Lennart Johannes Gruber

Background/Aim: To assess knowledge of initial management of traumatic dental injuries among senior medical students and to compare knowledge at cohort level before and after implementation of structured teaching on traumatic dental injury management within an emergency medicine module. Material and Methods: This single‐center study was conducted at a German medical faculty. An anonymous structured questionnaire covering common first‐aid scenarios for traumatic dental injuries, including avulsion, luxation, and fracture management, was administered to two independent cohorts of senior medical students before and after implementation of a dental trauma lecture. The questionnaire comprised 16 multiple‐choice items regarding knowledge of traumatic dental injury management. Total knowledge scores and item‐level results were compared between cohorts using unpaired statistical analyses. Results: A total of 117 students participated in the pre‐implementation cohort and 92 in the post‐implementation cohort. Mean knowledge scores were higher in the post‐implementation cohort (10.0 vs. 6.6 points, p < 0.0001). The proportion of students classified with low knowledge decreased, whereas moderate and high knowledge categories increased at cohort level after structured teaching. Higher proportions of correct responses were observed in avulsion‐related items, including replantation and appropriate timing of intervention. However, no significant differences were found in management of luxated primary teeth and recommended timing of dental referral after initial management. Conclusions: Knowledge of traumatic dental injury management among senior medical students was predominantly low before lecture implementation and was higher at cohort level after structured teaching within an emergency medicine module. Given the anonymous unpaired design, these findings should be interpreted as cohort‐level differences rather than direct within‐subject learning effects. Clinically relevant gaps persisted in dentition‐specific management and dental referral timing. These findings support structured integration of guideline‐based dental trauma management into medical curricula while highlighting the need for future studies assessing practical skills and clinical performance.

Background/Objectives: Guideline-recommended adjuvant therapy, including radiotherapy alone or concurrent chemoradiotherapy, is an established component of treatment for patients with high-risk oral squamous cell carcinoma (OSCC). However, a considerable proportion of patients (30.7%) refuse postoperative treatment despite a clear guideline-based recommendation. Data on determinants of treatment refusal and its association with oncologic outcomes remain limited. Methods: This retrospective single-center cohort study included 88 patients with histologically confirmed OSCC and a clear indication for adjuvant therapy between 2015 and 2021. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method. Group comparisons were performed using Breslow tests to account for potential early differences in survival. Exploratory Cox proportional hazards models were calculated for OS to assess the association between completion of adjuvant therapy and survival after limited adjustment for clinically relevant covariates. Results: Refusal of indicated adjuvant therapy occurred in 27 of 88 patients (30.7%) and was significantly associated with older age (p = 0.002) and female sex (p = 0.002). In unadjusted Kaplan–Meier analyses, patients who refused adjuvant therapy showed shorter median OS compared with those who completed treatment, although the difference did not reach statistical significance (p = 0.155). In exploratory Cox regression analyses, completion of adjuvant therapy was associated with a reduced risk of death after adjustment for age and sex (HR 0.22, 95% CI 0.09–0.54; p = 0.001). In the overall cohort, no statistically significant difference in DFS was observed according to adjuvant therapy status (p = 0.129). However, exploratory subgroup analyses suggested that DFS differences according to adjuvant therapy status were more apparent in patients with advanced primary tumors (pT3/4; p = 0.032) and those with more extensive nodal disease (pN2/3; p = 0.019). Conclusions: Refusal of guideline-recommended adjuvant therapy is frequent in patients with high-risk OSCC and was associated with less favorable survival patterns in this cohort. Given the retrospective design, limited sample size, and exploratory nature of the analyses, these findings should be interpreted as associative rather than causal. Nevertheless, they highlight the potential clinical relevance of treatment adherence and support the importance of patient-centered counseling to improve uptake of guideline-recommended postoperative therapy.

Objectives: Tobacco smoking is one major risk factor in the development of oral squamous cell carcinoma (OSCC). Continuation of smoking after diagnosis and treatment is associated with an increase in recurrence rate and incidence of second tumors, with a shorter lon g‐term survival and poorer response to therapy. In the current German guideline for the treatment of OSCC, there is no clear recommendation to participate in structured smoking cessation programs. Materials and Methods: A total of 202 patients with histologically confirmed OSCC completed a one‐time assessment of their smoking behavior using three standardized questionnaires during regular tumor follow‐up. In addition to sociodemographic data, patients were asked retrospectively about their smoking habits and motivation to quit smoking before and after diagnosis and treatment. Results: A serious smoking cessation attempt before diagnosis of OSCC were stated in 54.8% of the participants. This number increased up to 82.2% after OSCC diagnosis. However, only 48.5% managed to quit smoking after diagnosis. Professional support was with only 21.92% ( n = 16) rarely used. Motivation to quit was significantly lower before (2.75 ± 2.41) than after OSCC diagnosis (7.27 ± 2.41) ( p = 0.001) and significantly higher among the participants who finally managed to quit (9.38 ± 1.68) than among those who continued smoking (4.79 ± 3.43) ( p = 0.001). Conclusions: The diagnosis of OSCC appears to be an important teachable moment for smoking cessation. To maximize this effect, an early and standardized implementation of systematic smoking cessation programs into the therapeutic concept of patients with OSCC is strongly recommended.

Despite the advances in automated medical image segmentation, AI models still underperform in various clinical settings, challenging real-world integration. In this multicenter evaluation, we analyzed 20 state-of-the-art mandibular segmentation models across 19,218 segmentations of 1,000 clinically resampled CT/CBCT scans. We show that segmentation accuracy varies by up to 25% depending on socio-technical factors such as voxel size, bone orientation, and patient conditions such as osteosynthesis or pathology. Higher sharpness, isotropic smaller voxels, and neutral orientation significantly improved results, while metallic osteosynthesis and anatomical complexity led to significant degradation. Our findings challenge the common view of AI models as “plug-and-play” tools and suggest evidence-based optimization recommendations for both clinicians and developers. This will in turn boost the integration of AI segmentation tools in routine healthcare.