bluuebunny/crossref_metadata_2025 huggingface dataset:
CJD and the Dentist
Authors: Smith Andrew , Bagg Jeremy
Published: August 2017

The last 10 years have seen the emergence of a new disease termed variant CJD. This disease is thought to be initiated by abnormal prion proteins. This article reviews the different clinical manifestations of human prion diseases and provides some background information on the biological nature of this unique infectious agent. Prion proteins present a challenge to infection control because of their relative resistance to the conventional sterilization process. This article highlights the issues involved and discusses current guidelines for management of patients with human transmissible encephalopathies.
Halitosis
Authors: Scully Crispian , Rosenberg Mel
Published: August 2017

Halitosis (oral malodour or breath odour) is a fairly common complaint. Halitosis is most often a consequence of oral bacterial activity, typically from anaerobes. Occasional causes include systemic disease, and some patients have a psychogenic background to the complaint. The management is outlined in this paper.
A Resin Alternative for Posterior Teeth: Questions and Answers on Dental Amalgam
Authors: Wahl Michael J.
Published: August 2017

Amalgam has been used to restore cavities in posterior teeth for over 100 years, but formulations used today are different from those used a century ago. Amalgam restorations have been blamed for a number of problems, such as cusp fracture and higher rates of secondary caries. This article discusses these issues, along with possible toxic effects, in the light of current literature.
Paediatric Dentistry in the New Millennium: 2. Behaviour Management – Helping Children to Accept Dentistry
Authors: Fayle Stephen A , Tahmassebi Jinous F
Published: August 2017

Children's dentistry can be a challenge for both the patient and the dentist. The way a dentist interacts with the child patient will have a major influence on the success of any clinical or preventive care. In order to deliver high-quality dentistry to a child whilst also developing a positive attitude towards dental health, the dentist should have a good understanding of the factors that might affect the behaviour of children in the dental setting. A working knowledge of strategies to minimize anxiety and make positive behaviour more likely is essential, as is a grasp of how best to deal with anxiety or negative behaviour.
Perioperative Corticosteroid Supplementation and Dento-alveolar Surgery
Authors: Key S.J. , Hodder S.C. , Davies R. , Thomas D.W. , Thompson S.
Published: August 2017

Patients are referred to hospital for dento-alveolar surgical procedures requiring supplemental corticosteroid administration. However, it has been reported that medically compromised patients who require routine dental treatment are being referred unnecessarily. This article reports a retrospective study undertaken at a Regional Maxillofacial Unit over a 24-month period, which reveals the referral pattern and management of patients specifically referred for outpatient dental treatment with corticosteroid supplementation. The paper highlights the dilemma confronting practitioners when reviewing the literature on corticosteroid supplementation and the confusion that still exists in both the primary and secondary care settings as to which patients should be prescribed supplemental corticosteroids. A simplified guide is proposed for the clinical management of these patients.
Periodontal Ligament: Structural and Clinical Correlates
Authors: Berkovitz Barry K.B.
Published: August 2017

This paper reviews certain structural aspects of the periodontal ligament. These include collagen (type, crimping and fibril diameters), ground substance (functions), cells (fibroblast morphology, cell heterogenicity and distinguishing of cell phenotypes, cell kinetics, ‘foetal’ characteristics), nerves (presence of neuropeptides) and blood vessels (presence of fenestrations). Attention is drawn to recent advances in our understanding of the development of the periodontal ligament, especially cementum formation, and in the presence of bioactive molecules such as growth factors and cytokines.
Managing Discoloured Non-Vital Teeth: The Inside/Outside Bleaching Technique
Authors: Poyser Neil J. , Kelleher Martin G.D. , Briggs Peter F.A.
Published: August 2017

The discoloured, non-vital anterior tooth is a common aesthetic concern for many patients. It can have a profound effect on their self-esteem, interaction with others and employability. Discoloured non-vital teeth are frequently compromised owing to previous trauma, caries, endodontic therapy and failed restorations. Destructive invasive treatment options are likely to weaken the residual structure of the tooth. This can reduce the prognosis and challenge the long-term viability of the tooth, thereby initiating further prosthetic predicaments. This paper discusses modern approaches to the treatment of discoloured teeth. The importance of preventing and eliminating the potential for discoloration will be highlighted. The paper will include a detailed technical account on the application of the inside/outside bleaching technique, with several clinical examples.
Professionals Complementary to Dentistry: The Expanding Role of PCDs
Authors: McGlashan Gregor , Watson David J. , Shanks Susan
Published: August 2017

The role of Professionals Complementary to Dentistry is increasing in importance as new ways of exploring dental service provision are considered. Skill-mix and team-building are not just buzzwords, but signify the new view of a multi-disciplinary approach in healthcare. Since the Nuffield and DARG reports of the last decade urged consideration of manpower issues within dentistry, the ensuing change from often small, single-handed practice, to larger team approaches has resulted in significant changes in service delivery. It is unsurprising that the bewildered practitioner can become lost in the mire of proposed new regulations. Outlining the current developments in the expanding role of PCDs, this paper illustrates the dynamic nature of the changes.
Bitewing Examination to Detect Caries in Children and Adolescents – When and How Often?
Authors: Mejàre Ingegerd
Published: August 2017

It is generally agreed that the decision to take bitewing radiographs for detecting caries should be based on the benefit to the individual patient in relation to the risks associated with low dose radiation exposure and the costs. There is incomplete knowledge about the effectiveness of various methods for selecting individuals who will benefit from bitewing examination. Available knowledge suggests, however, that our ability to identify correctly those who will benefit is limited. It may, therefore, be more effective to combine population-and individual-based selection criteria. For this purpose, four key ages and individual-based criteria between the key ages are suggested.
An Overview of the Use of Lasers in General Dental Practice: 2. Laser Wavelengths, Soft and Hard Tissue Clinical Applications
Authors: Sulieman M
Published: August 2017

The profession now benefits from many different laser wavelengths that enable their use in nearly every dental specialty. This article will cover these wavelengths and their uses for soft and hard tissue procedures.
How to Write a Case Report
Authors: Dowsing Paul , Sandler Jonathan
Published: August 2017

Case reports form an invaluable source of learning and discussion material. The aim of this article is to provide some guidance to help authors who are thinking of submitting reports for future publication. Some common pitfalls are highlighted, as well as useful hints to increase the authors' chances of publication.
Developing a Tooth Restorability Index
Authors: McDonald AV , Setchell DJ
Published: August 2017

It is generally agreed that the inherent strength of a tooth is dependent on the remaining dentine. It therefore seems logical that preservation of coronal dentine is important to the survival of intra- and extra-coronal restorations. The clinical assessment of the amount of dentine needed for functional requirements and the strategic value of remaining tooth structure is currently based on clinical opinion. This paper discusses what recommendations have been published and proposes an index that may be useful in assessing the restorability of a tooth.
Use of Radiographs in the Diagnosis of Periodontal Disease
Authors: Tugnait Aradhna , Carmichael Fiona
Published: August 2017

Radiographs are commonly used in the diagnosis of periodontal diseases. They can be used to assess bone loss and the pattern of loss as well as in the identification of other periodontally relevant features, such as overhanging restoration margins, calculus deposits and furcation lesions. Horizontal and vertical bitewings, panoramic radiographs and periapicals can be used for periodontal assessment. Referral (selection) criteria based on clinical signs can assist the decision of the radiographs to use. All exposures must be made in accordance with the Ionizing Radiation (Medical Examination) Regulations 2000 and each exposure justified.
Amalgam: Dead or Alive?
Authors: Osborne John W
Published: August 2017

The use of dental amalgam is on the decline, yet its many advantages, including the contrast in colour with the tooth, increase the possibility that the patient's dentition will lasta lifetime.
Facts and Fallacies: An Evidence Base for Complete Dentures
Authors: Carlsson Gunnar E
Published: August 2017

The rate of edentulism is falling but many edentulous people still need complete dentures. There is poor correlation between the quality of dentures and patient satisfaction. There is no evidence that a more complex fabrication technique including face-bow registration results in a better clinical outcome. Balanced occlusion/articulation is not necessary for successful complete denture function. Variations in materials and techniques appear to have only minor influence, if any, on the clinical end result. Psychosocial factors, especially a good relationship between dentist and patient, are more important than prosthodontic factors for a positive outcome.
Vital Tooth Bleaching in Dental Practice: 2. Novel Bleaching Systems
Authors: Brunton P A , Aminian A , Pretty I A
Published: August 2017

This paper describes some of the novel commercial approaches to tooth bleaching. Known as ‘direct-to-consumer’ products there are two main systems available, one employing coated, cellulose strips and the other a paint-on gel. A further development is the production of dentifrices that contain active hydrogen peroxide, made possible by the use of dual chambered tubes. Each of the systems is described and demonstrated and an overview of the research supporting their safe, effective use is presented in each case. It is likely that our patients have access to these products and, hence, it is important that we are aware of their strengths and weaknesses.
IOTN (DHC): Is It Supported By Evidence?
Authors: Ferguson J W
Published: August 2017

The strength of the evidence linking some common malocclusion traits (which are used as the basis for IOTN classification) with dental disease is reviewed. It is concluded that IOTN is not a reliable predictor of the potential impact of malocclusion on future dental health, and that alternative indices, which place greater emphasis on the aesthetic impairment and take account of patient perceptions, are more appropriate for assessing an individual's orthodontic treatment need.
The Surgical Management of the Oral Soft Tissues: 3. Biopsy
Authors: Jephcott Anna
Published: August 2017

Offering patients a broad range of services, whilst inspiring patient confidence and reducing their anxiety and waiting time, is an advantage for a general dental practitioner wishing to perform simple biopsies. But which lesions need a biopsy, which lesions are suitable to biopsy in practice, and how should this be done? This article covers the basic knowledge and technical skills required to perform simple biopsies in general practice.
Patient-Centred Measures in Dental Practice: 3. Patient Satisfaction
Authors: Newsome Philip RH , McGrath Colman
Published: August 2017

This, the final paper in this three-part series, looks at how patients evaluate the dental care they receive and how this translates into either satisfaction, dissatisfaction or something in between. It explains how it might be possible to manage patient expectations so that patients are more likely to be satisfied with all aspects of the care provided and describes a framework for dentists and staff to use when trying to enhance patient experience in everyday dental practice.
How to Make a Well-Fitting Stabilization Splint
Authors: Moufti M Adel , Lilico Jeff T , WWassell Robert
Published: August 2017

This article demonstrates a clinical step-by-step approach to constructing stabilization splints. These splints can be invaluable for many restorative procedures and forTMD management. To help the busy practitioner, we have included tips on trouble shooting problems encountered during splint fitting.
Safeguarding Children in Dental Practice
Authors: Harris Jenny C , Sidebotham Peter D , Welbury Richard R
Published: August 2017

The dental team is well placed to notice signs of child abuse and neglect, yet research shows that UK dentists are unprepared for a role in protecting children at risk. This article describes how to recognize signs of child abuse and neglect and what to do when concerned about a child. It highlights that advice and support are available from colleagues in other health professions and social services. The concept of ‘safeguarding’ children and promoting their welfare in dental practice is introduced.
The Surgical Management of the Oral Soft Tissues: 1. Flap Design
Authors: Jephcott Anna
Published: August 2017

Correct management of the soft tissues during minor oral surgery is of great importance to ensure rapid and uncomplicated healing. This paper will cover the design of the most commonly required mucoperiosteal flaps in general practice.
The Ferrule Effect
Authors: Stankiewicz Nikolai , Wilson Peter
Published: August 2017

When the supra-marginal dentine of a root-filled tooth is engaged by a crown, it may create a stronger tooth/restoration complex. This has been termed the ferrule effect. This paper reviews the current evidence for this effect and examines the influence various post and core materials have on it. Means of achieving a ferrule are discussed and the importance of planning for failure is considered.
High Fluoride Toothpastes: Their Potential Role in a Caries Prevention Programme
Authors: Davies Robin M , Davies Gill M
Published: August 2017

This paper reviews the clinical evidence for the effectiveness of two, prescription only, toothpastes which contain 2800 and 5000 ppm F. The potential benefit of these toothpastes for high caries risk adolescents, adults and the elderly are discussed.
Contemporary Periodontal Surgery: 1. Surgical Principles
Authors: Bateman Geoffrey J , Saha Shuva , Pearson David
Published: August 2017

Periodontal surgery comprises surgical intervention of the supporting tissues of the teeth. This ranges in complexity from simple exodontia to technically demanding periodontal plastic surgery and includes the management of periodontal diseases, implant placement and preparatory treatment for fixed and removable prostheses. Modern surgical management reflects both a move towards evidence-based practice and the introduction of improved techniques and armamentarium. General principles of surgical management hold true regardless of what procedure is being carried out. These principles form a sound basis for any practitioner contemplating surgical interventions for their patients.
Atypical Fulminating Dental Infections
Authors: Mohammed-Ali Ricardo I , McGurk Mark
Published: August 2017

Dental surgeons are faced with treating dental infections on a daily basis and the cases discussed in this paper highlight the potential outcome of such infections, especially in immunocompromised patients.

Fulminating infection in the head and neck may present as a rapidly progressive, potentially fatal condition characterized by extensive necrosis of the subcutaneous tissues. One form of such infection is necrotizing fasciitis. Although first described in 1793 by Pouteau, the term necrotizing fasciitis was first coined in 1952 by Wilson who noted that facial necrosis was the most consistent feature of this disease. When necrotizing fasciitis occurs in the head and neck region it is usually odontogenic in origin. This paper reviews the cases of four patients presenting with atypical fulminating dental infection who presented to the oral and maxillofacial department at Guy's and St Thomas's Hospital, London, resulting in cellulitis and necrotizing fasciitis. Aggressive management is critical for patient survival and time wasted is tissue lost.
Autotransplantation of Teeth: An Overview
Authors: Amos Michael J , Day Peter , Littlewood Simon J
Published: August 2017

Autotransplantation is the surgical repositioning of a tooth within the same patient. It can be thought of as a controlled avulsion and re-implantation of a tooth in a new, surgically prepared socket. The indications for its use are discussed, as too are factors affecting the success and the clinical procedures. The preservation and regeneration of the periodontal ligament is the key to success of this treatment. A case involving the transplantation of a premolar tooth into the central incisor location in a child is presented to show the different stages of the process.
Apical Limit and Working Length in Endodontics
Authors: Simon Stephane , Machtou Pierre , Adams Nick , Tomson Phillip , Lumley Philip
Published: August 2017

Establishing the working length is an important step in endodontic treatment as inaccurate length determination may lead to failure. There is an ongoing debate regarding the extent of the apical limit of root canal preparation. This controversy is based upon different clinical opinions concerning the distance between the end point of the root canal preparation and the periodontal tissues. In this paper, we review the different schools of thought for working length determination, and how apex locators work and how they must be used for optimal accuracy. The reliability of these devices has been proven; the price is moderate and apex locators are now part of the basic armamentarium in the achievement of quality and predictable endodontic treatment.
Orthodontic Extrusion: An Interdisciplinary Approach to Patient Management
Authors: Addy Liam D , Durning Peter , Thomas Matthew BM , McLaughlin William S
Published: August 2017

Root fractures that occur at the cervical margin do not always heal predictably, even following a period of splinting. This often leaves margins either sub-gingival or sub-crestal. This provides an unsatisfactory situation for restoring the remaining root as restorations will impinge on the biological width. Provided a root is long enough to support a post crown, then orthodontic extrusion to provide sufficient supra-gingival tooth tissue is a useful treatment option to consider. A review of the literature on orthodontic extrusion is considered in conjunction with a case report of the management of a young male who fractured a canine and lateral incisor whilst playing cricket.
Taurodontism – A Review
Authors: Haskova Joanna E , Gill Daljit S , Figueiredo JAP , Tredwin Christopher J , Naini Farhad B
Published: August 2017

Taurodontism is the morpho-anatomical change in the shape of a tooth, which involves enlargement of the body of the tooth and shortening of the roots. It has been reported in permanent and deciduous teeth, in premolars and molars and associated with certain syndromes, particularly in those involving an ectodermal defect. It has clinical implications which are relevant to both the general dental practitioner and the orthodontist.
A Review of the Diagnosis and Management of the Cracked Tooth
Authors: Nguyen Vy , Palmer Guy
Published: August 2017

A cracked tooth is a common presentation in general dental practice. It may be difficult to diagnose, owing to the variations in the clinical presentation. The symptoms that result from a cracked tooth have given rise to the term Cracked Tooth Syndrome (CTS). This article reviews and discusses the clinical signs, symptoms and the management of CTS. An early diagnosis is important to relieve pain, restore function and improve the prognosis for the tooth. The prognosis can be unpredictable and this needs to be understood by patients before embarking on definitive treatment.
Minimally Destructive Management of Amelogenesis Imperfecta and Hypodontia with Bleaching and Bonding
Authors: Nathwani Neil S , Kelleher Martin
Published: August 2017

Amelogenesis imperfecta has a prevalence of 1:700 to 1:14,000, according to the populations studied and hypodontia has around 4.6−6.3% prevalence within the permanent dentitions of Caucasian European populations. Traditional treatment methods for these conditions include veneers and conventional bridges, which are invasive and unnecessarily destructive of remaining tooth tissue. The authors describe how, with the non-destructive use of bleaching, bonding and adhesive bridges, it is possible to achieve a reasonable aesthetic result in a practical way.
Does Periodontal Treatment Improve General Health?
Authors: Seymour Robin A
Published: August 2017

The association between periodontal disease and various systemic conditions raises the question of the impact of periodontal therapy on general health. There is increasing evidence that periodontal intervention can reduce the prevalence of an adverse pregnancy outcome, improve glycaemic control in diabetics, reduce systemic markers of inflammation, lower cholesterol levels and improve vascular endothelial function. The magnitude of the impact of periodontal therapy on these modalities needs further quantification/study. Despite such reservations, there are indications that any form of periodontal treatment may have outcomes that extend beyond improving life expectancy of the dentition.
Prevention of Iatrogenic Inferior Alveolar Nerve Injuries in Relation to Dental Procedures
Authors: Renton Tara
Published: August 2017

This article aims to review current hypotheses on the aetiology and prevention of inferior alveolar nerve (IAN) injuries in relation to dental procedures. The inferior alveolar nerve can be damaged during many dental procedures, including administration of local anaesthetic, implant bed preparation and placement, endodontics, third molar surgery and other surgical interventions. Damage to sensory nerves can result in anaesthesia, paraesthesia, pain, or a combination of the three. Pain is common in inferior alveolar nerve injuries, resulting in significant functional problems. The significant disability associated with these nerve injuries may also result in increasing numbers of medico-legal claims.

Many of these iatrogenic nerve injuries can be avoided with careful patient assessment and planning. Furthermore, if the injury occurs there are emerging strategies that may facilitate recovery. The emphasis of this review is on how we may prevent these injuries and facilitate resolution in the early post surgical phase.
Magnifying Loupes in Modern Dental Practice: An Update
Authors: James Teresa , Gilmour Alan SM
Published: August 2017

There are three principal reasons for adopting magnifying loupes for operative dentistry: to enhance visualization of fine detail, to compensate for the loss of near vision (presbyopia) and to ensure maintenance of correct posture. The wearing of loupes is becoming an accepted norm amongst qualified practitioners and increasingly in the undergraduate population. However, further research is required before evidence-based recommendations can be made about their effectiveness in achieving the three principles. Compared to the medical literature, there is a paucity of studies on the use of loupes in dentistry. This article presents an overview of the well-documented (but under-researched) optical and ergonomic benefits of wearing loupes and highlights special circumstances where the use of loupes would be inadvisable. The article concludes with a review of the small number of studies on magnifying loupes specifically for restorative dentistry.
Multiple radio-opacities in an opg: a case report of cavernous haemangioma of temporalis muscle with multiple phleboliths
Authors: Gadhia Kushal , Bunyan Robert , Chan Chi-Hwa
Published: August 2017

Intramuscular haemangiomas of the head and neck region are rare. They may present as an incidental finding, a mass or swelling, pain, tenderness, limitation of movement or cosmetic deformity. Treatment depends on the clinical signs and symptoms. Because of the apparent rarity of this lesion, we report a case of an incidental finding of multiple radio-opacities in a dental panoramic tomograph that was diagnosed as cavernous haemangioma in temporalis muscle with multiple phleboliths.

Clinical Relevance: Symptoms may not always be what they seem.
Chondrolipoma presenting as a lump on the lateral tongue
Authors: Shabbir Fahad , Greenwood Mark
Published: August 2017

The oral cavity is an uncommon site for a true lipoma. A distinct histological variant is chondrolipoma, which is a rare oral lesion. A case of chondrolipoma in a 71-year-old male is reported and histology and differential diagnosis are discussed.

Clinical Relevance: An oral lump is a common presenting complaint and requires further investigation.
Treatment options for the free end saddle
Authors: Kumar Anju B , Walmsley A Damien
Published: August 2017

Many treatment options are available for the management of the free end saddle. This paper reviews past and current treatment methods for management of this situation.

Clinical Relevance: To understand the problem posed by the free end saddle and the techniques available to clinicians for its management in general dental practice.
Endodontics and the older patient
Authors: Qualtrough Alison JE , Mannocci Francesco
Published: August 2017

The number of elderly people in the population is rising and there is an increasing trend for tooth preservation. Older patients are more likely to have complex medical histories and/or physical disabilities. They are increasingly likely to retain their teeth, which could be heavily restored or broken down and root treatment may be challenging. In order to maintain teeth, a decision needs to be made as to whether or not to carry out endodontic treatment, which may be challenging in itself, and may also be associated with other age-related considerations. This paper considers endodontic issues related to the older patient, bearing in mind the plethora of considerations which may be relevant to root canal treatment.

Clinical Relevance: There are many benefits of retaining teeth, but there may be disadvantages.
Aesthetic composite veneers for an adult patient with amelogenesis imperfecta: a case report
Authors: Brignall Ian , Mehta Shamir B , Banerji Subir , J Millar Brian
Published: August 2017

This case has been presented as part of the continual assessment requirement for the MSc in Aesthetic Dentistry, King's College Dental Institute. Amelogenesis imperfecta (AI) is a hereditary disorder of enamel formation, affecting both the permanent and deciduous dentitions. It can be classified into hypoplastic, hypomaturation and hypocalcified types and presents with different hereditary patterns. The aim of this article is to provide an overview of amelogenesis imperfecta, including a detailed case report for an aesthetically concerned adult patient presenting in general practice with a Witkop's Type IA defect managed with the placement of direct, layered resin composite veneers.

Clinical Relevance: Amelogenesis imperfecta patients are susceptible to the restorative cycle of replacement restorations like any other patient, but start with a distinct disadvantage. This case report demonstrates a minimally invasive, relatively simple and cost-effective option for the aesthetic correction of a case of hypoplastic amelogenesis imperfecta with layered composite veneers.
Oral healthcare considerations for the pregnant woman
Authors: Nayak Ajay G , Denny Ceena , KM Veena
Published: August 2017

Pregnancy is a period of both joy and anxiety in a woman's life and is characterized by various physiological changes in her body brought about by the circulating female sex hormones. The oral cavity is also the seat of changes and these physiologic changes of pregnancy need to be addressed while managing the pregnant woman in the dental clinic. The main goal is to minimize the occurrence of any complications that might harm the mother-to-be and/or the unborn child. Preventive, emergency, and routine dental procedures are all deemed suitable during various phases of pregnancy, with some treatment modifications and initial planning.

Clinical Relevance: The dentist should be in a position to manage pregnant women in clinical practice effectively.
Dental management of the elderly patient
Authors: Preston AJ
Published: August 2017

The dental management of the elderly individual is becoming more of an issue in both general dental practice and specialist prosthodontic practice. This is because, in general, the population is living longer and often elderly patients are retaining their natural teeth into their old age. In addition, there are often related significant medical, social and oro-dental issues that require consideration.

Clinical Relevance: The dental management of the elderly patient is an increasing problem. This paper seeks to consider the main relevant issues pertaining to this important subject area.
Invisalign®, an innovative invisible orthodontic appliance to correct malocclusions: advantages and limitations
Authors: AH Ali Shaymaa Abdulreda , Miethke Henno Rainer
Published: August 2017

Tooth movement may be achieved by the use of sequential positioners made by altering tooth positions on set-up models to simulate progress of treatment. The principle is based upon Kesling's positioner concept of 1945, though its subsequent application to splint therapy was labour intensive and did not result in precise tooth movement. Invisalign® was developed by Align Technology, Inc (Santa Clara, CA, USA) in 1997 by applying 3-D imaging technology to overcome these problems, and permitting customization on a large scale. Their system offers significant advantages, but still suffers from limitations which are discussed in this article.

Clinical Relevance: By providing an aesthetic means of correcting malocclusions of minor to moderate severity, Invisalign® has met with high patient acceptance. Aggressive marketing of the system makes it essential that the orthodontists and dentists understand the basic mechanism whereby the system works, along with its strengths and limitations.
The talon cusp – an uncommon anomaly
Authors: Seehra J , Coutts F
Published: August 2017

Talon cusps are an uncommon dental anomaly of odontogenic origin. Talon cusps can also present with other dental anomalies, however these have been infrequently reported in the literature. The following is a report of two cases in which talon cusps were detected in combination with two distinct dental anomalies: an ectopic canine and transposition.

Clinical Relevance: It is important to recognize that the management of talon cusps may require a multidisciplinary approach and should be considered during treatment planning.
Ozone and caries: a review of the literature
Authors: Burke FJ Trevor
Published: August 2017

Ozone, either in gaseous form or as ozonated water, has been available for use as a treatment for dental caries for a decade. This paper reviews the literature on the subject by examining the findings of publications in the peer review literature. Eighteen papers were identified by a literature search. From the review of these, it was concluded that, while some laboratory studies and some short duration clinical studies have suggested that ozone may be effective in the treatment of root caries or killing of oral micro-organisms, the clinical evidence for the use of ozone in treatment of caries is not compelling.

Clinical Relevance: It may be considered that there is presently no justification for the routine use of ozone in the treatment of caries.
Tumoral calcinosis: a dental literature review and case report
Authors: Krstevska Ana , Gale Sarah , Blair Fiona
Published: August 2017

Tumoral calcinosis (TC) is a rare familial disease characterized by abnormal peri-articular calcification in affected joints, without any associated renal, metabolic or collagen vascular disease. It is characterized by usual hyperphosphataemia with normal serum calcium and alkaline phosphatase values. There are only a few reported cases of TC patients with dental findings. This article reviews the dental literature and describes progressive gingival, alveolar and mandibular tori enlargement in a 41-year-old female from Zimbabwe with tumoral calcinosis.

Clinical Relevance: Tumoral calcinosis is a rare disorder of mineral metabolism with oral manifestations.
Ethical marketing in ‘aesthetic’ (‘esthetic’) or ‘cosmetic dentistry’ part 3
Authors: Kelleher Martin G D , Djemal Serpil , Lewis Nicholas
Published: August 2017

This, the third and final article in this series on ethical marketing, makes it clear that cosmetic dentistry is not a guaranteed one-way ticket to happiness for either patients or dentists, but it can be for lawyers. In fact, this area of dentistry is fraught with many dangers for the unwary patient and even for the enthusiastic or experienced dentist. In general, it is not at all wise to raise patient expectations beyond that which is definitely going to be easily achievable in his/her particular case.

Clinical Relevance: If things go wrong with extensive cosmetic dentistry, or are judged as being suboptimal, or unacceptable, by the patient, then that dentist may become liable for all the remakes of that elective cosmetic dentistry for the lifetime of the patient, together with all the associated general and specific damages. This is because, if the elective cosmetic dentistry had not been done, the patient would not have needed to have the remakes. Informed consent is a major issue with cosmetic dentistry, as is avoiding any possible claims for breach of contract, which could be verbal, implied or written.
Dentinogenesis imperfecta: full-mouth rehabilitation using implants and sinus grafts – a case report
Authors: Seymour DW , Chan M F W-Y , Nixon PJ
Published: August 2017

This case report outlines one possible treatment modality to manage the developmental abnormality dentinogenesis imperfecta (DI). In this case, the patient's dentition is restored using a combination of full-coverage crowns for the remaining teeth and implant-supported crowns to replace missing teeth in a re-organized occlusal scheme. The case also demonstrates the effective use of the sinus graft procedure with simultaneous placement of dental implants. This paper also aims to make the reader aware of the current thinking behind treatment delivered to this group of patients, focusing on full-mouth rehabilitation using a combination of implant-supported and conventional metal ceramic crowns.

Clinical Relevance: For the general dental practitioner this case outlines the prevalence and cause of DI. It demonstrates how early diagnosis and appropriate referral has an impact on future treatment.
Denture fixative cream and the potential for neuropathy
Authors: Shammaa Yasir , Rodgers Jennifer
Published: August 2017

The body requires zinc in small amounts to remain healthy. Because the body balances zinc and copper, people who ingest excessive zinc have resulting dangerously low levels of copper. An acute zinc overdose itself may be toxic and chronic zinc ingestion results in bone marrow suppression and degeneration of the spinal cord, usually resulting in crippling nerve damage. It's been called ‘human swayback disease’. A case of a 54-year-old female whose nerve damage greatly reduced her mobility due to copper deficiency myelopathy as a result of the use of denture fixative cream is discussed.

Clinical Relevance: Many cases of mysterious nerve damage turn out to be caused by overuse of popular denture products, eg Fixodent. Thus we are encouraging patients to read the manufacturer's leaflet and follow the instructions carefully.
A study to assess management of patients on warfarin by general dental practitioners (GDPS) in the west midlands
Authors: Dewan Karun , Vithlani Viren , Patel Neil , Warren Kathy
Published: August 2017

Current management protocols for anticoagulated patients undergoing dental procedures are influenced by evidence-based guidelines. These guidelines state that the risk of significant bleeding is low in patients who have a stable INR within a therapeutic range, (2-4). The risks of interruption of anticoagulant therapy is greater than the risk of bleeding. This paper discusses the current practice of general dental practitioners (GDPs) in the West Midlands when treating patients taking warfarin and compares these findings with standard guidelines. A questionnaire was sent to 638 GDPs in West Midlands in 2010, 492 (77%) were returned. This study was carried out three years after a similar study carried out in South West Wales and after the guidance updated by the BNF and NMWIC. Thirty-three (7%) of the respondents did not treat patients on warfarin. The majority of respondents (86%) considered that a dental extraction in a patient on warfarin is a procedure associated with a high risk of bleeding. Surgical implant placement (75%), subgingival debridement (49%) and inferior dental block (40%) administration were also considered by GDPs to be associated with a high risk of bleeding. The majority (88%) of the respondents check the INR of anticoagulated patients before carrying out treatment. Of these, 244 (52%) would do so within 24 hours and 78 (17%) of them within 72 hours. Only 117 (25%) considered 4.0 as the safe upper limit for the INR for performing high-risk procedures.

Clinical Relevance: The findings of this study demonstrate that there is general awareness about how to manage patients on warfarin but uncertainties still exist among general dental practitioners. Further education and training would improve the care of patients on warfarin in a primary care setting.
Retention systems for implant-retained overdentures
Authors: Vasant Ronuk , Vasant Manjul K
Published: August 2017

There have been demographic and cultural changes in the past few decades with regards to edentulism. Conventional mucosa-borne dentures can be poorly accepted by some patients. Implant overdentures have a useful role to play in the treatment of some of these patients. Some form of attachment mechanism between the implants and the prosthesis is normally required. This paper updates the reader on the different types of attachment systems and bars available.

Clinical Relevance: It is important that dentists and technicians are able to understand the advantages and disadvantages of different attachment types for overdentures, in order to select the most appropriate technique for each patient.
Spontaneous resolution of a periapical lesion during orthodontic treatment: a case report
Authors: Bainbridge M , Cousley RRJ
Published: August 2017

Teeth with periapical lesions can undergo successful orthodontic treatment, but conventional protocols indicate that such teeth should be endodontically stabilized prior to such treatment. A case report is presented where such endodontic stabilization was not possible, yet a chronic periapical lesion resolved as orthodontic treatment progressed. This paper will discuss the possible causes of the initial lesion, and reasons why it resolved without endodontic treatment.

Clinical Relevance: This report illustrates the possible combined roles of trauma, occlusion and periodontal disease in the development of a perio-endo lesion, and how orthodontic treatment potentially relieved some of the exacerbating factors, thus enabling resolution of the infection without endodontic treatment.
Antibiotics in dentistry – an update
Authors: Seymour Robin A
Published: August 2017

This review article considers the changes in antibiotic usage over the past 40 years. Perhaps the most significant advance is in the prophylactic use of these drugs to reduce the effect of dentally induced bacteraemia. A greater understanding of various dental infections and, in particular, the role of bacteria in the pathogenesis of periodontal disease, has led to further interest in the indications for these drugs as adjunctive measures. Whilst new indications for the use of antibiotics become more widespread, all members of the healthcare professions need to be aware that these drugs have significant adverse effects and their misuse can lead to life-threatening infection.

Clinical Relevance: Antibiotics have revolutionized the control of infectious diseases and have a significant role in dental practice. Dentists should be fully appraised of the benefits of these drugs and when they should be prescribed. Antibiotics usage should not be a substitute for interventional procedures, such as drainage of pus or removal of sources of infection. Indications for the use of these drugs as prophylactic measures are now reducing.
The diagnosis and management of invasive cervical resorption
Authors: SK Al-Salehi , O Omar
Published: August 2017

Abstract: A 23-year-old female patient presented complaining of sensitivity relating to LR4. She had good oral health and no history of trauma. Cone beam computed tomography, however, revealed advanced invasive cervical resorption (ICR) in LR4, as well as an incidental finding of ICR in LR6.

Clinical Relevance: CBCT proved essential in the diagnosis and treatment planning of this unusual case. Owing to the destructive nature of ICR, it is imperative to remove the entire lesion to avoid any chance of recurrence.
Dentine hypersensitivity – guidelines for the management of a common oral health problem
Authors: Gillam David G , Chesters Richard K , Attrill David C , Brunton Paul , Slater Mabel , Strand Peter , Whelton Helen , Bartlett David
Published: August 2017

Dentine hypersensitivity (DHS) remains a worldwide under-reported and under-managed problem, despite making some dental treatments more stressful than necessary and having a negative impact on the patient's quality of life. This article is designed to build dental professionals' confidence and remove any confusion regarding the diagnosis, prevention and treatment of sensitive teeth caused by dentine hypersensitivity in those patients known to be at risk. There is a need for simple guidelines, which can be readily applied in general practice. However, it is also obvious that one strategy cannot suit all patients. This review describes a DHS management scheme for dental professionals that is linked to management strategies targeted at three different groups of patient. These patient groups are: 1) patients with gingival recession; 2) treatment patients with toothwear lesions; and 3) patients with periodontal disease and those receiving periodontal treatment. The authors also acknowledge the role of industry as well as dental professionals in a continuing role in educating the public on the topic of sensitive teeth. It is therefore important that educational activities and materials for both dental professionals and consumers use common terminology in order to reduce the possibility for confusion.

Clinical Relevance: This review article provides practical, evidence-based guidance on the management of dentine hypersensitivity for dental professionals covering diagnosis, prevention and treatment. Sensitivity associated with gingival recession, toothwear and periodontal disease and periodontal treatment are specifically addressed in the article.
Special care dentistry: part 1. dental management of patients with inherited bleeding disorders
Authors: Rafique Sobia , Fiske Janice , Palmer Guy , Daly Blanaid
Published: August 2017

The most common cause of excessive bleeding is idiopathic, but bleeding can also be caused by inherited or acquired conditions associated with vascular defects, platelet defects or coagulation disorders. This paper will cover inherited bleeding disorders. Every clinician will encounter a patient who complains of prolonged bleeding following certain procedures; most commonly dental extractions. In the majority of cases the cause is often a local one and can be managed using simple local measures. However, prolonged post-operative bleeding following dental treatment might be one of the first signs of a bleeding disorder in an undiagnosed patient, necessitating referral for further investigations. Some patients may present with an already confirmed diagnosis of a bleeding disorder, requiring appropriate treatment planning and dental management in an appropriate setting with haematological advice. This paper will provide guidance on how to achieve this.

Clinical Relevance: To update clinicians on the dental management of patients with inherited bleeding disorders and how to decide the most appropriate setting for the provision of dental care.
Can oil lubricated dental handpieces be sterilized?:part 2. literature review
Authors: Kudhail Ravinder Singh
Published: August 2017

A literature search revealed six laboratory-based microbial challenge studies which support the opinion that oil contamination does not prevent successful sterilization of the lumen of dental handpieces. However, a detailed appraisal of these papers revealed lack of detail in the cleaning methods used prior to sterilization and none of the papers considered the risks of prion contamination.

Clinical Relevance: An examination of the evidence base on sterilization of oil-lubricated handpieces is of potential value to dental clinicians and their teams.
Self-adhesive resin cements: a new perspective in luting technology
Authors: Makkar Sumit , Malhotra Neeraj
Published: August 2017

Many materials are available for the fabrication of indirect restorations such as, metal alloys, resin-based composites and ceramics. Resin cements have long been valued as luting agents for indirect restorations because of their high retentive strength, resistance to wear, and low solubility. However, one of the common discouraging factors regarding their chairside use is the need of multiple-steps (etching, drying, priming and luting) for bonding. Thus the current impetus is towards the use of self-adhesive cements that require no etching, priming or bonding agents to bond to the tooth surface. Their increased popularity can be judged by the commercial availability of more than a dozen self-adhesive resin products/brands, in a short span of time. This article reviews the composition, physical and biological properties, adhesion characteristics and clinical performance of self-adhesive (resin) cements.

Clinical Relevance: Self-adhesive resin cements are dual-cured and adhere to tooth structure without the requirement of a separate etching step and application of an adhesive/bonding agent.
Minimal intervention dentistry and older patients part 1: risk assessment and caries prevention
Authors: Hayes Martina , Allen Edith , da Mata Cristiane , McKenna Gerald , Burke Francis
Published: August 2017

Ten million people in the UK today are aged over 65. The latest projections estimate that there will be 5½ million more people aged 65 and older in the next 20 years. This projected pattern of population ageing will have profound consequences for dentistry. Minimal intervention dentistry (MID) is a modern evidence-based approach to caries management in dentate patients that uses the ‘medical model’ whereby disease is controlled by the ‘oral physician’. This approach offers considerable benefits over conventional dentistry for older patients. It encourages patients to be responsible for their oral health through the provision of both knowledge and motivation. MID encompasses risk assessment for dental disease, early detection and control of disease processes, and minimally invasive treatment.

Clinical Relevance: Risk assessment tools can aid the general dental practitioner and the patient to develop a suitable caries prevention programme for that individual and reduce the need for future operative intervention.