This letter is in reference to the technical note by de Vera et al 1 The technical note is an important contribution to dental and oral surgery as it documents the need of the hour, which is the safety of the dental professionals. I commend the authors for their meticulous work and well-written note. The emphasis on "most publications related to the prevention of facial injuries caused by medical equipment are described in patients but not amongst healthcare professionals" 2 was an eye-opener on one of the most unaddressed topics. It shows the intricate efforts by the author and also gives us a solution to the one of the most ignored, yet a disruptive issue, by the healthcare professionals. The use of hydrocolloid dressing is an outstanding choice based on its excellent healing properties by 40% on superficial trauma, cost-efficiency and availability. 3 The use of many adjunct measures like facial massage and cold application are also implemented by some professionals. This technical note motivates us to try it out for professionals in our hospital too. I would once again like to compliment the authors for their insightful work.

The BDA will also never shy away from talk about funding, and that is why we are pursuing this vital issue on two fronts.We want to help colleagues meet their professional obligations both to audit and to prescribe appropriately. That's why we have provided our members with this toolkit.But we also believe they require funded emergency time. We've spoken personally to the CMO, to the CDO, to NICE, the DH and NHS England on this matter, and it's a message we will be taking directly to parliamentarians in a dedicated event this summer.These are complimentary strategies. Commissioners are never going to recognise the need for funding without evidence. The users of our toolkit are already generating records on diagnosis and the treatment. The data colleagues have already pulled together will make a powerful case for funding. Electronic cigarettes Necrotic ulcerSir, we would like highlight an interesting case of a severe, necrotic looking oral ulcer attributed to the use of an electronic cigarette (e-cigarette).A 72-year-old Caucasian male was referred by his GP as a two week wait referral to the oral and m axillofacial clinic. He had previously been smoking 20 cigarettes a day for 30 years before starting to use electronic cigarettes to aid his smoking cessation. He gave a history of a painful area appearing after inhaling strongly on his e-cigarette and suffered extreme discomfort immediately afterwards.On examination a 2 cm × 1 cm necrotic ulcer was clearly visible (Fig. 1). An incisional biopsy confirmed no evidence of malignancy and suggested the diagnosis of non-specific ulceration. The ulcer was managed conservatively and after a prolonged period of regular reviews the area eventually healed completely.The e-cigarette device consists of a heating element and a container that holds the vapour solution. It vaporises the liquid solution into an aerosol mist that contains varying amounts of nicotine.1 The role of the e-cigarette in smoking cessation is widely accepted and its usage is rapidly increasing worldwide. 2Despite the availability of research on the direct physiological effects of the e-cigarette, there is a paucity of data available on the physical effects and safety concerns of the e-cigarette on human health. 1 The potential for intra oral burns and injuries may present a challenge to the oral healthcare provider. Burns in particular, as in the above case, should be considered as a differential diagnosis of nonhealing oral ulceration. Burns and explosions from e-cigarettes are thought to be under reported, although cases of fires and explosions of e-cigarette do exist in the literature. 3-5With the increasing use of the electronic cigarette worldwide, we aim to make healthcare professionals aware of the potential harm these items can cause. We also highlight the importance of including burn injuries in the differential diagnosis of soft tissue oral ulceration. Potential hazards and safety concerns associated with the e-cigarette requires further research. Drug interactions Time to put our pens downSi...

Background The aim of this study was to generate utility data to support economic evaluation of interventions for compromised first permanent molars (cFPMs) and to assess the reliability of responses using alternative elicitation methods.MethodsFifty adult respondents attending a Paediatric Dentistry department with their child completed a questionnaire to elicit utility values for eight clinical treatment scenarios for a compromised first permanent molar tooth (cFPM). These scenarios included restorations, prosthetic replacements or presence of a gap (missing tooth). The question formats included a ranking, a visual analogue scale (VAS) and a time trade off (TTO) exercise.ResultsMean utility values for each health state were generated using the VAS and TTO data. A white filling generated the highest utility (0.786 [VAS], 0.763 [TTO]) and was ranked as the most favourable treatment option. An open gap generated the lowest utility (0.344 [VAS], 0.523 [TTO]). A closed gap (0.6392 [VAS]) was rated below various tooth restorations but above a traditional bridge (0.5944 [VAS]) or denture (0.4312 [VAS]), according to mean VAS scores. VAS responses showed better agreement (kappa=0.48) with the ranking exercise compared to TTO responses (kappa= -0.003).ConclusionsPlausible and broadly consistent values were generated with VAS and TTO, but TTO data seemed to be less reliable. These data allow comparison of treatment options involving extraction and gap closure or restoration of cFPMs using a single measure of patient preference.

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