis or management, by comparing the provisional treatment plan with the definitive treatment plan, post-CBCT. A total of 130 paediatric patients underwent CBCT in a 12-month period, of which 52 satisfied the inclusion criteria. CBCTs were most commonly requested for the localisation of unerupted/impacted teeth 14/52 (27%), assessment of supernumerary teeth 12/52 (23%), and to investigate root resorption 9/52 (17%). All CBCTs provided additional information that assisted treatment planning, diagnosis, or management and, most significantly, 16/52 (31%) of treatment plans were changed based on CBCT findings. All CBCTs requested in this study were justified and confirmed or influenced the management of paediatric patients, ultimately reducing the risk of complications and further treatment

Bitewing radiography for caries diagnosis in children: when and why?

Untreated dental caries affects children in the UK, with significant burden to the child, family and health service. High quality bitewing radiography is more effective than clinical observation alone at detecting proximal caries in children. Accurate diagnosis before cavitation allows preventive rather than operative management. Research has demonstrated that most children find bitewing radiography acceptable. It is therefore vital that bitewing radiographs of children are taken as per national guidance in general practice. CPD/Clinical Relevance: Timely and high quality bitewing radiography is required for accurate diagnosis and treatment planning in children

Dental and maxillofacial radiology: confidence, knowledge and skills in the newly graduated dentist

Introduction The UK General Dental Council says that the new graduate will have the range of skills required to begin working as part of a dental team and be well-prepared for independent practice. This study examines the views of new dental graduates in the area of dental and maxillofacial radiology. Materials and methods A questionnaire survey of newly graduated dentists in Wales and South West England asked about their experience of undergraduate education in dental and maxillofacial radiology, and their confidence in the use and interpretation of imaging techniques in early independent practice. Results Most survey participants were confident in the teaching they had received in dental radiography and radiology, and that they could apply their knowledge and understanding to the more common investigations used in general dental practice. They were less confident in the uncommonly used techniques, such as oblique lateral and lateral cephalometric views. Discussion This study is encouraging in that new dental graduates say that their undergraduate education has given them the knowledge to be able to take, interpret and make clinical diagnoses using the commonest radiological investigations. This tends to validate the undergraduate education received and identifies areas to improve. Conclusion New dental graduates are confident in their knowledge and skills, and apply these to the most commonly used radiological investigations used in general dental practice

Ultrasound-guided fine-needle aspiration cytology of lesions in the head and neck performed without local anaesthesia – An analysis of pain perception

Introduction Ultrasound-guided fine-needle aspiration cytology is commonly carried out in the head and neck. The aim was to examine the amount of pain experienced by patients undergoing this procedure carried out without the use of local anaesthetic. Methods A questionnaire was given to 109 consecutive patients undergoing ultrasound-guided fine-needle aspiration cytology containing a visual analogue scale. Patients were asked to mark with a vertical line on the 100 mm horizontal scale amount of pain they experienced during the biopsy. The pain was subsequently categorised as ‘no pain’, ‘mild pain’, ‘moderate pain’ or ‘severe pain’ based on previous pain studies. Results Hundred patients completed the visual analogue scale section of the questionnaire satisfactorily. Twenty-one patients experienced no pain, 62 experienced mild pain and 17 experienced moderate pain. No patients experienced severe pain. Further analysis showed that females had significantly higher visual analogue scale scores (Mann–Whitney test: U = 925.5, z = 2.211, P = 0.027). Patients who were aware that they were going to have a biopsy had significantly lower visual analogue scale scores than those who were not aware (Mann–Whitney test: U = 859.5, z = 2.263, P = 0.024). Conclusions Ultrasound-guided fine-needle aspiration cytology is generally a well-tolerated procedure with pain scores being higher in females. It is advised that patients are told by the referring clinician the need for biopsy as this reduces the amount of pain experienced. Keywords: Biopsy, ultrasound, pai

The impact of time to death in donors after circulatory death on recipient outcome in simultaneous pancreas-kidney transplantation

Time to arrest in donors after circulatory death is unpredictable and can vary. This leads to variable periods of warm ischaemic damage prior to pancreas transplantation. There is little evidence supporting procurement team stand-down times based on donor time to death (TTD). We examined what impact TTD had on pancreas graft outcomes following DCD SPK transplantation. Data were extracted from the UK transplant registry from 2014 to 2022. Predictors of graft loss were evaluated by a Cox proportional hazards model. Adjusted restricted cubic spline (RCS) models were generated to further delineate the relationship between TTD and outcome. Three-hundred-and-seventy-five DCD simultaneous kidney-pancreas transplant recipients were included. Increasing TTD was not associated with graft survival (aHR 0.98, 95% CI 0.68-1.41, P=0.901). Increasing asystolic time worsened graft survival (aHR 2.51, 95% CI 1.16-5.43, P=0.020). RCS modelling revealed a non-linear relationship was demonstrated between asystolic time and graft survival, and no relationship between TTD and graft survival. We found no evidence that TTD impacts on pancreas graft survival after DCD SPK transplantation, however increasing asystolic time was a significant predictor of graft loss. Procurement teams should attempt to minimise asystolic time to optimize pancreas graft survival rather than focus on the duration of TTD

“Universal Dharma”: Authority, Experience and Metaphysics in the Transmission of Mindfulness-Based Stress Reduction

This work was supported by the Arts and Humanities Research Council (grant number 04174)

The use of cone beam computed tomography in the management of isolated orbital floor fractures

Isolated fractures of the orbital floor are diagnosed by a combination of clinical I and radiographic findings. computed tomography is considered the imaging method of choice. We describe the use of cone beam computed tomography for use in isolated fractures of the orbital floor. This shows defects in the orbital floor but with I lower dose of radiation than conventional computed tomography. (C) 2008 The British Association of Oral and Maxillofacial surgeons. Published by Elsevier Ltd. All rights reserved

Cone beam computed sialography of sialoliths

Cone beam CT is an emerging imaging modality used in maxillofacial imaging. This paper describes the use of cone beam sialography in two patients with salivary gland obstruction. In both cases, the obstruction was identified. The dose is comparable with conventional fluoroscopic techniques and has the advantage that the data may be viewed in it series of fine slices and in three dimensions, which may help in diagnosis and further management of the patient. Dentomaxillofacial Radiology, (2009) 38, 301-305. doi: 10.1259/dmfr/9078444