key: cord-0013180-32m4nisv
authors: Elisetti, N.
title: Bio-fuel from PPE
date: 2020-10-09
journal: Br Dent J
DOI: 10.1038/s41415-020-2237-8
sha: 5a36159c723e6ea923f6dda745617e37836c00a8
doc_id: 13180
cord_uid: 32m4nisv

nan

the other PPE (polluting Planet Earth). One good alternative to protect Mother Nature in this situation is the conversion of plastic waste material into a liquid biofuel. Pyrolysis is the procedure of conversion of any material at very high temperatures. All PPEs which at present are disposed in landfills, oceans, etc, which impose negatively on aquatic animals, can be transferred to an incinerator and then pyrolysis can be done to break down the propylene chains to form a liquid. The liquid obtained can be used as a biofuel. We are very much in need of fuel for the operation of various mechanical devices.

This biofuel can be further reused thus protecting our planet. Due to the increasing population and their demand for energy consumption, this would serve as a healthy alternative and also preserve our nature. 2 

Sir, were Dexamethasone to be included in the Dental Formulary, practitioners need to be aware of common and important physical and psychiatric side effects of this potent glucocorticoid (steroid), prior to prescribing for the control of pain related to root canal treatment.

It is widely recognised that steroids can cause or worsen hyperglycaemia, and national guidelines recommend monitoring glucose levels in those with and at risk of diabetes. 1 Although much of the evidence concerns long term steroid use, hyperglycaemia has been frequently reported after short courses, for example in oncology practice. 2 Glucose levels can rise within hours of high dose steroids, with a disproportionate effect on afternoon and evening levels. 3, 4 Patients with or at risk of diabetes therefore need to be counselled to monitor their glucose levels after taking dexamethasone and may need to make short term adjustments of their diabetes therapy.

Even short courses of Dexamethasone in the peri-operative period may have an impact on wound healing, 5 which would be relevant to the proposed use in endodontics.

Another established side effect of Dexamethasone is that it can cause steroid induced psychiatric reactions, including psychosis, mood changes, behavioural disturbance and cognitive dysfunction. These symptoms can develop within days of a 5 mg single dose even in those who have no psychiatric history. 6, 7, 8, 9 The incidence of a psychiatric episode to steroids has been recorded at being between 13% and 62%. 8 Many of these are mild reactions such as euphoria and increased irritability and may not impact on functioning, but patients need to be warned about the severe reactions in up to 5-6% of patients, 8, 10 such as mania and suicidal thoughts. Severe and persistent symptoms will require treatment which is beyond the remit of the dentist.

Whilst Dexamethasone may reduce pain related to endodontic procedures 11,12 it is not a drug to be used when other safer treatment options may be available. We would be opposed to it being more widely available. 

Sir, I concur with your correspondent R. Dean 1 on the unprecedented usage of PPE (personal protective equipment) leading to

Sir, I was surprised to read an article (BDJ 2020; 229: 15-18) reporting that dentists cannot prescribe co-codamol. I have been prescribing it for years on a private prescription in different practices and never had an issue with it, as well as other drugs that are not on the dental practitioners section of the BNF. After seeing the article, I checked the GDC website where it states: ' A dentist can prescribe any medicine from the British National Formulary (BNF) on a private prescription; however you must only prescribe medicines to meet the identified dental needs of your patients' . As for myself, I believe that many colleagues that deal with surgical procedures are prescribing it as it would be very counterproductive and difficult to seek medical advice every time you have procedures that are bound to cause moderate to severe pain. In that same light I believe that we may prescribe any medications that we judge to be beneficial and justifiable for the patient's dental condition.

D. Silveira, London, UK 

Joint British Diabetes Societies for inpatient care. Management of hyperglycaemia and steroid (glucocorticoid) therapy

The effect of steroid pulse therapy on carbohydrate metabolism in multiple myeloma patients: a randomized crossover observational clinical study

Continuous monitoring of circadian glycemic patterns in patients receiving prednisolone for COPD

Diurnal profile of interstitial glucose following dexamethasone prophylaxis for chemotherapy treatment of gynaecological cancer

Adverse side effects of dexamethasone in surgical patients

Steroidinduced psychosis

American Psychiatric Association aww. Diagnostic and statistical manual of mental disorders: DSM-5

Steroid-induced psychiatric syndromes: A report of 14 cases and a review of the literature

Steroid-induced psychosis: report of case

Corticosteroids: easy psychiatric side-effects

Is the use of dexamethasone effective in controlling pain associated with symptomatic irreversible pulpitis? A systematic review

Effect of pretreatment medication on postendodontic pain: a double-blind, placebo-controlled study