Orofacial granulomatosis is a chronic relapsing-remitting inflammatory condition that shares a similar phenotypic presentation to some other granulomatous diseases, particularly Crohn's disease. However, subtle clinical and pathological differences justify it as a separate disease entity. Previous studies have assessed the effectiveness of interventions used in the management of orofacial granulomatosis. This article reviews the management options available. A literature search was conducted to identify studies, in English, which assessed the effect of non-pharmacological and pharmacological interventions in the treatment of orofacial granulomatosis. The interventions were categorised into dietary modification, pharmacological (topical, intralesional and systemic therapy), surgery and psychological. A combination of interventions is often required to effectively manage each patient. There is convincing evidence that diet plays a role in disease severity. In patients where dietary manipulation alone is unsuccessful, topical, intralesional and/or systemic treatment may be considered to manage the condition.

Background Orofacial Granulomatosis (OFG) is an uncommon disease which is associated with Inflammatory Bowel Disease (IBD).1 These patients often have severe oral symptoms which can be disfiguring and difficult to treat. There is little published data on the response to biologics in this important group.2 We aimed to assess the response of patients with OFG and IBD to different biological therapies. Methods We performed a retrospective analysis of patients with OFG and IBD treated with biologic therapies at our institution between 2010 and 2022. Results Of the 48 patients identified 18 (38%) were female and the mean age of OFG onset was 26 years (range 4–67 years). 25 (52%) of patients were diagnosed with OFG before or at the same time as the diagnosis of IBD. 46 (96%) of patients had been treated with an immunomodulator in their disease course. 48 patients were exposed to at least one biologic, 21 (44%) to at least two biologics, 8 (17%) to at least three biologics, 4 (8%) to at least four biologics. There is no validated scoring system for OFG activity so the clinical response to each biologic was graded by an experienced oral medicine clinician into the categories of: no response, partial response and full response. Table 1 illustrates the response to each biologic. 16 patients were treated with both adalimumab and infliximab. Conclusion This is the largest described cohort of patients with OFG treated with biological therapy. Our results would suggest that anti-TNF is an effective treatment for OFG with response rates of 89%. Ustekinumab may also show promise with a response rate of 50%. Limitations of this study are that it is retrospective with small numbers of patients treated with the newer biologics. It is also limited by the lack of a validated scoring system and a significant number of patients where the response was unknown. References Gavioli CFB, Florezi GP, Dabronzo MLD, Jiménez MR, Nico MMS, Lourenço SV. Orofacial Granulomatosis and Crohn Disease: Coincidence or Pattern? A Systematic Review. Dermatology 2021;237(4):635–640. Elliott T, Campbell H, Escudier M, Poate T, Nunes C, Lomer M, Mentzer A, Patel P, Shirlaw P, Brostoff J, Challacombe S, Sanderson J. Experience with anti-TNF-α therapy for orofacial granulomatosis. J Oral Pathol Med. 2011 Jan;40(1):14–9.

COVID-19 presents a unique and significant challenge to healthcare systems across the globe. Dental workforce redeployment, in England, during the response to Coronavirus (COVID-19), is the first reported national effort to redeploy a professional body into new clinical environments. The policy decision to facilitate redeployment of the dental workforce, in March 2020, by the Office of the Chief Dental Officer (OCDO), increased flexibility within workforce systems and allowed increasing demand on healthcare services to be managed safely and effectively. This paper outlines how this policy change was achieved via a multi-professional approach, mapping competencies of the dental workforce to high-priority areas of healthcare need. The dental workforce has a varied and often specialised skill set, offering expertise in infection prevention and control, airway management and often, behaviour management. These skills can be an important contribution to tackling a pandemic where expertise in these areas is vital. This increase in workforce supply allows healthcare systems to improve their surge response capabilities. Additionally, redeployment presents an opportunity to create greater and sustained collaboration between the medical and dental professions, leading to greater understanding of the contribution of oral health to wider medical wellbeing.

AbstractObjectiveThe COVID‐19 pandemic resulted in a rapid shift to the use of virtual consultations in both primary and secondary care. The aim of this study was to assess patient experience of virtual consultations (telephone and video) in the Oral Medicine department during the first wave of the COVID‐19 pandemic.MethodsA validated survey was developed with the Patient Experience Team in Guy's and St Thomas' NHS Foundation Trust. A combination of previously validated questions and newly validated psychometric questions were used to design the patient feedback questionnaire. The survey was administered to all patients following their virtual (telephone or video) consultation. Data were synthesised and electronically analysed. Qualitative data were thematically analysed.ResultsA total of 115 surveys were completed. Over 82% rated their experience as good or very good and 69% preferred a virtual consultation for their next consultation. Thematic analysis of individual comments identified positive themes including convenience and positive/helpful clinical experience. Areas for development identified from thematic analysis included accessibility and clinical limitations in not undertaking a physical examination.ConclusionOverall, the patient experience of virtual consultations in Oral Medicine was positive.

The foundations of patient interactions are heavily dependent on facial expression, tone and inflection that help communicate treatment plans, obtain consent and break bad news. The expansion in use of face masks during the COVID-19 pandemic may adversely affect the quality of patient-clinician interaction and service provision. ##OBJECTIVES: To assess the impact of face masks on the experience of dental staff and patients at Guy’s and St Thomas’ NHS Foundation Trust. ##METHODS: A survey was developed using a combination of validated psychometric and demographic questions. The survey was administered to 166 dental staff and 57 patients. Data was electronically analysed. Qualitative data was thematically analysed. ##RESULTS: Themes identified included: clinical; physical effects; psychological; pre-existing communication difficulties; communication barriers; and accessibility to dental services. Sixty-three percent (32/57) of patients noted that PPE affected their communication and interaction. Over 70% (119/164) of dental staff reported repetition during consultations. ##CONCLUSION: This study highlights the positive and adverse physical and psychological impacts of facemasks on healthcare professionals and patients. Alternative solutions to mitigate the negative impact of face masks on communication include the use of virtual and visual aids. Furthermore, the implementation of wellbeing and support resources can aid in the challenges presented to healthcare teams.

British Journal of DermatologyAccepted Articles RESEARCH LETTEROpen Access Validation of an Oral Disease Severity Score for use in oral lichen planus Martyn Ormond, Martyn Ormond Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorHelen McParland, Helen McParland Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorPriya Thakrar, Priya Thakrar Department of Oral Medicine, Birmingham Dental Hospital and School of Dentistry, Birmingham, UKSearch for more papers by this authorAna Donaldson, Ana Donaldson Biostatistics and Research Methods Centre, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorManoharan Andiappan, Manoharan Andiappan Biostatistics and Research Methods Centre, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorRichard J. Cook, Richard J. Cook Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Oral Clinical and Translational Sciences, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorMichael Escudier, Michael Escudier Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorJon Higham, Jon Higham Department of Oral Medicine, Birmingham Dental Hospital and School of Dentistry, Birmingham, UKSearch for more papers by this authorEsther Hullah, Esther Hullah Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorRoddy McMillan, Roddy McMillan Department of Oral Medicine, Eastman Dental Hospital, UCLH / Eastman Dental Institute, UCL, London, UKSearch for more papers by this authorJennifer Taylor, Jennifer Taylor Department of Oral Medicine, Glasgow Dental Hospital and School, Glasgow, UKSearch for more papers by this authorPepe J. Shirlaw, Pepe J. Shirlaw Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorStephen J. Challacombe, Stephen J. Challacombe Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorJane F. Setterfield, Corresponding Author Jane F. Setterfield jane.setterfield@kcl.ac.uk Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UK St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK Correspondence Jane Setterfield Email: jane.setterfield@kcl.ac.ukSearch for more papers by this author Martyn Ormond, Martyn Ormond Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorHelen McParland, Helen McParland Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorPriya Thakrar, Priya Thakrar Department of Oral Medicine, Birmingham Dental Hospital and School of Dentistry, Birmingham, UKSearch for more papers by this authorAna Donaldson, Ana Donaldson Biostatistics and Research Methods Centre, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorManoharan Andiappan, Manoharan Andiappan Biostatistics and Research Methods Centre, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorRichard J. Cook, Richard J. Cook Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Oral Clinical and Translational Sciences, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorMichael Escudier, Michael Escudier Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorJon Higham, Jon Higham Department of Oral Medicine, Birmingham Dental Hospital and School of Dentistry, Birmingham, UKSearch for more papers by this authorEsther Hullah, Esther Hullah Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorRoddy McMillan, Roddy McMillan Department of Oral Medicine, Eastman Dental Hospital, UCLH / Eastman Dental Institute, UCL, London, UKSearch for more papers by this authorJennifer Taylor, Jennifer Taylor Department of Oral Medicine, Glasgow Dental Hospital and School, Glasgow, UKSearch for more papers by this authorPepe J. Shirlaw, Pepe J. Shirlaw Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorStephen J. Challacombe, Stephen J. Challacombe Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorJane F. Setterfield, Corresponding Author Jane F. Setterfield jane.setterfield@kcl.ac.uk Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UK St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK Correspondence Jane Setterfield Email: jane.setterfield@kcl.ac.ukSearch for more papers by this author First published: 04 January 2022 https://doi.org/10.1111/bjd.20968 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/bjd.20968 AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract - Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

In this commentary, we discuss the short-term and long-term implications of COVID-19 on postgraduate dental training in the UK, specifically Dental Core Training (DCT) and Specialty Training. Although this commentary focuses on the authors' experiences within Guy's and St Thomas' NHS Foundation Trust (GSTT) in London, we hope that our viewpoint will resonate with dental postgraduate trainees across Europe and may guide further discussion in this area. We also reflect on adaptations that may be required if there are any future disruptions to dental postgraduate training in the UK.

BackgroundThe COVID-19 pandemic has stretched EDs globally, with many regions in England challenged by the number of COVID-19 presentations. In order to rapidly share learning to inform future practice, we undertook a thematic review of ED operational experience within England during the pandemic thus far.MethodsA rapid phenomenological approach using semistructured telephone interviews with ED clinical leads from across England was undertaken between 16 and 22 April 2020. Participants were recruited through purposeful sampling with sample size determined by data saturation. Departments from a wide range of geographic distribution and COVID-19 experience were included. Themes were identified and included if they met one of three criteria: demonstrating a consistency of experience between EDs, demonstrating a conflict of approach between emergency departments or encapsulating a unique solution to a common barrier.ResultsSeven clinical leads from type 1 EDs were interviewed. Thematic redundancy was achieved by the sixth interview, and one further interview was performed to confirm. Themes emerged in five categories: departmental reconfiguration, clinical pathways, governance and communication, workforce and personal protective equipment.ConclusionThis paper summarises learning and innovation from a cross-section of EDs during the first UK wave of the COVID-19 pandemic. Common themes centred around the importance of flexibility when reacting to an ever-changing clinical challenge, clear leadership and robust methods of communication. Additionally, experience in managing winter pressures helped inform operational decisions, and ED staff demonstrated incredible resilience in demanding working conditions. Subsequent surges of COVID-19 infections may occur within a more challenging context with no guarantee that there will be an associated reduction in A&E attendance or cessation of elective activity. Future operational planning must therefore take this into consideration.

Disorders of the mouth, whether as a consequence of primary disorders, systemic disease or treatment, may be encountered across most medical specialties. Recurrent aphthous ulceration represents the most common primary oral disease, but oral lesions may indicate active systemic disease at less accessible sites such as the gut. Moreover, oral disease can have a detrimental impact on quality of life. For these reasons, it is important to be aware of the more common lesions affecting the oral cavity and to formulate a differential diagnosis appropriate for each lesion. In this article, we address the more common disorders seen in clinical practice. A distinction is made between primary oral disorders and systemic disease with oral manifestations. We have attempted to categorize systemic disease affecting the oral cavity into the medical specialties where they are likely to be encountered and for ease of reference for the general reader. Finally, we include a table of commonly used therapeutic regimens for oral disease, summarizing their mode of action and indications.

Orofacial pain is a common complaint with the vast majority of cases the result of an acute dental cause. There are, however, a number of patients who experience chronic orofacial pain in whom no dental cause can be found, and it is therefore important to identify these patients in order to avoid unnecessary dental procedures. Successful management of chronic orofacial pain depends on the correct diagnosis and appropriate interventions with a biopsychosocial approach.

Oral ulceration is a common finding yet its classification, diagnosis and management remain a challenge for many hospital physicians. This article discusses the different types of oral ulceration and how to investigate and manage them.

British Journal of Hospital MedicineVol. 76, No. 8 Clinical NewsEuropean Hematology AssoCiation Vienna, austria, 11–14 JuneSusan Mayor'sSusan Mayor'sSearch for more papers by this authorSusan Mayor'sPublished Online:8 Aug 2015https://doi.org/10.12968/hmed.2015.76.8.442AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Serrano JM, González I, Del Castillo S et al. (2015) Diastolic dysfunction following anthracycline-based chemotherapy in breast cancer patients: incidence and predictors. Oncologist (doi: https://doi.org/10.1634/theoncologist.2014-0500) Crossref, Medline, Google ScholarPaccou J, Edwards MH, Ward KA et al. (2015) Ischemic heart disease is associated with lower cortical volumetric bone mineral density of distal radius. Osteoporos Int 26(7): 1893–901 (doi: https://doi.org/10.1007/s00198-015-3132-z) Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 August 2015Volume 76Issue 8ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 8 August 2015 Published in print 2 August 2015 Information© MA Healthcare LimitedPDF download