Oral and maxillofacial surgery: trauma Management of animal bite injuries of the face: experience with 94 patients

Wolff K-D J Oral Maxillofac Surg 1998; 56: 838–843

The author of this study suggests that aesthetics should have priority in treatment of these injuries.

Over a 7 year period, 907 animal bite wounds were treated in a Berlin medical centre, and 94 involved the face and head. Upper limbs were involved in 48% of wounds, legs in 26% and trunk in 16%. Facial wounds were mainly on the lip (33), cheek (23) and nose (14), and 51 patients were under 15 years of age. Dogs caused 90% of the wounds, and in most cases belonged to the household.

All but 17 patients attended within 24 hours for treatment. Of 26 who did not attend immediately, 18 with inflammatory symptoms were given antibiotics. Prophylactic antibiotics were also given to 53 with no sign of infection. All wounds without apparent infection were surgically closed. Four patients given prophylactic antibiotics, and 2 of the 23 who received no antibiotics, developed infections requiring further treatment.

The author considers that antibiotics should have a more restricted role, and an accompanying discussion by another surgeon questions this conclusion whilst agreeing with the surgical management.

Dental public health; metabolic medicine Type 1 diabetes mellitus and oral health: assessment of tooth loss and edentulism

Moore PA Weyant RJ et al. J Public Health Dent 1998; 58: 135–142

A population of insulin-dependent diabetics had a significant dental treatment need.

For 6–8 years, a population of 406 juvenile onset diabetics was monitored in a longitudinal study of medical complications. Mean age of onset was 8.4 years, and an oral health examination took place when the group was at a mean 33 years of age.

At the time of oral examination, the group had mean glycosylated haemoglobin of 11% ( < 10.1% considered adequate control), 44% had advanced retinopathy, 23% nephropathy, 27% neuropathy and 11% peripheral vascular disease. Sixteen edentulous subjects were older and had a greater level of complications.

Partial tooth loss was associated with extensive periodontal disease in remaining teeth, diabetes duration > 24 years, not using floss, neuropathy, low household income and multiple coronal cavities/restorations. The authors concluded that there should be an oral health component to overall management of Type 1 diabetes.

Oral diagnosis: remote assessment Telemedicine consultations in oral and maxillofacial surgery

Rollert MK Strauss RA et al. J Oral Maxillofac Surg 1999; 57: 136–138

Remote assessment was fully satisfactory for 43 patients, only two of whom were determined to require further evaluation prior to planning treatment.

In some places where specialist advice and treatment involves significant travel and other expense, there is a trend towards interactive remote consultation. Over a 3 week period in a maximum- security prison in Virginia, 43 patients were assessed.

Patients attended an examination room with ancillary medical support, and were interviewed and examined visually by a specialist over a video link. Available support data (radiographs etc.) were also assessed, and in 19 cases, further tests were performed locally (ECG, radiographs etc).

In 33 cases, dentoalveolar surgery with GA was arranged and performed without further need for pre-operative examination. In two patients with complicated medical histories, a decision was possible on detailed further assessment, which was fully planned in advance. The authors discuss the potential of telemedicine technology.

Dental public health; communication and information Coverage and quality of oral cancer information in the popular press: 1987–98

Canto MT Kawaguchi Y et al. J Public Health Dent 1998; 58: 241–247

This US study suggests some reasons for the widespread ignorance about oral cancer.

Oral cancers have a high potential for disfigurement and debility, and result in 2–3% of all cancer deaths, with an unchanged 50% 5-year survival rate over the past 40 years. Studies have shown the public is largely unaware of the problem.

The authors searched 3 US databases over a 10-year period, covering 400 popular magazines, 8 influential newspapers and a health-related journalism index, for all articles and news items on oral cancer: 50 were identified. In addition, 22 magazines with circulations from 0.5–15 million were searched for tobacco advertisements over the year to March 1998: 417 were found, compared with just 10 articles on oral cancer.

Most articles mentioned one or more risk factors (43 identified tobacco); more than half did not mention warning signs, or prevention; one third recommended tobacco cessation. Few mentioned self-examination, and 10 included inaccurate statements. The authors stated that the large amount of tobacco advertising and the lack of adequate oral cancer information sent a mixed message.