Edmund Bailey

Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth, a Cochrane systematic review

This paper compares the beneficial and harmful effects of paracetamol, ibuprofen and the novel combination of both in a single tablet for pain relief following the surgical removal of lower wisdom teeth. In this systematic review only randomised controlled double-blinded clinical trials were included. We calculated the proportion of patients with at least 50% pain relief at 2 and 6 hours post dosing, along with the proportion of participants using rescue medication at 6 and 8 hours. Adverse events were also analysed. Data was meta-analysed where possible. Seven studies were included with a total of 2,241 participants enrolled. Ibuprofen 400 mg is superior to 1,000 mg paracetamol with a risk ratio for at least 50% pain relief at 6 hours of 1.47 (95% confidence interval [CI] 1.28 to 1.69). For the combined drug, the risk ratio for at least 50% maximum pain relief over 6 hours is 1.77 (95% CI 1.32 to 2.39) based on total pain relief (TOTPAR) data. There is high quality evidence that ibuprofen is superior to paracetamol. The novel combination drug shows encouraging results when compared to the single drugs (based on two trials).

Patient safety in primary care dentistry: Where are we now?

In contemporary healthcare settings, ensuring patient safety must be an underlying principal through which systems, teams, individuals and environments work in tandem to strive for. The adoption of a culture in the NHS where patient safety is given greater priority is key to improvement. Recent events at Mid-Staffordshire hospitals among others have brought patient safety into the minds of the public and it increasingly demands attention from clinicians, the press and governments. However, much of the work into patient safety has been completed in the secondary care field with very little work completed in primary care settings. In primary care dentistry, improving patient safety is a relatively new concept with a distinct lack of evidence base. In this article, we discuss what patient safety is and debate its relevance to primary care dentistry. We also look at previous work completed in this field and make recommendations for future work to address the current lack of research.

Awareness of medication related osteonecrosis of the jaws (MRONJ) amongst general dental practitioners.

Background Recent evidence suggests that medication-related osteonecrosis of the jaw (MRONJ) can be caused by a number of anti-resorptive and anti-angiongenic agents not limited to bisphosphonates. A working knowledge of these medications is important for dental practitioners.Methods A total of 129 general dental practitioners (GDPs) were surveyed regarding their awareness of MRONJ and its causes.Results More than 90% of the GDPs sampled were unaware of anti-resorptive and anti-angiogenic medications other than bisphosphonates that had the potential to cause MRONJ. Just over 40% of the sampled GDPs were confident to treat patients on oral bisphosphonates in primary care. Much of the reluctance to manage these patients was due to lack of accessible guidelines and unclear protocols.Conclusions The results demonstrate GDP attitudes to patients taking bisphosphonates and highlight how further education is needed to increase confidence to perform simple exodontia amongst this cohort of patients in a primary care setting. As there continues to be a shift to providing dentoalveolar services in primary care, we must ensure that those performing the treatments have a greater understanding of potential MRONJ risks and have guidance as to when to refer.

An unusual case of disappearing bone disease in the mandible and literature review

Abstract Disappearing bone disease is a rare disorder that causes spontaneous and progressive osteolysis and proliferation of lymphatic tissue and blood vessels. It is debilitating and there is evidence of mortality in reported cases including those affecting mandible. A 38-year-old man was diagnosed with disappearing bone disease of the mandible in 2013. This had progressed from being in the right ramus only, and now extends to the lower right first molar and affects the left coronoid process and ramus. Mandibular involvement has shown to be high-risk. In older patients, misdiagnosis can occur without thorough investigation, and education of clinicians needs to be paramount to provide the appropriate treatment for this rare condition. The disease can be debilitating and as such education and support of patients is essential.

Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database of Systematic Reviews.

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of anti-adhesion therapy versus placebo, no therapy or an alternative anti-adhesion therapy following operative hysteroscopy for the treatment of female subfertility.To determine the efficacy and safety of metformin in treating women with endometrial hyperplasia