Discusses the rationale potentially underpinning antibiotic prescribing patterns during the COVID-19 pandemic and highlights the importance of further consideration of prudent antibiotic prescription in light of potential future mandatory closures of dental practices.

The aim of this study is to report a series of patients with mandibular division trigeminal nerve (V ) injuries secondary to endodontic treatment, evaluate presentation characteristics and identify prevention strategies. This article describes a retrospective review of patients referred to a tertiary clinic 2007-2015 with V injury following endodontic treatment. The sample included 12 male and 16 female patients with a mean age of 41.5 years. Sixteen cases presented following endodontic treatment of the first and second molar, premolar teeth in eight cases and canine in two cases. Fifteen patients reported immediate post-operative symptoms, in eleven cases there was a 24-48 h asymptomatic period. The average referral delay was 23.1 months. Twenty patients had permanent neuropathy. Four patients experienced resolution of symptoms within 8 weeks. V injury following endodontic treatment is rare but can result in permanent neuropathy and functional impairment. This can be avoided through comprehensive pre-operative radiographic examination, identification and referral of high-risk cases.

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Introduction The Guide for commissioning oral surgery and oral medicine published by NHS England (2015) prescribes the level of complexity of oral surgery and oral medicine investigations and procedures to be carried out within NHS services. These are categorised as Level 1, Level 2, Level 3A and Level 3B. An audit was designed to ascertain the level of oral surgery procedures performed by clinicians of varying experience and qualification working in a large oral surgery department within a major teaching hospital.Materials and methods Two audit cycles were conducted on retrospective case notes and radiographic review of 100 patient records undergoing dental extractions within the Department of Oral Surgery at King's College Dental Hospital. The set gold standard was: '100% of Level 1 procedures should be performed by dental undergraduates or discharged back to the referring general dental practitioner'. Data were collected and analysed on a Microsoft Excel spreadsheet. The results of the first audit cycle were presented to all clinicians within the department in a formal meeting, recommendations were made and an action plan implemented prior to undertaking a second cycle.Results The first cycle revealed that 25% of Level 1 procedures met the set gold standard, with Level 2 practitioners performing the majority of Level 1 and Level 2 procedures. The second cycle showed a marked improvement, with 66% of Level 1 procedures meeting the set gold standard.Conclusion Our audit demonstrates that whilst we were able to achieve an improvement with the set gold standard, several barriers still remain to ensure that patients are treated by the appropriate level of clinician in a secondary care setting. We have used this audit as a foundation upon which to discuss the challenges faced in implementation of the commissioning framework within both primary and secondary dental care and strategies to overcome these challenges, which are likely to be encountered in any NHS care setting in which oral surgery procedures are performed.

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