Charlotte C. Currie

Objectives: Lack of regular access to dental services for children can increase disease prevalence and burden on NHS services, which is aggravated for the most vulnerable. Non‐clinical community hubs could be a feasible alternative for dental checks and oral health education. The aim of this study was to assess the oral health of children attending a non‐clinical community hub, and the feasibility/acceptability of these settings to children. Method: This study adopted an parallel mixed‐methods approach. Dental screening of children (0–16 years old) was undertaken in a non‐clinical community hub by a trained and calibrated dentist in April 2024. Basic demographics, global quality of life and clinical data were collected. All children were given oral health education using tooth models and dietary advice. A sub‐sample of children were recruited for qualitative inquiry, using a purposive sampling strategy. Three focus groups were facilitated with a pre‐determined topic guide and creative arts‐based techniques to facilitate discussion. These were audio‐recorded, transcribed verbatim and inductively coded following thematic analysis. Results: Over the 5‐day period, 141 children were screened with a mean age of 6.4 years (SD 3.8). Mean d ₃ mft was 1.7 (SD 2.9; 0–15), D ₃ MFT was 0.3 (SD 0.9; 0–4), and combined d ₃ mft/D ₃ MFT was 2.0 (SD 3.1; 0–19). Fifteen patients had silver diamine fluoride, 125 had fluoride varnish and one refused. Forty‐one children were signposted for future care. Three focus groups involving 11 children identified three themes that were constructed from the data were: ‘space’ requirements; promoting positive engagement; familiarity with the environment. Children were generally accepting of foodbanks as settings for oral health screening and preventive care. They emphasised the importance of child‐friendly, non‐threatening spaces and highlighted how familiar environments and trusted staff fostered feelings of safety and engagement. Conclusion: Non‐clinical community hubs are feasible and acceptable spaces to children to screen for oral health, providing a unique opportunity to reduce barriers to access and to target underserved groups with following on screening activities.

Human papillomavirus (HPV)-associated non-salivary adenocarcinoma of the oropharynx is exceptionally rare and poorly defined. We report a multi-institutional series of 12 cases from 6 tertiary centers. Histologic, immunohistochemical, HPV testing, molecular, and follow-up data were reviewed. Among 11 patients with available sex data, all were men; the median age was 62 years (range: 46 to 70 y). The cohort comprised 9 primary oropharyngeal adenocarcinomas and 3 metastatic adenocarcinomas, including a right neck metastasis of presumed oropharyngeal origin and 2 distant metastases in patients with previously documented HPV-associated oropharyngeal squamous cell carcinoma. Primary sites included the palatine tonsil or tonsil-palate region (n=7), base of tongue (n=1), and oropharynx, not otherwise specified (n=1). Among cases with available T-category, 5 of 6 were T3/T4. All tumors showed high-grade adenocarcinoma morphology without a recognizable squamous component, with infiltrative glandular, ductal, or cribriform architecture. Diffuse p16 expression was present in all cases, and high-risk HPV was confirmed by polymerase chain reaction or in situ hybridization. p40 was negative in the tumor cell population in cases 1 to 6, 8, 9, 11, and 12, whereas case 7 showed p40 and CK5/6 expression confined to abluminal cells. Molecular profiling in 2 cases identified alterations or variants involving PIK3CA and PIK3R1 . Follow-up in 6 patients with primary tumors showed distant metastases in 3 and disease-specific death in 1. HPV-associated nonsalivary adenocarcinoma of the oropharynx is a diagnostically challenging tumor that expands the morphologic spectrum of HPV-related oropharyngeal carcinoma. Recognition requires exclusion of salivary-type and metastatic adenocarcinoma and confirmation of HPV association.

Introduction: Cases of syphilis are increasing, with 9513 cases diagnosed in England in 2023, the highest annual number since 1948. Oral healthcare professionals should therefore be aware of how oral syphilis presents, the differential diagnosis and the appropriate care pathway and management.Case Series: We present 14 contemporary cases of oral syphilis to highlight the clinical features, outline the diagnostic pathway and document the management of the patients. We present the first patient in the literature to receive a diagnosis of neurosyphilis following an initial presentation with an oral lesion, emphasising the importance of early diagnosis and treatment of this increasingly prevalent infection.

Human papillomavirus (HPV)–associated multiphenotypic sinonasal carcinoma is a rare and recently described epithelial neoplasm exhibiting myoepithelial differentiation and morphological overlap with salivary gland neoplasms, especially adenoid cystic carcinoma; it is commonly associated with HPV, especially type 33. It has mainly been reported in the nasal cavity and paranasal sinuses with a single case reported in the breast. Herein, we report the first vulval example in a 47-year-old patient who presented with a large craggy mass in the region of the Bartholin gland. The histologic features were of a high-grade carcinoma composed of basaloid cells arranged in sheets and nests, with occasional ductal formations, surrounded by densely hyalinised basement membrane-type material. There was diffuse block-type immunoreactivity with p16 and HPV genotyping revealed high-risk HPV type 16. In reporting this case, we highlight the propensity for “salivary gland-type” neoplasms to arise in the vulva, especially in the Bartholin gland, and stress that pathologists should consider salivary-type neoplasms when faced with a morphologically unusual vulval tumor.

Patients with persistent orofacial pain (POFP) can go through complex care pathways to receive a diagnosis and management, which can negatively affect their pain. This study aimed to describe 44-y trends in attendances at Welsh medical practices for POFP and establish the number of attendances per patient and referrals associated with orofacial pain and factors that may predict whether a patient is referred. A retrospective observational study was completed using the nationwide Secure Anonymised Information Linkage Databank of visits to general medical practices in Wales (UK). Data were extracted using diagnostic codes (“Read codes”). Orofacial and migraine Read codes were extracted between 1974 and 2017. Data were analyzed using descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 468,827 POFP and migraine diagnostic codes, accounting for 468,137 patient attendances, or 301,832 patients. The overall attendance rate was 4.22 attendances per 1,000 patient-years (95% confidence interval [CI], 4.21–4.23). The attendance rate increased over the study period. Almost one-third of patients ( n = 92,192, 30.54%) attended more than once over the study period, and 15.83% attended more than once within a 12-mo period. There were 20,103 referral codes that were associated with 8,183 patients, with over half these patients being referred more than once. Odds of receiving a referral were highest in females (odds ratio [OR], 1.23; 95% CI, 1.17–1.29), in those living in rural locations (OR, 1.17; 95% CI, 1.12–1.22), and in the least deprived quintile (OR, 1.39; 95% CI, 1.29–1.48). Odds also increased with increasing age (OR, 1.03; 95% CI, 1.03–1.03). The increasing attendance may be explained by the increasing incidence of POFP within the population. These patients can attend on a repeated basis, and very few are referred, but when they are, this may occur multiple times; therefore, current care pathways could be improved.

: IntroductionAround one-third of the UK population are 'problem-orientated dental attenders', only seeking care when suffering with dental pain and often on a repeated basis to secondary care. Little is known about attendance in primary care. The aim here was to examine the period prevalence of repeat urgent care attenders and establish predictors of repeat attendance in primary care.MethodsData on urgent and emergency dental care attendances in primary dental care in the North East and Cumbria were analysed from 2013-2019. Variables included: patient sex; ten-year age band; lower super output area; and Index of Multiple Deprivation. Period prevalence was calculated and data were considered year by year to identify trends in attendances. Analysis was with descriptive statistics and predictors of repeat attendance were identified using logistic regression modelling.ResultsOver the six-year period, there were 601,432 attendances for urgent primary dental care, equating to a period prevalence of 2.76% for the geographic population studied. In total, 16.15% of attendances were repeat attendances (period prevalence 0.45%) and predictors included being a woman and residence in deprived and rural areas. All urgent care attendances decreased over the six-year period, with one-off attendances beginning to increase again in 2019, while repeat attendances stabilised.ConclusionInterventions to encourage regular dental attendances should be targeted at patients from the most deprived and rural areas of the North East and Cumbria; however, a decrease in repeat attendance was noted in these areas.

Background: Regular dental attendance is important in order to receive preventive care, maintain good oral health and identify oral and dental disease at an early stage; however, many people do not visit their dentist regularly. Barriers to regular attendance have been studied in small patient groups but not in the wider general population.Objective: To outline concerns about visiting the dentist and suggestions about how dentists could help using a general population sample.Method: A survey was constructed using Qualtrics XM software and circulated. Respondents completed questionnaires about dental anxiety and about their concerns and suggestions around dental appointments including the option for free‐text answers.Results: One hundred and fifty‐four people completed the survey. Common concerns were the unknown element (62.58%) and worries about ‘bad teeth’ (60.54%). The most popular request for change was for dentists to inform patients of the condition of all their teeth including those in good health (86.30%). A thematic analysis of qualitative responses identified themes of control, shame, discomfort, long‐term impact and cost. Several concerns and suggestions for improvement were expressed.Conclusion: Although the pain associated with dental treatment was identified as important, concerns about the unknown and feeling vulnerable were seen as a higher priority. People in the general population want dentists to help them to feel informed and in control at dental appointments and to be involved in discussions about how they are feeling and what is important to them.

One-third of the UK population is composed of problem-oriented dental attenders, seeking dental care only when they have acute dental pain or problems. Patients seek urgent dental care from a range of health care professionals, including general medical practitioners. This study aimed to identify trends in dental attendance at Welsh medical practices over a 44-y period, specifically in relation to dental policy change and factors associated with repeat attendance. A retrospective observational study was completed via the nationwide Secure Anonymised Information Linkage (SAIL) Databank of visits to general medical practice in Wales. Read codes associated with dental diagnoses were extracted for patients attending their general medical practitioner between 1974 and 2017. Data were analyzed with descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 439,361 dental Read codes, accounting for 288,147 patient attendances. The overall attendance rate was 2.60 attendances per 1,000 patient-years (95% CI, 2.59 to 2.61). The attendance rate was negligible through 1987 but increased sharply to 5.0 per 1,000 patient-years in 2006 (95% CI, 4.94 to 5.09) before almost halving to 2.6 per 1,000 in 2017 (95% CI, 2.53 to 2.63) to a pattern that coincided with changes to National Health Service policies. Overall 26,312 patients were repeat attenders and were associated with living in an area classified as urban and deprived (odds ratio [OR], 1.22; 95% CI, 1.19 to 1.25; P < 0.0001) or rural (OR, 0.84; 95% CI, 0.83 to 0.85; P < 0.0001). Repeat attendance was associated with greater odds of having received an antibiotic prescription (OR, 2.53; 95% CI, 2.50 to 2.56; P < 0.0001) but lower odds of having been referred to another service (OR, 0.75; 95% CI, 0.70 to 0.81; P < 0.0001). Welsh patients’ reliance on medical care for dental problems was influenced by social deprivation and health policy. This indicates that future interventions to discourage dental attendance at medical practitioners should be targeted at those in the most deprived urban areas or rural areas. In addition, health policy may influence attendance rates positively and negatively and should be considered in the future when decisions related to policy change are made.