Background: The contribution of oral inflammatory conditions to systemic disease burden remains underexplored within multimorbidity frameworks. Emerging evidence suggests that periodontal inflammation may play a role in the clustering of chronic diseases, yet few studies have evaluated this at a population level using robust datasets. The aims of this study were to investigate whether periodontal diseases are associated with Multiple long-term conditions (MLTCs) burden and severity in two population-based cohorts and to examine whether systemic inflammatory biomarkers mediate these associations. Materials and Methods: We analyzed two population-based cohorts: the UK Biobank (UKB; n = 500,612) and the US National Health and Nutrition Examination Survey (NHANES; n = 10,714). MLTCs were defined as the coexistence of ≥2 chronic diseases. Associations between periodontal diseases and MLTCs were assessed using multivariable logistic and multinomial logistic regression. Causal mediation analyses examined the contribution of systemic inflammatory markers. Results: Approximately half of all participants had MLTCs. The prevalence of periodontal diseases was 17.8% in UKB (self-reported symptoms), and 42.3% in NHANES (clinically assessed). Periodontal diseases were independently associated with greater odds of MLTCs in both UKB (OR 1.12; 95% CI 1.10-1.14) and NHANES (OR 1.22; 95% CI 1.09-1.37). Associations were stronger among adults aged ≤ 60 years. A consistent dose-response relationship was observed between periodontal status and the number and severity of chronic conditions, as well as inflammatory-related MLTCs. Mediation analyses suggested partial effects through white blood cell count, neutrophils, and C-reactive protein. Conclusions: Periodontal inflammation is independently associated with greater multimorbidity burden, particularly in younger adults. Systemic inflammation may offer a plausible biological link, and these findings position oral health as an underrecognized and modifiable target in multimorbidity prevention and management frameworks, warranting prospective investigation.

The IMPOSTERS study analysed 150 recurring 'human' Simpsons characters and found that periodontitis or tooth loss was associated with a 23-fold higher hazard of all-cause mortality. This was reported in the Simpsons universe, with the death of 'Bleeding Gums' Murphy, 3 years before the first such reports in our universe. Fictional universe, very real methodological lessons to learn.

Objectives To evaluate the predictive accuracy of single-factor, multi-factor, and machine learning-based caries risk assessment (CRA) methods in predicting caries risk among children and adults, updating the 2015 review. Data The review was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, supplemented by relevant items adapted for prognostic accuracy reviews. Paired sensitivity and specificity data were extracted, and 2 × 2 contingency tables were reconstructed where necessary. Source PubMed, Web of Science, Cochrane Library, Embase, and Scopus were searched from February 2015 to July 2025. Study Selection Studies evaluating CRA methods with a minimum 1-year follow-up and sufficient data to reconstruct a 2 × 2 table were included. Of the 7,332 records identified, 30 studies met the inclusion criteria; 16 contributed to the meta-analysis. Results The full Cariogram in children demonstrated pooled sensitivity 72.10% and specificity 69.96%. Caries Management by Risk Assessment (CAMBRA) yielded a sensitivity of 67.65% and a specificity of 58.96% with substantial heterogeneity. The American Academy of Paediatric Dentistry (AAPD) CRA showed high sensitivity (95.56%) but very low specificity (5.12%), suggesting it may be more suitable for initial screening than for definitive risk stratification. Past caries experience demonstrated moderate predictive accuracy. Machine learning showed potential but lacked sufficient data for pooling. Conclusions CRA methods demonstrate moderate predictive accuracy, with substantial variability across populations, tools, and study designs. Clinical Significance CRA methods should be used alongside clinical judgement. Further prospective validation and incorporation of objective biomarkers may improve future caries risk prediction.

This review aims to summarise the current epidemiological evidence for associations between periodontitis and chronic kidney disease (CKD), and to explore the underlying biological mechanisms. CKD is strongly associated with periodontitis in both cross-sectional and longitudinal studies, with 2.5 higher odds of having periodontitis in the presence of CKD and 2-times higher likelihood of developing CKD in the presence of periodontitis. Patients with CKD and periodontitis have a hazard ratio of 3.1 for progression of CKD when pockets are greater than 4.5mm compared to without. The biological mechanisms underlying this relationship include common risk factors of smoking and diabetes, the systemic inflammatory burden posed by periodontitis, and the detrimental effect of periodontal pathogens on renal tissues. Evidence supports a bidirectional relationship between periodontitis and CKD whereby periodontal care may represent an important and novel management strategy for individuals with CKD.

BACKGROUND:Peri-implantitis is an oral inflammatory disease with increased incidence across the population as linked to the wide use of dental implants to replace missing teeth. While the recent World Workshop Classifications provided a framework for clinicians to diagnose and assess the severity of peri-implantitis, an objective assessment of the mucosal inflammatory burden around the dental implant is still lacking. Based on the periodontal epithelium surface area (PESA) and periodontal inflamed surface area (PISA) scores previously reported, a study was conducted to explore a similar approach for peri-implant inflammatory surface quantification. The aim of this study was to develop two novel scores of peri-implant mucosal inflammation and their clinical application to help with the quantification of the dental-implant inflamed surface area (DISA). METHODS:Formulas were created to quantify the dental-implant surface area (DESA), and then DESA of both tapered and cylinder implants was compared based on a dataset that included probing pocket depth, mucosal recession, and implant morphology parameters. The DISA was subsequently calculated using the epithelial/connective tissue areas multiplied by the proportion of bleeding on probing sites around the implant. The new scores were applied and validated using clinical cases of peri-implantitis. RESULTS:Firstly, a total of 10,000 dental implants were included in a simulation study to evaluate the performance of the new scores. Under-estimation of the real surface areas around dental implants was less than 2% when using the DESA score for cylinder and tapered dental implants (universal formula is presented). The DISA score was created in the simulations and then applied to 21 participants suffering from peri-implantitis. DESA scores ranged from 54.24 to 400.29 mm2, and the DISA scores ranged from 36.76 to 400.29 mm2. CONCLUSIONS:Two novel scores (DESA and DISA) to estimate the peri-implant surface area in health and disease were proposed and applied to clinical cases. The inflammatory surface caused by peri-implantitis could be quantified by DISA with good precision. Future steps could include microbiome assessments and investigation of the association of these scores with the host response and general health status of patients with peri-implantitis. PLAIN LANGUAGE SUMMARY:Peri-implantitis is a common gum disease surrounding dental implants. Although recent guidelines help diagnose it, there's still no clear way to measure the inflammation surface area around implants. We developed formulas to calculate the dental-implant surface area (DESA) and compared them for different implant shapes using data on pocket depth, gum recession, and implant type. We then calculated the dental-implant inflamed surface area (DISA) by multiplying the tissue area around the implant by the proportion of bleeding sites. In our study, we included data from 10,000 implants to test the new scores. The DESA score was very accurate, underestimating the real surface area by < 2%. We then used the DISA score on 21 patients with peri-implantitis. The DESA scores ranged from 54.24 to 400.29 mm2, while the DISA scores ranged from 36.76 to 400.29 mm2. In conclusion, we introduced two new scores (DESA and DISA) to measure the inflammation caused by peri-implantitis. These scores could help in better diagnosing and treating peri-implantitis, with future research exploring their link to overall health.

AIM:The relationship between oral and systemic inflammation has profound implications for understanding the broader health impacts of periodontitis. The aim of this study was to (a) explore the association between periodontal inflammation and markers of systemic inflammation and metabolic health, and (b) preliminarily assess periodontal status based on systemic health indicators using machine learning techniques. METHODS:Data from a cross-sectional cohort (N = 667) were modelled (simple/multiple linear, fractional polynomial, logistic and random forest regression) to examine the association between systemic and periodontal measures. Three classifiers-random forest (RF), support vector machine (SVM) and gradient boosting (GB)-were used using periodontal inflamed surface area (PISA) and demographic and anthropometric variables (age, gender, ethnicity, body mass index [BMI] and smoking habits) as inputs to predict systemic inflammation (defined using serum C-reactive protein [CRP] levels). The best performing classification models (evaluated using area under the curve, AUC analyses) were validated using a second nationally representative dataset from the National Health and Nutrition Examination Surveys (NHANES) 2001-2002 and 2003-2004 combined datasets (N = 2288). Next, RF, SVM and GB were employed incorporating a set of systemic parameters (including serum CRP and lipid profiles) to predict the diagnosis of periodontitis. The best performing classification models were then validated using the NHANES 2009-2010 (N = 664) dataset. RESULTS:A nonlinear trend of CRP levels and PISA was confirmed by fractional polynomial regression (p = 0.008). Further, multiple linear regression analyses (adjusted for age, gender, ethnicity, BMI and smoking habits) confirmed a statistically significant relationship between log-transformed CRP levels and PISA (p < 0.0001). Logistic regression confirmed a relationship between PISA and low-density lipoprotein (LDL) in both crude and adjusted models. Among the classification models, SVM showed the highest performance in distinguishing CRP < 2 mg/L from CRP ≥ 2 mg/L (AUC = 0.71). The SVM model was successfully replicated in the NHANES 2001-2002 and 2003-2004 waves (AUC = 0.74). Prediction of periodontitis status (case vs. control) based on systemic indicators using the SVM model achieved the best performance with a mean AUC of 0.82. This was partially confirmed after external validation using the 2009-2010 NHANES dataset (AUC of 0.72). CONCLUSION:This study confirmed a consistent relationship between measures of cumulative periodontal inflammation and systemic inflammation through machine learning models. A predictive model incorporating systemic health parameters helped in identifying a case with periodontitis. Both models have potential for use in primary healthcare settings, including screening programmes, as providing confirmation of the bidirectional link between periodontitis and systemic health.

AIM:To explore mechanistic links between rheumatoid arthritis (RA) and periodontitis (PD) through the lens of subgingival microbial dysbiosis-mediated inflammation. METHODS:Subgingival plaque from 100 volunteers with RA and PD (RAPD), 22 with RA (RAnoPD), 18 with PD (PDnoRA) and 19 healthy controls (noRAnoPD) was analysed using 16S-amplicon sequencing, semi-quantitative bead-based flow cytometry to measure crevicular fluid cytokines and ELISA to quantify antibodies to oral pathogens and systemic inflammatory markers in serum. The RAPD group had been randomised to receive intensive non-surgical periodontal therapy (PMPR) or oral hygiene alone and reviewed at 3 and 6 months in our previously reported study. RESULTS:Subgingival microbial dysbiosis, as evidenced by higher species richness, alpha-diversity and higher levels of known and putative periodontal pathobionts, was evident at baseline in RAnoPD, RAPD and PDnoRA. Higher serum antibodies to oral pathogens were recorded in RAPD. PMPR restored host-microbial homeostasis in RAPD within 3 months. Significant decreases in serum antibodies to microbial antigens and clinical measures of RA activity were seen after 3 and 6 months in the PMPR group but not controls. CONCLUSIONS:We demonstrate a mutualistic influence of RA and PD, beginning with RA-induced dysbiosis of the periodontal microbiome, progressing to periodontal inflammation and culminating in PD-driven exacerbation of systemic inflammation.

Step 2 of periodontal therapy primarily aims at the non-surgical, mechanical disruption of the subgingival biofilm and removal of plaque-retentive factors, allowing a shift from disease to health. Numerous therapeutic agents have been proposed as adjuncts to non-surgical periodontal therapy, generally through either aiding disruption of the dental plaque biofilm, or though alteration of the host immune response. This article reviews the British Society of Periodontology's implementation of the S3-level guidelines in relation to adjunctive therapies. CPD/Clinical Relevance: Recommendation to use adjunctive therapies in the treatment of periodontitis requires careful consideration of the available evidence as well as the wider effects of the proposed therapy.

Periodontitis is a ubiquitous chronic inflammatory disease affecting the supporting tissues of the teeth and is a major cause of multiple tooth loss. Despite being preventable, periodontitis and dental caries are responsible for more years lost to disability than any other human condition. The most severe form of periodontitis affects 1 billion individuals, and its prevalence is increasing globally. Periodontitis arises from a dysregulated and hyperactive inflammatory response to dysbiosis in the periodontal microbiome. This response has systemic effects associated with premature mortality and elevated risk of several systemic non-communicable diseases (NCDs), including atheromatous cardiovascular disease, type 2 diabetes and chronic kidney disease (CKD). This risk association between periodontitis and NCDs is independent of their shared common risk factors, suggesting that periodontitis is a non-traditional risk factor for NCDs such as CKD. As periodontitis progresses, the immune cells and mediators underpinning its pathophysiology leak into the systemic circulation through the ulcerated oral mucosal lining, inducing in a systemic inflammatory profile that closely mirrors that observed in patients with CKD. The relationship between periodontitis and CKD seems to be bi-directional, but large-scale intervention studies are required to clarify causality and could lead to new care pathways for managing each condition as an exposure for the other.

Statement of problem. Literature reporting on the prosthetic survival and complications of implant -retained prostheses in patients with head and neck cancer is sparse. Purpose. The purpose of this retrospective study was to present the survival rates and complication -free survival rates of both fixed and removable implant -retained oral prostheses in patients with head and neck cancer while also reporting on the frequency and causes of failure and complications for each prosthesis type. Material and methods. A retrospective analysis of the prosthetic survival rates and complication -free survival rates of implant -retained oral prostheses and the frequency and causes of failure and complications in patients with head and neck cancer treated in a regional unit from 2012 to 2017 was performed. Differences in categorical and continuous data were assessed for statistical signi ficance by using the Pearson chi -squared test, Fisher exact test, t test, and analysis of variance as appropriate. Cox proportional hazard regression models were fitted to evaluate the association between prostheses type, clinical and medical factors, and the outcomes of survival and complication -free survival. Descriptive statistics were used to analyze the frequency and type of prosthetic complications. Results. The sample was composed of 153 patients diagnosed with head and neck cancer who had completed implant -retained prosthodontic rehabilitation and had been provided with 221 prostheses. The 5 -year survival rate was 87% for maxillary fixed prostheses, 79% for mandibular fixed, 66% for maxillary removable, and 50% for mandibular removable. Hazard ratios were calculated showing that the 5 -year survival rate of a mandibular removable prosthesis (HR=5.1; 95% CI 1.60-16.25) ( P =.006) was greater than that of a maxillary fixed prosthesis (HR=1.0). The 5 -year complication -free survival rate was highest for mandibular fixed prostheses (62%), followed by maxillary fixed (58%), maxillary removable (36%), and mandibular removable prostheses (29%). Hazard ratios showed that the 5 -year survival rate of maxillary removable (HR=1.91; 95% CI 1.01-3.66) ( P =.048) and mandibular removable prosthesis (HR=2.29; 95% CI 1.234.25) ( P =.009) was greater than that of a maxillary fixed prosthesis (HR=1.0). Variables of radiotherapy, grafting, age, and sex and their in fluence on the survival rate and complication -free survival rate were assessed but were not statistically signi ficant. Conclusions. This evaluation indicated that fixed implant -retained prostheses had a higher 5 -year survival rate and 5 -year complication -free survival rate than removable implant -retained prostheses in patients with head and neck cancer. (J Prosthet Dent 2024;132:278-87)

Quorum sensing molecules (QSMs) in the oral cavity regulate biofilm formation, the acquisition of iron, stress responses, and the expression of virulence factors. However, knowledge of the direct QSM–host interactions in the oral environment is limited, although their understanding could provide greater insight into the cross-kingdom communication occurring during oral disease development. This review aims to explore the literature on oral QSM–host interactions and to highlight areas of advancement in this field. The studies included in this review encompass an array of cell types and oral QSMs, with particular emphasis on immune cells and their relationship to periodontal diseases. It can be inferred from the current literature that QSMs are utilised by host cells to detect bacterial presence and, in the majority of cases, elicit an immune response towards the environmental QSMs. This may provide a base to target QSMs as a novel treatment of oral diseases. However, N-acyl homoserine lactone (AHL) detection methods remain an area for development, through which a greater understanding of the influence of oral QSMs on host cells could be achieved.

Oral diseases remain a major health problem worldwide, with the World Health Organisation reporting that oral health neglect affects almost half of the world’s population. Quorum sensing molecules (QSMs) influence oral biofilms in various ways with knowledge of direct oral QSM-host interaction being limited, and such studies could provide more insight into the cross-kingdom communication occurring during oral disease development. This review aims to explore the literature on oral QSM-host interaction and to highlight areas of advancement in this field. QSM CSP-1 produced by Gram-positive oral bacteria was found to interact with T2R receptors, activating NF-kB signalling and leading to remodeling of the cytoskeleton. AI-2 in the oral cavity was found in various studies to elicit an inflammatory response in specific oral cells. Overall AHL detection methods remain an area for development, through which greater understanding of oral QSMs’ influence on host cells can be achieved. In conclusion, from the current literature it can be inferred that that QSMs are utilised by host cells to detect bacterial presence and in the majority of cases elicit an immune response towards the environmental QSMs. This may provide a base to target QSMs as novel treatment of oral diseases.

AIM:To explore the associations between periodontal health and patient-reported outcomes (PROs), accounting for changes over time, in a large, non-specialist dental practice patient cohort.MATERIALS AND METHODS:This longitudinal study used data from 13,162 dentate patients, collected by 162 dentists at routine appointments between May 2013 and April 2020, in 238 non-specialist dental practices across the United Kingdom. Dentists collected data, as part of routine clinical care, on periodontal probing pocket depths, alveolar bone loss, bleeding on probing, as well as a range of covariates. Patients inputted data on outcomes (oral pain/discomfort, dietary restrictions, and dental appearance). Mixed-effects logistic regression analysis was used to investigate the associations between periodontal health and PROs. Models accounted for clustering at the patient and dentist level and were adjusted for time and variables which were thought to confound these associations.RESULTS:The odds of all PROs tended to increase with worsening periodontal parameters. For example, the odds of reporting pain in the worst periodontal health category were 1.99 (95% confidence interval: 1.57-2.53) times higher than in the best periodontal health category.CONCLUSIONS:This study confirms, using a large longitudinal dataset from a unique non-specialist setting, the associations between poorer periodontal health and poorer PROs.

Chapter 10 Supportive Periodontal Therapy Praveen Sharma, Praveen SharmaSearch for more papers by this author Praveen Sharma, Praveen SharmaSearch for more papers by this author Book Editor(s):Serge Dibart, Serge DibartSearch for more papers by this authorThomas Dietrich, Thomas DietrichSearch for more papers by this author First published: 14 November 2023 https://doi.org/10.1002/9781119830344.ch10 AboutPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShareShare a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract The 2017 World Workshop classification recognizes periodontitis as a condition, for which patients retain a lifelong susceptibility. With this in mind, clinicians should think of "management" of periodontitis, as opposed to "treatment" of periodontitis. This is similar to other, chronic, noncommunicable diseases, such as diabetes. In practice, the lifelong management of periodontitis takes different forms and needs to be personalized to the individual patient. After the phase of active periodontal therapy, patients are entered into the maintenance phase of treatment called supportive periodontal therapy (SPT) or supportive periodontal care. With this support in place, most patients can expect to retain most teeth. The evidence supporting SPT and the steps involved in delivering SPT are detailed in this chapter. Just as periodontal disease and therapy is highly individualized between patients, so is the recall therapy. References Axelsson , P. and Lindhe , J. ( 1981 ). The significance of maintenance care in the treatment of periodontal-disease . J. Clin. Periodontol . 8 ( 4 ): 281 – 294 . 10.1111/j.1600-051X.1981.tb02039.x CASPubMedWeb of Science®Google Scholar Carvalho , R. , Botelho , J. , Machado , V. et al. ( 2021 ). Predictors of tooth loss during long-term periodontal maintenance: an updated systematic review . J. Clin. Periodontol . 48 ( 8 ): 1019 – 1036 . 10.1111/jcpe.13488 PubMedWeb of Science®Google Scholar Chapple , I.L.C. , Mealey , B.L. , Van Dyke , T.E. et al. ( 2018 ). Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions . J. Clin. Periodontol . 45 : S68 – S77 . 10.1111/jcpe.12940 PubMedWeb of Science®Google Scholar Costa , F.O. , Lages , E.J.P. , Cota , L.O.M. et al. ( 2014 ). Tooth loss in individuals under periodontal maintenance therapy: 5-year prospective study . J. Periodont. Res . 49 ( 1 ): 121 – 128 . 10.1111/jre.12087 CASPubMedWeb of Science®Google Scholar Ramseier , C.A. , Nydegger , M. , Walter , C. et al. ( 2019 ). Time between recall visits and residual probing depths predict long-term stability in patients enrolled in supportive periodontal therapy . J. Clin. Periodontol . 46 ( 2 ): 218 – 230 . 10.1111/jcpe.13041 PubMedWeb of Science®Google Scholar Ramseier , C.A. , Woelber , J.P. , Kitzmann , J. et al. ( 2020 ). Impact of risk factor control interventions for smoking cessation and promotion of healthy lifestyles in patients with periodontitis: a systematic review . J. Clin. Periodontol . 47 : 90 – 106 . 10.1111/jcpe.13240 PubMedWeb of Science®Google Scholar Sanz , M. , Herrera , D. , Kebschull , M. et al. ( 2020 ). Treatment of stage I–III periodontitis – The EFP S3 level clinical practice guideline . J. Clin. Periodontol . 47 : 4 – 60 . 10.1111/jcpe.13290 PubMedWeb of Science®Google Scholar Practical Periodontal Diagnosis and Treatment Planning, Second Edition ReferencesRelatedInformation

AIM:To investigate the sources of periodontitis misclassification under partial-mouth protocols (PMPs) and to explore possible approaches to enhancing protocol validity.MATERIALS AND METHODS:Using data from 10,680 adults with 244,999 teeth from the National Health and Nutrition Examination Survey, we compared tooth-, site-, and quadrant-specific periodontal parameters and case identification under full-mouth protocols and PMPs. Separately, we utilized population measures of tooth-specific periodontal severity to generate PMPs with tooth selection based on the population ranking of clinical severity and assessed the sensitivity of case identification.RESULTS:Symmetry of clinical severity was generally confirmed, with the exception of lingual inter-proximal sites, which yielded greater sensitivity in identifying periodontitis compared to buccal sites due to more severe pocketing and attachment loss on average. Misclassification of severe periodontitis occurred more frequently under commonly implemented PMPs compared to ranking-based selection of teeth, which yielded sensitivity estimates of 70.1%-79.4% with the selection of 8 teeth and reached 90% with the selection of only 14 teeth.CONCLUSIONS:Clinical symmetry and sources of periodontitis misclassification were confirmed. The proposed selection of teeth based on population rankings of clinical severity yielded optimal sensitivity estimates for the detection of severe periodontitis and may present a favourable alternative to current options.

Introduction: Regional anesthesia (RA), i.e., spinal or epidural anesthesia when performed for lower segment cesarean section (LSCS) provides excellent surgical conditions, avoiding manipulation of the maternal airway, maternal satisfaction, and good postoperative analgesia. However, in situations like fetal distress (fetal heart rate abnormalities), obstetric indications (abruption of placenta, antenatal placental bleeding, cord prolapse), maternal refusal for RA, contraindications to neuraxial anesthesia (anticoagulation, coagulopathy), and at times failed RA general anesthesia (GA) is administered. Several studies have demonstrated greater mortality and morbidity when LSCS is done under GA when compared to neuraxial block. Methods: After necessary approval, we retrospectively reviewed data over a period of 1 year (January 1, 2020–December 31, 2020) of LSCS under GA versus RA. The aim was to compare immediate postoperative complications, postoperative pulmonary complications up to 4 weeks from the time of elective and emergency LSCS under either RA or GA. Results: Of the 753 patients who underwent LSCS in one calendar year, there were 272 (36.12%) elective and 481 (63.87%) emergency LSCS. The number of elective LSCS under neuraxial block was 219 (29.09%) and under GA were 53 (7.03%). Emergency LSCS done under neuraxial block were 268 (35.59%) and under GA were 213 (28.28%). There were no adverse pulmonary complications at the end of 4 weeks in either group. Conclusion: RA provides maternal satisfaction and excellent perioperative analgesia in LSCS. Safe GA can be achieved with proper airway planning, if case is attended by at least two anesthesiologist with adequate preoperative fasting, and postoperative monitoring.

Background Point of care testing (POCT) devices have been developed to facilitate immediate results with the potential to aid screening for new disease and enable patients to self-monitor their disease. Non-communicable diseases (NCDs) are the major cause of mortality globally and are increasing in prevalence as the population ages. Allied health care professionals (AHPs) are skilled in undertaking risk assessment and delivering preventative advice, providing opportunities to access large proportions of the population who may not visit their doctor, within non-traditional community settings. There is evidence of high levels of support from public, patients and health professionals for engaging AHPs in risk-targeted early case detection of certain NCDs. Thus, POCT devices offer a potential alternative to traditional venous blood collection, as novel care pathways for increasing early case detection and access to preventative care. The objectives of this study were to: (i) determine the concordance of the specific POCT devices with laboratory-based standard assays employed within clinical biochemistry laboratories. (ii) compare the sampling experience of both methods via patient-reported experiences. Methods A prospective, two-centre study was undertaken involving 158 participants who provided informed consent. Venous blood was collected for traditional assays of HbA1c, creatinine/ estimated Glomerular-Filtration-Rate (eGFR) and vitamin-D. Capillary blood was collected by finger prick test and also assayed for the same biochemical indices (Nova StatSensor (creatinine/eGFR); Siemens DCA-Vantage (HbA1C); CityAssays (vitamin-D)). All users were provided with device training. Participants reported any discomfort experienced by each simultaneously applied method (randomised in order) via a 100 mm Visual-Analogue-Scale. Results Results for each POCT device and the laboratory standard were analysed by Bland-Altman plots to determine assay concordance. POCT devices demonstrated good concordance with laboratory testing, with at least 95% of all samples being within two standard deviations, for each of the devices tested. The majority of participants reported less discomfort with POCT than venepuncture, with the average reported discomfort being 17/100 mm less for POCT compared to venous blood sample collection on the visual analogue scale. Conclusions The POCT devices demonstrated acceptable concordance with laboratory-based assays, and patients reported lower levels of discomfort compared to traditional means of blood collection. This study demonstrates the potential of using these devices as acceptable methods for opportunistic testing of “at-risk” individuals within non-traditional community care settings.

Historically, oral and dental issues for head and neck cancer patients were often not considered until after cancer treatment was complete. As a result, outcomes for oral rehabilitation were sometimes suboptimal. Inconsistencies in service delivery models and qualification, training and experience of staff delivering dental care often compounded this problem, making research and audit almost impossible. Collaborative working by consultants in restorative dentistry from all over the UK as part of a Restorative Dentistry-UK (RD UK) subgroup, renamed more recently as the RD-UK Head and Neck Cancer Clinical Excellence Network (CEN), has re-emphasised the importance of specialist restorative dentistry intervention at the outset of the head and neck cancer pathway to optimise outcomes of patient care. The CEN has driven several initiatives, reflecting Getting It Right First Time (GIRFT) principles aimed at reducing unwarranted variation. This improved consistency in approach and optimised collaborative working of the team now presents a better environment for multicentre audit and research. Ultimately, this should result in a continued improvement in patient and carer experience.

1. Ebert A-K, Reutter H, Ludwig M, Rösch WH. The exstrophy-epispadias complex. Orphanet J Rare Dis 2009;4:23. 2. Marietta M, Facchini L, Pedrazzi P, Busani S, Torelli G. Pathophysiology of bleeding in surgery. Transplant Proc 2006;38:812-4. 3. Rixen D, Siegel JH. Bench-to-bedside review: Oxygen debt and its metabolic correlates as quantifiers of the severity of haemorrhagic and post-traumatic shock. Crit Care 2005;9:441-53. 4. Choi AY, Ahmad NS, de Beer DA. Metabolic changes during major craniofacial surgery. Paediatr Anaesth 2010;20:851-5. 5. Hugot P, Sicsic J-C, Schaffuser A, Sellin M, Corbineau H, Chaperon J, et al. Base deficit in immediate postoperative period of coronary surgery with cardiopulmonary bypass and length of stay in intensive care unit. Intensive Care Med 2003;29:257-61. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.