Aim: This paper describes a newly created primary care oral surgery specialist service operating in a managed clinical network caring for the United Kingdom military population. It aims to review its outcomes and to consider the structure of the service in relation to the recommendations of the 2010 NHS sponsored 'Review of Oral Surgery Services and Training' by Medical Education England which made recommendations for the delivery of UK oral surgery services. Materials and methods: A retrospective audit of patient records and referral data. Results: This paper describes a primary care focused, specialist delivered oral surgery referral service that has demonstrated how the recommendations of this review can be successfully implemented to the benefit of patients and those that commission and resource care whilst simultaneously delivering clinical training to General Dental Practitioners in oral surgery. Furthermore it illustrates the successful implementation and integration of a managed clinical network for the delivery of oral surgery referral services from primary care general practice through primary care specialist practice to secondary care hospital services. Conclusions: The benefits of the service include an efficient, effective and fiscally economical patient centred service with referral to treatment timings and complication rates that compare favourably to current alternatives and with the structures and processes that facilitate the achievement of quality outcomes. Clinical relevanceScientific rationale for study: To assess the delivery of core oral surgery services in a primary care setting.Principal findings: Of a sample of 795 cases, 92% were definitively managed in the primary care clinic. Of those referrals transferred for management in a hospital unit, 85% were due to a requirement for general anaesthesia with only seven cases (1% of total referrals) judged to be for care that fell out with the oral surgery core competencies.Practical implications: Specialists in oral surgery can deliver a substantial portion of their services in the primary care setting with benefits to patients and to commissioners of care while maintaining a postgraduate teaching commitment.Primary care oral surgery referral service Davies et al. 66Oral Surgery 6 (2013) 61-66.

IntroductionHealth professionals working in the dental environment are potentially at risk of noise-induced hearing loss (NIHL) due to the use of clinical and laboratory equipment. Workplaces engaging in the practice of dentistry within the UK are subject to legislation from the Control of Noise at Work (CNW) regulations 2005. Clinicians working in the military are at further increased risk of NIHL due to exposure from additional risk factors such as rifles or aircraft engines. To our knowledge, no authors have previously studied the noise levels experienced in a military dental setting or compared noise levels in a typical dental practice with current UK legislation.MethodMeasurements of noise levels experienced by a dentist, dental nurse and dental hygienist during a standard conservation procedure were assessed using wearable noise dose-badges. Furthermore, noise levels within a dental technician’s work space were also assessed. Noise levels produced by representative clinical and laboratory equipment were assessed and compared with CNW legislation.ResultsThe highest level for clinical equipment was produced by the suction apparatus while aspirating up a cup of water at 76 dB. For laboratory equipment, the lower exposure action value (LEAV) of 80 dB would be exceeded in 2.1 hours’ use of the trimmer, 3.6 hours’ use of the vibrating table and 9 min use of the airline.ConclusionsNoise levels experienced by clinicians within the dental surgery were well below the legislative LEAV thresholds for both peak and continuous noise. However, noise levels produced by laboratory equipment were far higher and there is clearly the potential for excessive noise exposure for dental professional in the everyday setting. Dental professionals responsible for dental laboratory settings must be familiar with the CNW regulations and measures put in place that control the inadvertent breach of legislation. Hearing protection must be mandated when using equipment that exceeds the LEAV and an educational programme is required to explain both their correct use and the rationale behind it. Methods of mitigating that risk further require exploration such as alternative methods of completing the tasks performed by the airline or reducing the noise generated by it, such as by reducing the supply pressure or using an alternative nozzle design.

Introduction: Anxiety toward dental treatment can lead to preventable morbidity, most notably oral pain and infection. This is of concern to the UK Armed Forces (UK AF), as dental care may not be immediately accessible during deployments and exercises, necessitating aeromedical evacuation. Current Defence Policy states that serving UK AF personnel requiring sedation to tolerate routine dental treatment are to have their Joint Medical Employment Standard (JMES) reviewed to restrict their deployability and employability. This article explores current sedation delivery, dentist opinion, and adherence to policy. Materials and Methods: The total number and type of intravenous (IV) sedation appointments over a 6-month period was assessed using surgical logbooks. Questionnaires were sent to all dentists in primary care responsible for treating military patients to ascertain their attitudes toward the requirement for sedation in support of recruitment and deployability. Ten-year retrospective data analyses were used to identify current trends in sedation use in the UK AF. Results: Responses were received from 117/137 (85%) dentists. All of the responding Civilian Dental Practitioners felt that there was a requirement for IV sedation in contrast to the Royal Navy (RN), where over a quarter (28%) disagreed. The majority, 48 (81%), of Army dentists felt that military patients unable to tolerate routine treatment under local anesthesia alone should not deploy on operations, compared with 7 (63%) of their civilian counterparts. Overall, 72 (62%) respondents felt that patients unable to tolerate routine treatment without sedation should not be recruited. Conclusions: Civilian Dental Practitioners in the sample indicated that they were less likely to recommend a patient for JMES review, less likely to prevent patients from deploying and less likely to believe that individuals requiring sedation for routine treatment should not be recruited into the UK AF. These attitudes are contrary to current Defence direction and could increase the risk of UK AF personnel experiencing morbidity on deployment requiring aeromedical evacuation. Over the longer term, civilianization of Defence dentistry is likely to reduce collective operational experience and Defence must ensure that clinicians understand the management of anxious patients in the military context and their responsibilities in relation to JMES. Furthermore, policy limiting the recruitment of personnel with significant dental anxiety is not being robustly adhered to. Based on the number of dental procedures undertaken under IV sedation in the UK AF, consistent application of this policy would not affect recruitment at an organizational level, but would limit the risk of deploying these personnel. Further work is required to understand dental anxiety within the UK Armed Forces so that the operational morbidity risks can be quantified and provision appropriately planned.

Introduction: Oral Health Related Quality of Life (OHRQoL) is a determinant of an individual's wellbeing and can be affected by dental disease. For military recruits, adverse OHRQoL may result in poor performance, and has safety implications. The aim of this study was to determine the incidence of dental extractions and dental health of a sample of new infantry recruits.Method: Electronic healthcare recordings of tooth extraction incidence was compared to recruits from the general military population. Clinical dental examinations and patient questionnaires were used to determine the prevalence and impact of caries using the PUFA (Pulp exposure, Ulceration, Fistula, Caries) criteria. The association between caries and PUFA lesions with self-reported oral health behaviors and beliefs was explored. Results:The incidence of tooth extraction was 2.4 times higher in new Army Infantry recruits than recruits in the general UK military population. 211 recruits were assessed, with a 100% response rate. 135/211 (64%) had caries, and 37/21117.5% had a PUFA lesion at the time of inspection. Sleep loss was significantly more likely in those with PUFA lesions than those without (OR 5.62, p <0.0001). Conclusions:Those military Infantry recruits with caries and PUFA lesions had worse OHRQoL than those that did not. This was evidenced by poorer sleeping patterns and an inability to perform tasks at work. Treatment of dental disease through extractions was higher in Army Infantry recruits and will likely reduce the number of days taken off sick, but its effect on overall OHRQoL cannot yet be substantiated.