key: cord-0016639-h6g211ra
authors: Devine, C.
title: Aptly coined acronym
date: 2021-04-09
journal: Br Dent J
DOI: 10.1038/s41415-021-2903-5
sha: b0b96b2135c34e2928b640e3a6fba46f7767ad1f
doc_id: 16639
cord_uid: h6g211ra

nan

Primary care

Sir, I was pleased to read the article Introducing the FATLIPS acronym for assessing the red flag clinical features of dental infection. 1 As a DCT in oral and maxillofacial surgery I am familiar with assessing patients who present to A&E with dental infections and regularly receive referrals from GDPs for suspected infections. I believe this acronym is readily applicable for GDPs as it is based on assessments that don't require tests that are likely to be unavailable in practice. Even with the increased frequency of phone triaging and patients emailing in photographs of suspected swellings, GDPs should be able to successfully work through this aptly coined acronym, identifying those that require management in secondary care and those that don't. Furthermore, this acronym provides not only a useful tool by which a referring GDP can assess patients, but can also provide a framework to facilitate communication between the referring practitioner and accepting on call DCT. This will ensure only appropriate referrals are accepted and avoid patients attending hospital unnecessarily, which is particularly pertinent in the current COVID-19 climate. Upon reading this

Sir, we read with great interest the letter by Dadnam et al. presenting the case of a Romanian patient and we felt it might be helpful to provide some additional insight as dentists who trained and/or are practising dentistry in Romania. 1 We agree with the authors that most dental care in Romania is delivered privately and as evidence suggests, treatment costs can present a significant barrier for accessing care for certain members of the community. However, it is important to point out that socio-economic inequalities regarding access to oral healthcare are not a problem unique to Romania but are prevalent worldwide. 2 Furthermore, it is important to consider the significant limitations of interpreting health insurance data for international comparisons and the need for additional research in this area. 3 Evidence suggests that privately delivered dental care is being consistently underreported in various Eastern European countries as a way of avoiding fiscal duties. 3 For context, the tariff paid through the limited national health insurance system for a non-surgical extraction is around £12 (free for low income patients) meanwhile the same treatment delivered privately could cost starting from £10 or more depending on the location of the practice (urban/rural) and other factors such as being delivered by a GDP or specialist. It is worth noting that the national minimum wage is around £400/ month. 4 Considering the limitations of the available data, our direct clinical experience of working both in the private and public healthcare systems suggests that the case presented in the letter might be an exception rather than a representative example for the entire population. These are uncertain times for ethnic minorities, and it is important to remember the risk of stereotyping which might lead to

Sir, the essence of dentistry is pain perception and the alleviation thereof. Accordingly, the existence of the dental profession is essentially founded upon the peculiarities of dentine sensitivity which is undoubtedly the most frequently experienced form of pain perception. The exposure of dentine to salivary solutes of acidity and temperature variations within the mouth make dentine perception as the sine qua non of painful experiences. The ability to transmit 'sweetness' as a stimulus for pain is a property shared by no other tissue, and the mechanism of this peculiarity has hitherto never been explained. 1 Presumably, the high osmotic pressure of a sugar solution acting on exposed dentine is productive of a painful sensation. Yet even a strong isotherm salt solution does not elicit a reaction from dentine.

The histology of dentine revealing the contents of the dentinal tubes to be extensions of peripheral odontoblasts in the dental pulp categorises these cells as extensions of the peripheral nervous system. Thereby, the inclusion of odontoblasts as 'nerve tissue' is justified on the basis of their physiological activity rather than their histological appearance. The expanded classification of nerve tissue to include odontoblasts calls for a denouement of neurons and odontoblasts as equal pain perceivers. Essentially then, dentine is

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