Colette Balmer

A role for nitric oxide-mediated glandular hypofunction in a non-apoptotic model for Sjögren's syndrome

OBJECTIVE To investigate a role for the inflammatory mediator, nitric oxide (NO) in SS, an autoimmune condition characterized by salivary and lacrimal gland hypofunction resulting from failure of acinar cells to secrete. METHODS FURA-2 microfluorimetry was used to measure agonist-evoked changes of [Ca(2+)](i) in isolated mouse and human salivary acinar cells following exposure to NO donors. RESULTS NO had a biphasic effect on salivary acinar function. Acute exposure to NO (2 min) caused a cyclic guanosine monophosphate (GMP)-dependent, 1-H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-sensitive increase in the Ca(2+) signal elicited in response to acetylcholine (ACh) stimulation, consistent with stimulation of ryanodine receptors by cyclic adenosine diphosphate ribose. Prolonged exposure to NO (>40 min) significantly reduced the ACh-evoked Ca(2+) signal by a mechanism independent of cyclic GMP. We found no differences between the responses of human and mouse acinar cells. CONCLUSION Our data show that chronic exposure to NO, which is known to be elevated in SS, could have a role in salivary gland hypofunction. We note a similarity in the response to stimulation of salivary acinar exposed to NO and that which we have previously reported in salivary acinar cells isolated from patients with SS. We speculate that NO-mediated nitrosylation of one or more elements of the signal transduction pathway could underlie down-regulation of salivary function in SS.

A generic consensus assessment of undergraduate competence in forceps exodontia in the United Kingdom

UNLABELLED The assessment of competence in clinical skills has become more frequent in published healthcare curricula and syllabuses recently. There are agreed mechanisms for the assessment of competence in the post-graduate environment, but no consensus within the undergraduate curriculum. This paper seeks to develop an agreed generic checklist for the assessment of competence in forceps exodontia. MATERIALS AND METHODS A modified Delphi process was undertaken with representatives from all UK dental schools (n = 13) to develop a generic checklist for the assessment of competence in forceps exodontia. A content analysis of the assessments employed by each school was used to help discussion and inform the Delphi process. RESULTS Seven schools currently employ a summative assessment of competence in forceps exodontia, with the majority employing a structured clinical objective test (n = 6). From the seven assessments, there were a total of 29 putative items and 10 putative domains identified for a generic checklist. These were reduced to five domains and 19 items through the content analysis and Delphi process, and a generic overarching checklist was created. CONCLUSION Using this generic checklist, it may now be possible to pool data inter-institution to perform more powerful analyses on how our students obtain, or fail to obtain competence in forceps exodontia.

Dental student suturing skills: a multicentre trial of a checklist-based assessment

BACKGROUND The assessment of clinical skills is essential to determine whether an undergraduate is competent to perform the tasks outlined in the curriculum. Such assessments in dentistry have historically not been subjected to large scale validity and reliability testing due the relatively small student numbers at each institute. The aims of this study were to test the validity and reliability of a standardised, checklist-based, suturing objective structured clinical examination (OSCE) and then to perform a multicentre trial to determine its performance over a large cohort of students. MATERIALS AND METHODS A total of seven UK schools agreed to take part in the trial. To test the validity and reliability of the checklist, the examiner at each institution reviewed and scored video footage of 10 students performing the assessment. Each institution then carried out the assessment providing a checklist score and a global score for each of their own students. RESULTS The assessment was well received by the staff, with acceptable inter-examiner variability. In total, 496 students completed the suturing OSCE with a success rate of 81% with a variation between schools of between 66% and 96%. A significant correlation was found between the checklist score and the global score (r = 0.361, P = 0.000). No one item on the checklist was found to be a determinant factor in the outcome of the OSCE. CONCLUSIONS This checklist-based assessment of suturing skills was found to have face and content validity. Its reliability was promising, but merits further investigation. There may be an argument for the standardisation of the assessment of this core surgical skill throughout several UK-based dental schools.

Cementoblastoma in the maxilla: a case report.

The cementoblastoma is a rare, benign odontogenic tumour. It is generally asymptomatic and usually occurs in young adults. It is more common in males. It is most often associated with mandibular molar teeth and has a characteristic radiographic appearance. This case report is of a young male patient who presented with a cementoblastoma associated with a maxillary second molar. The initial presentation was to his dentist with pain, which was assumed to be of dental origin. This case highlights the importance of adequate radiographic investigation and appropriate interpretation in forming a diagnosis. It also serves as a reminder that rare odontogenic tumours may present initially in primary care and it is essential that all practitioners are aware of them.

A chemical burn from a garlic poultice applied to the face to treat toothache: a case report.

This case report is of a significant chemical burn to the face resulting from the use of an external garlic poultice for toothache. The patient used internet search engines to seek a toothache remedy and did not identify any reports of this complication. This report aims to inform all dentists of the risks of raw garlic application to the skin and also to ensure that in the future any patient using the internet for a toothache remedy will be made aware of the potential risk and how to avoid it.

Nurses’ study day at the oral surgery conference

The British Association of Oral Surgeons’ conference included a study day for nurses working in oral surgery or who have an interest in the area, with discussions on a wide range of topics to meet CPD requirements and stimulate interest

Pump power: the cardiovascular system

The cardiovascular system is the bodys essential transport system for the passage of oxygen around the body. It is important for dental nurses to understand about the cardiovascular system in case a problem arises with a patient in the dental practice.

Role of the DCP in dental foundation training

Dental care professionals (DCPs) play a vital role in the dentistry team and are ideally placed to give feedback to new graduates on aspects of their professional development, including communications skills and professionalism.

Getting to grips with CPD

One of the requirements of professional registration is to undertake continuing professional development (CPD). Here, Colette Balmer, Brian Grieveson and David Brigden explain the ins and outs of CPD, the different opportunities available and how to get the best from it.