M R Brickley

FACTORS INFLUENCING NERVE DAMAGE DURING LOWER THIRD MOLAR SURGERY

OBJECTIVE To investigate relationships between pathology, eruption status, age, anaesthetic modality and nerve damage during lower third molar surgery. DESIGN Single centre prospective study. SETTING Oral surgery out-patient clinics. SUBJECTS 367 patients unselected for age, gender or social class, scheduled for lower third molar removal. At 1 week, any evidence of iatrogenic nerve damage was recorded. Patients with altered lingual and/or labial sensation were followed up for 6 months. RESULTS 718 lower third molars were removed from 250 males and 117 females. 96 removals (13.4%) were associated with altered lingual, labial or buccal sensation. There were no significant associations between nerve damage and eruption status, age and pre-operative pathology. There was a highly significant difference in the incidence of nerve damage between LA removal (3%) and GA removal (18%) (chi-squared = 17.18; f = 2; P < 0.01) but no significant associations between surgical difficulty and nerve damage within each of the two groups. CONCLUSIONS Lingual and inferior alveolar nerve damage was five times more frequent when lower third molars were removed under general anaesthesia rather than local anaesthesia. This could not be explained in terms of surgical difficulty, pre-operative pathology, age or anatomical position.

The relationship between alcohol intoxication, injury severity and Glasgow Coma Score in assault patients

To assess the effect of alcohol intoxication on injury severity and head injury assessment, blood alcohol concentrations (BAC) were related to the severity of injuries (Injury Severity Score and Assault Trauma Score) and Glasgow Coma Scores (GCS) in 242 consecutive victims of weekend, night-time assault, none of whom had head injuries. No correlation was found between degree of intoxication and severity of injury. There was a highly significant correlation between BAC and GCS. However, high BACs (greater than 240 mg/100 ml) were associated with only a 2-3 point reduction in GCS. The median BAC in patients with a normal GCS was 115 mg/100 ml. Neurological assessments need to take account of the highly variable, depressive effects of alcohol.

Oral surgery: Factors influencing nerve damage during lower third molar surgery

Objective To investigate relationships between pathology, eruption status, age, anaesthetic modality and nerve damage during lower third molar surgery.Design Single centre prospective study.Setting Oral surgery out-patient clinics.Subjects 367 patients unselected for age, gender or social class, scheduled for lower third molar removal. At 1 week, any evidence of iatrogenic nerve damage was recorded. Patients with altered lingual and/or labial sensation were followed up for 6 months.Results 718 lower third molars were removed from 250 males and 117 females. 96 removals (13.4%) were associated with altered lingual, labial or buccal sensation. There were no significant associations between nerve damage and eruption status, age and pre-operative pathology. There was a highly significant difference in the incidence of nerve damage between LA removal (3%) and GA removal (18%) (chi-squared = 17.18; f = 2; P < 0.01) but no significant associations between surgical difficulty and nerve damage within each of the two groups.Conclusions Lingual and inferior alveolar nerve damage was five times more frequent when lower third molars were removed under general anaesthesia rather than local anaesthesia. This could not be explained in terms of surgical difficulty, pre-operative pathology, age or anatomical position.

Risk of occupational glass injury in bar staff.

One hundred and twenty-six bar staff (median length of service 2.7 years) working in 42 randomly selected public houses in South Glamorgan were interviewed and examined in the workplace to investigate the incidence, characteristics and treatment of lacerations from bar glassware. 41 per cent reported previous injury, 13 per cent on five or more separate occasions. All injuries but one were of the hand. After 13 per cent of incidents, treatment had been sought in an A & E department, but 58 per cent of incidents causing hand lacerations were not treated. Straight-sided (nonik) one pint (0.6 l) capacity glasses were responsible for two-thirds of injuries, usually during stacking and washing of used glasses. Of bar-workers familiar with toughened glassware, 86 per cent favoured its use on safety grounds. It was concluded that the incidence of sharps (glass) injury was unacceptably high and that this was also a potential cause of cross-infection in this group of workers.

Factors affecting choice of anaesthetic modality for third molar surgery

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treatment planning: A controlled trial of three referral methods for patients with third molars.

Aim To evaluate the accuracy, sensitivity and specificity of three primary to secondary care referral strategies.Method Thirty two primary care dental practitioners (GDPs) were randomly allocated one of three referral strategies: current practice (control strategy); a neural network embedded within a computer program and a paper-based clinical algorithm. One hundred and seven patients were assessed for lower third molar treatment: 47, 30 and 30 in each group, respectively. Clinical details were assessed by a panel of experts against a gold standard for third molar removal (the National Institutes of Health criteria). The accuracy, sensitivity, specificity, positive and negative predictive values were calculated for each strategy.Results The referral decisions made by the GDPs in the control group displayed greater accuracy and sensitivity but poorer specificity (0.83; 0.97; 0.22) compared with the neural network (0.67; 0.56; 0.79) and clinical algorithm (0.73; 0.56; 0.93).Conclusions It was concluded that incorporation of the clinical algorithm into primary care was the most appropriate option. The computer neural network performed less well than either current practice or the clinical algorithm.