bluuebunny/crossref_metadata_2025 huggingface dataset:
TADs: an evolutionary road to success
Authors: Pace Audrey , Sandler Jonathan
Published: August 2017

This is a literature search about the clinical use of temporary anchorage devices (TADs) as a means of providing effective orthodontic anchorage. It takes the reader through a journey from the initial description of the technique to the enormous popularity TADs are currently experiencing in clinical practice. This paper aims to present good quality clinical information to allow the clinician and the patient to make an informed decision.

Clinical Relevance: The purpose of this literature review is to provide readers with an overview of the current available literature on this subject and encourage general dental practitioners to adopt a more evidence-based approach to this aspect of orthodontic care.
Does stress predispose to periodontal disease?
Authors: Parwani Rajkumar N , Parwani Simran R
Published: August 2017

The relationship of a sound mind to the maintenance of a healthy body has been recognized throughout most of recorded history. The term ‘stress’ is used to describe adverse emotions or reactions to unpleasant experiences. Individuals with high levels of stress and poor coping skills experience twice as much periodontal disease as compared to those with minimal stress and good coping skills. Although stress may predispose an individual to more destruction from periodontitis, the presence of periodontal pathogens remains the essential aetiologic factor. This review presents a summary of stress, discussing how it can predispose an individual to periodontal disease.

Clinical Relevance: Stress, which is a universal phenomenon, is implicated to have various systemic effects besides being a risk factor for periodontal disease. This article elucidates the relationship between psycho-social stress and destructive periodontal disease.
Haemostasis part 1: the management of post-extraction haemorrhage
Authors: McCormick Neal J , Moore Undrell J , Meechan John G
Published: August 2017

The management of bleeding complications following a dental extraction is an essential skill for the dental practitioner. Extractions are often carried out on patients with complex medical histories and a long list of medications. This paper aims to help the clinician manage post-extraction haemorrhage. A review of the management of patients on anti-thrombotic medications will be covered in a subsequent paper.

Clinical Relevance: This article reviews the management of haemorrhage following tooth extraction; from the risk assessment of any underlying medical conditions and medications, to the clinical techniques used to control bleeding following an extraction.
Bilateral balanced articulation: science or dogma?
Authors: Farias-Neto Arcelino , Carreiro Adriana da Fonte Porto
Published: August 2017

For more than a hundred years, it has been supposed that canine guidance should be avoided in conventional complete dentures, since it would result in denture instability. Thus, bilateral balanced articulation has been held by many authors as fundamental for treatment success. However, randomized clinical trials have shown that balanced articulation is not as important as previously thought. The issue about which occlusal concept is the most appropriate for individual needs is clinically and economically relevant for both the dentist and dental technician. Therefore, the purpose of this study is to provide an evidence-based update on complete denture occlusion.

Clinical Relevance: The issue about which occlusal concept is the most appropriate for individual needs is clinically and economically relevant.
Electronic cigarettes: harm reduction or another addiction?; the dental perspective
Authors: Holliday Richard , Horridge Catherine , Corson Margaret
Published: August 2017

The use of electronic cigarettes (e-cigarettes) has grown rapidly over recent years with an estimated 2.1 million people ‘vaping’ in the UK. E-cigarettes are battery-powered devices which simulate smoking. A heated element vaporizes chemicals, usually nicotine plus diluents like propylene glycol and glycerine as well as flavourings, which are then inhaled.

Only limited research exists on the safety and efficacy of e-cigarettes and opinions are divided in the health profession as to whether they should be endorsed or not. Similarly, at a regulatory level and among the general public, an intense debate is taking place as to how they should be considered.

In this paper we will review the available research with regards to e-cigarette contents, safety and health effects. As the mouth will take the initial insult from the vapour, we consider the potential effects on oral health as well as discussing the current regulatory and political position, so that we can be in a more informed position to advise our patients.

Clinical Relevance: As dental health professionals it is already our duty of care to educate patients about the impact of smoking on their oral health. So if patients look to alternatives in the form of e-cigarettes, it is important that we are informed about this new technology and its potential effects on oral health to be able to advise in discussions on the subject.
Management of patients with non-syndromic clefts of the lip and/or palate part 1: from antenatal diagnosis to primary surgery
Authors: McIntyre Grant T
Published: August 2017

Patients with clefts of the lip and/or palate require input from a diverse group of medical, surgical, dental and parasurgical specialties working as part of a multidisciplinary team in the UK. Co-ordinated care ensures that the patient receives optimal treatment whilst minimizing the burden of care for the NHS and family. The primary care dentist has an important role in the overall management of patients with clefts. Because the dentist-patient/parent relationship is of a long-term nature, the primary care dentist can also provide useful support and advice for families as they progress through the care pathway. This three-part article will illustrate the integration of dentistry with the other aspects of care.

Clinical Relevance: Dentists should be aware of the different types of cleft lip and/or palate that occur and the role of the dentist in the overall management of patients who have clefts.
The dos and don'ts of social networking in dentistry
Authors: Khatoon Binish , Hill Kirsty B , Walmsley A Damien
Published: August 2017

Online social networking sites are a popular way to share interests, build and maintain relationships and stay more connected to the world. Tools that were not available a few years ago are now used on a daily basis. Social networking has been likened to a digital tattoo. Both Universities and Healthcare Institutions have concerns about the potential implications that students, educators and practitioners may face when using the media. The main concerns are related to patient protection by both qualified and student healthcare workers. This article outlines the guidelines put in place to avoid any mistakes made on SNS and how to maintain an e-professional aura whilst using SNS. Examples of good and bad social networking by students and practitioners are given. How the implementation of recently introduced guidelines impacts on the use of SNS in dentistry requires further research.

Clinical Relevance: Social networking has become part of everyday life and yet it can create problems for dental healthcare professionals as they attempt to accommodate both personal and professional ‘aura’ in the medium.
Local drug delivery in the management of periodontal diseases part 1: general principles
Authors: Eastham Jane E , Seymour Robin A
Published: August 2017

Periodontal pockets provide an ideal environment for the application of local drug delivery for the management of periodontitis. In this first article, consideration is given to the principles that underlie local drug delivery and the pharmacological challenges. It is essential that such systems are compatible with the periodontal tissues. Potential unwanted effects that can arise from both drug and delivery vehicle are also appraised.

Clinical Relevance: Local drug delivery systems still have a place in the management of periodontal diseases. This first article considers the pharmacological principles and unwanted effects that can arise from the use of such systems.
Can a concise, benchmarked patient survey help to stimulate improvements in perceived quality of care?
Authors: Busby Mike , Burke FJ Trevor , Matthews Roger , Cyrta Jakub , Mullins Anne
Published: August 2017

Second phase patient survey audit results were reviewed for 41 practices. Five of the six practices with the lowest first phase results achieved significantly improved results in the second phase. The average increase in a patient perception index between phase 1 and phase 2 for these 6 practices was 6 points. The average increase was only 1 point for the other 39 practices. The five practices recording significantly improved patient perceptions all reported that significant practice development had been taking place between the phase 1 and phase 2 audits. For 3 of these 5 practices their first phase audit result had been a significant inspiration for the practice development. It seems that this patient survey instrument may be inspiring significant development when practices score notably below the benchmark.

Clinical Relevance: Patient surveys may be of value.
Prosthetic rehabilitation of the gagging patient using acrylic training plates
Authors: Ali Rahat , Altaie Asmaa , Morrow Leean
Published: August 2017

Patients with a hyper-responsive gag reflex pose dentists with a challenging problem. The gag reflex of some patients may be so severe that patients (and operating clinician) may favour extraction of any painful, infected teeth as opposed to more lengthy and complicated procedures such as root canal therapy. However, consistently adopting this approach may render the gagging patient completely edentulous. Such patients may then present to the dental surgeon requesting tooth replacement with some form of denture. This in itself can be a challenging task given the difficulties one may experience whilst taking impressions in this cohort of patients. This article will discuss the prosthetic management of the maxillary arch in edentulous patients with a severe gag reflex. There will be particular emphasis on the aetiology and physiology of the gag reflex, impression-taking techniques to allow the construction of an acrylic training plate (as an interim measure), principles of training plate design and construction of the definitive removable denture.

Clinical Relevance: Removable training plates can be used as an interim measure to desensitize edentulous gagging patients before providing them with a definitive removable denture.
The use of the operating microscope in general dental practice part 2: if you can see it, you can treat it!
Authors: Bonsor Stephen J
Published: August 2017

The use of magnification by dental clinicians when carrying out examinations and treatments is becoming more commonplace. The best instrument for this purpose is the operating microscope which has been shown to enhance quality, longevity and outcome of clinical work as well as facilitating better ergonomics for both the dentist and dental nurse. This paper, the second of two, explores the potential uses for the operating microscope in general dental as well as specialist practice (such as endodontics) and discusses how the interested clinician can use such equipment in a practical manner.

Clinical Relevance: The operating microscope enhances the dental surgeon's vision so improving treatment outcomes not only in specialist fields, such as endodontics, but also in many of the disciplines which general dental practice encompasses.
Amelogenesis imperfecta with coronal resorption: report of three cases
Authors: Bhatia Shannu K , Hunter M Lindsay , Ashley Paul F
Published: August 2017

Intracoronal resorption of the permanent dentition in cases of amelogenesis imperfecta (AI) is a rare finding which poses an added complication to the already complex management of this condition. This paper presents three cases of AI associated with delayed eruption of permanent teeth in which asymptomatic intracoronal resorption occurred.

CPD/Clinical Relevance: This paper highlights the fact that teeth affected with amelogenesis imperfecta may undergo asymptomatic intracoronal resorption which is only identifiable radiographically.
Management of opacities in children and adolescents
Authors: Wallace Ann , Deery Chris
Published: August 2017

Enamel opacities can appear as white, cream, yellow or brown patches. They can result from developmental or acquired conditions. The diagnosis, severity of the opacity and patient's desire for treatment guide the clinician when choosing the correct management option. Microabrasion is indicated for surface opacities, whereas bleaching can treat opacities deep within the tooth. When these techniques have failed to achieve the desired result, camouflaging the opacity with composite resin may be useful. Novel techniques, such as infiltrating or sealing the opacity, can alter enamel's refractive index, offering further treatment choices.

CPD/Clinical Relevance: There are many conservative treatments available which can improve the appearance of enamel opacities.
Conservative management of macrodontia in the mixed dentition stage – a case report
Authors: Harker Ann R , Walley Sian , Albadri Sondos
Published: August 2017

Macrodontia is a rare dental abnormality, which can cause cosmetic concerns. Various management techniques for this condition have been documented in the literature. This case describes the initial management of macrodontia in the mixed dentition stage with the use of a minimally invasive approach to treatment.

CPD/Clinical Relevance: The importance of early referral of dental abnormities is highlighted. Short- and long-term treatment options for macrodontia are described, including the impact such anomalies can have on the developing dentition.
Oral healthcare implications of mass migration
Authors: Murphy Jasmine , Scully Crispian
Published: August 2017

Population movements, whether voluntary or forced, are an integral part of an increasingly globalized society and, while the health needs of migrant populations cannot be generalized, some migrants can have worse oral health outcomes compared with their host-country counterparts, with their first dental contact typically being for emergency care. Failure to provide immediately necessary treatment may be unlawful under the Human Rights Act 1998.

CPD/Clinical Relevance: NHS dental services need to evolve and address the challenges inherent in caring for vulnerable migrants. Education and appropriate training needs to be developed for the dental profession in order to enable new ways of promoting inter-sectoral care and community engagement.
Emergencies in orthodontics part 1: management of general orthodontic problems as well as common problems with fixed appliances
Authors: Dowsing Paul , Murray Alison , Sandler Jonathan
Published: August 2017

Fixed appliance treatment is a popular treatment modality with a burgeoning increase in the numbers of children and adults realizing the benefits that can be gained. Appliance breakage is an unavoidable nuisance which is at best inconvenient, and at worst may result in significant pain or discomfort for the patient. General dental practitioners (GDPs) should have the practical knowledge of how to provide timely and appropriate orthodontic ‘emergency treatment’. This will significantly reduce the sometimes considerable inconvenience and discomfort for both the patient and his/her parents, and the inevitable frustration for the clinician providing ongoing care. This first paper will deal with general orthodontic problems that commonly present, as well as some issues specific to fixed appliances. The second paper will deal with the other orthodontic appliances that may be encountered by GDPs in their daily practice.

Clinical Relevance: Appropriate handling of an orthodontic ‘emergency’ by the general practitioner will, on many occasions, provide immediate relief of pain and distress for the patient. This will in turn allow treatment to continue moving in the right direction, thus allowing more efficient and effective use of valuable resources.
Emergencies in orthodontics part 2: management of removable appliances, functional appliances and other adjuncts to orthodontic treatment
Authors: Dowsing Paul , Murray Alison , Sandler Jonathan
Published: August 2017

In the second of two papers, management of orthodontic emergencies involving appliances other than fixed appliances will be detailed. Problems relating to removable appliances, as well as other orthodontic adjuncts, will be discussed. Unfortunately, orthodontic appliance breakage does occur, despite the clinicians giving clear and concise instructions to the patients and their parents at fitting. If general dental practitioners have a practical knowledge of how to diagnose problems and to provide appropriate advice or timely ‘emergency’ treatment, this will significantly reduce the inconvenience for all parties concerned. It should also ensure that treatment progresses in the most efficient and comfortable manner for their patients. In specific situations the early, accurate identification of the problem and instigation of its appropriate management can avoid more serious consequences.

Clinical Relevance: Appropriate handling of an orthodontic ‘emergency’ by the dentist can, on many occasions, provide immediate relief to the patient. This will, in turn, allow treatment to continue in the right direction, thus allowing more efficient and effective use of valuable resources.
Keep an eye out for the bifid uvula: a case report
Authors: Alroyayamina Seyed , McKnight Mary
Published: August 2017

The incidence of submucous cleft palate is between 1:1250–1:6000. It is important for this relatively silent deformity to be identified early and referred appropriately as a delay in diagnosis may affect the patient's quality of speech in the long term. This paper presents a case of submucous cleft palate which was diagnosed late (age 14). Nevertheless, by the appropriate intervention of the multidisciplinary cleft team, the patient was treated successfully.

Clinical Relevance: Dentists and doctors need to be aware of the signs and symptoms associated with submucous cleft palate so that they can refer the patient to an appropriate specialist centre for further investigation and treatment. Moreover, patients with this condition are shown to have a higher incidence of dental abnormalities, such as hypodontia and peg-shaped laterals.
Seventeen years of using flowable resin restoratives – a dental practitioner's personal clinical review
Authors: Firla Markus Th
Published: August 2017

Seen through the author's eyes on the basis of his practising dentistry for almost three decades, light-activated flowable resin restoratives (FRCs) or, in common clinical dental terminology, flowable composites have gradually gained major importance in restorative dentistry. Inputs to this ongoing trend are coming from continuous improvements in material properties and the favourable handling characteristics experienced with this particular group of restoratives.

Intended to be used in direct adhesive filling procedures, the number and variety of recent generations of flowable composites for lining, restoration of all cavity classes (I–V), core build-ups and, more recently, ‘bulk-fill-restorations’, however, necessitates a profound clinical understanding of the selective use of flowable composites to ensure clinical success and guarantee long-term high quality results.

Clinical Relevance: Today's flowable composites allow for reliable restoration of all kinds of defects. However, both the handling characteristics and the material properties of FRCs must be fully understood before taking advantage of their potentially excellent clinical performance.
Essentials of medical history-taking in dental patients
Authors: Greenwood Mark
Published: August 2017

The starting point in the assessment and management of any patient is dependent on good history-taking. The main parts of the history-taking process well known to practitioners are the presenting complaint, the history of the presenting complaint and the current and past medical history. This paper concentrates on those aspects of the process that are particularly important to dental practitioners.

Clinical Relevance: The cornerstone of safe and effective patient management lies with the history. This paper describes various aspects of history-taking and highlights important areas.
Rehabilitation of oncology patients with hard palate defects part 1: the surgical planning phase
Authors: Ali Rahat , Altaie Asmaa , Nattress Brian
Published: August 2017

This article is the first in a series of three papers that will discuss the conventional non-implant retained prosthodontic rehabilitation of oncology patients with surgically acquired hard palate defects. In this first paper, the dental challenges posed by the oncology patients will briefly be discussed. The interface between the specialist restorative dentist and the maxillofacial surgeon when planning the conventional dental rehabilitation of an oncology patient with a hard palate defect will be discussed in detail.

Clinical Relevance: To highlight the importance of the restorative dentistry/surgical interface when planning a treatment for a patient requiring a maxillectomy and conventional obturation.
A clinical guide to needle desensitization for the paediatric patient
Authors: Taylor Greig D , Campbell Caroline
Published: August 2017

Needle phobia is a common problem encountered by dental practitioners and it can pose a challenge, especially in the paediatric patient. Needle desensitization can be used for patients who have needle fear or phobia and help them overcome this by repeated, non-threatening and controlled contacts. This paper will describe an accepted technique of needle desensitization and work through the steps required to achieve a successful outcome of local anaesthesia being delivered in a calm, safe and controlled manner.

Clinical Relevance: Needle desensitization is an effective technique which can be used to enable a needle phobic patient to receive a dental injection.
Minimally invasive long-term management of direct restorations: the ‘5 rs’
Authors: Green David , Mackenzie Louis , Banerjee Avijit
Published: August 2017

The assessment and operative long-term management of direct restorations is a complex and controversial subject in conservative dentistry. Employing a minimally invasive (MI) approach helps preserve natural tooth structure and maintain endodontic health for as long as possible during the restorative cycle. This paper discusses how minimally invasive techniques may be applied practically to reviewing, resealing, refurbishing, repairing or replacing deteriorating/failed direct coronal restorations (the ‘5 Rs’) and provides an update of contemporary MI clinical procedures.

CPD/Clinical Relevance: The assessment and long-term clinical management of deteriorating/failing direct restorations is a major component of the general dental practice workload and NHS UK budget expenditure for operative dentistry.
Rehabilitation of oncology patients with hard palate defects part 2: principles of obturator design
Authors: Ali Rahat , Altaie Asmaa , Nattress Brian
Published: August 2017

The first part of this series on the conventional rehabilitation of oncology patients with hard palate defects discussed the dental challenges posed by oncology patients and the surgical/restorative planning interface for conventional dental rehabilitation. This article will describe Aramany's classification of hard palate defects, Brown's classification of palatal defects and focus on the basic principles of obturator design which need to be appreciated when prosthetically rehabilitating a patient with a hard palate defect.

CPD/Clinical Relevance: A good understanding of basic removable prosthodontic theory relating to denture design, dental materials science and head and neck anatomy is a prerequisite when designing an obturator for a patient.
The truth about sugar
Authors: Yeung C Albert , Goodfellow Ashley , Flanagan Louise
Published: August 2017

Sugars are used by the industry to enhance the attractiveness of foods and drinks. These added sugars, or ‘free sugars’, are not easily identified in food or drink labels. Certain manufactured foods and drinks with ‘safe’ names, such as dried fruit and fruit juice, still contain free sugars and can be confusing. Guidance states that daily consumption of free sugars should be less than 10% of total energy intake (no more than 5% in the UK). However, it is found that both tooth decay and obesity are associated with consumption of free sugars in large quantities and at inappropriate times.

CPD/Clinical Relevance: When giving dietary advice to dental patients, it should be emphasized that free sugars hidden in certain foods and drinks are directly linked to tooth decay and obesity.
Worn down by toothwear? aetiology, diagnosis and management revisited
Authors: Yule Pamela L , Barclay Stewart C
Published: August 2017

The incidence of toothwear in the population is increasing, as is the number of referrals regarding this problem to secondary care dental hospital consultants and specialists. This paper outlines current theories in aetiology, diagnosis and management of localized and generalized toothwear, as well as describing clinical tips for assessing such patients.

CPD/Clinical Relevance: Clinicians will gain a better understanding of how to address the problem of toothwear and what can be achieved in primary care and secondary care settings.
Odontogenic cysts – an overview
Authors: Nayyer Namita V , Macluskey Michaelina , Keys William
Published: August 2017

This article aims to discuss the clinical features, radiological assessment, histopathology and management of a variety of odontogenic cysts. It also highlights the reclassification of odontogenic keratocysts to keratocystic odontogenic tumours.

Clinical Relevance: Dentists should be aware of the multiple odontogenic cysts that can present in the oral cavity and be able to formulate appropriate management plans.
Pain part 4: odontogenic pain
Authors: Thayer Tom
Published: August 2017

Pain is one of the major reasons that lead patients to seek dental care. For the majority of patients, the pain is of odontogenic origin, as a consequence of dental disease. The timely diagnosis and management of dental pain is an essential component of dental care, and this article reminds readers of the common presenting symptoms of simple dental pain, diagnoses and pragmatic management.

Clinical Relevance: Pain of odontogenic origin is common, and distressing. However, the pathology is consistent, as are the symptoms, and an understanding of this underpins the careful history-taking that will lead the clinician to the diagnosis.
Pain part 5a: chronic (neuropathic) orofacial pain
Authors: Renton Tara , Kahwaja Nadine
Published: August 2017

Neuropathic pain is a significant social and economic burden. Back pain, joint pain and headaches affect over 30% of the population. Chronic orofacial pain is a common condition and is difficult to diagnose and manage. This two-part paper aims to provide an overview of novel understanding of neuropathic pain, and furnish clinical teams with an update on the less common and less well-recognized chronic orofacial conditions. Headaches and temporomandibular disorders are the most common conditions and are covered in separate papers (6 and 10). Trigeminal neuralgia, burning mouth, and trigeminal autonomic cephalgias are also covered in separate papers (7, 8 and 9). The remaining conditions: post-traumatic neuropathy (nerve injury); and persistent idiopathic facial pain and atypical odontalgia are discussed in this and the following paper.

Clinical Relevance: Neuropathic pain, though rare, is a consequence of dental treatment. Nerve injury in relation to M3M surgery, dental implants, endodontics and local anaesthesia result in 70% of affected patients experiencing chronic neuropathic pain.
Minimizing digital data loss
Authors: Chande Milan
Published: August 2017

Clinical photography has now reached all areas of dentistry, with camera equipment and photography skills being present in many practices. Whilst taking good photographs is just one part of improving record-keeping, the other part, which is arguably the more important aspect, is to store securely this vast amount of data that is created. This article intends to explore the options available to practices to store the data securely and recommends the easiest and most effective ways available today.

CPD/Clinical Relevance: With clinical photographs becoming ever more important in the field of dentistry, correct storage and use of camera equipment is important.
Modern endodontic principles part 3: preparation
Authors: Darcey James , Taylor Carly , Roudsari Reza Vahid , Jawad Sarra , Hunter Mark
Published: August 2017

The purpose of instrumentation is to facilitate irrigation and allow controlled obturation. This article will revisit methods of instrumentation of the root canal system with consideration given to length determination, apical preparation and the concept of patency filing. It will discuss hand instrumentation and rotary preparation looking at emerging technology such as reciprocating systems and the self-adjusting file.

CPD/Clinical Relevance: Mechanical preparation of the root canal system is of fundamental importance in achieving success, creating a more easily managed environment from a biological perspective.
Dental materials: what goes where? class V restorations
Authors: Burke F J Trevor
Published: August 2017

A large number of Class V restorations are placed per annum to restore cervical lesions. This paper evaluates the pathogenesis of these lesions, with particular reference to the role of occlusal factors, and reviews the literature in order to provide advice on the material(s) which are most likely to produce optimal longevity of a Class V restoration.

CPD/Clinical Relevance: Resin-modified glass ionomer materials appear to provide optimal survival for a Class V restoration, but a (flowable) composite might produce a better aesthetic result.
Evidence-based dentistry in everyday practice
Authors: Gudray Kiran , Walmsley Anthony Damien
Published: August 2017

This article informs readers of a method of implementing evidence-based dentistry in practice. Following these steps, practitioners should be able to use this skill in an efficient manner. The importance of evidence-based dentistry and its relevance to situations encountered in everyday practice is also highlighted.

CPD/Clinical Relevance: This article highlights a series of steps to be followed by practitioners to ensure that treatment provided is supported by the most recent, good quality evidence.
Antimicrobial resistance and antibiotic prescribing in dental practice
Authors: Palmer Nikolaus O A
Published: August 2017

The purpose of this paper is to review the principles of antibiotic prescribing in light of the increasing worldwide problem of antimicrobial resistance and the evidence of inappropriate use of antibiotics in dentistry. Guidance on the management of dental infections and antibiotic prophylaxis based on a review of the scientific evidence will be given to ensure good patient care.

CPD/Clinical Relevance: To discuss the relevance of legislation around antimicrobial prescribing and antimicrobial stewardship for dentists.
Pain part 7: trigeminal neuralgia
Authors: Jurge Sabine
Published: August 2017

Trigeminal neuralgia (TN) is also known as ‘tic douloureux’ (in French, ‘painful twitch’). It is a rare chronic facial pain syndrome, characterized by severe, brief, stabbing, ‘electric shock-like’ recurrent pain attacks felt in one or more divisions of trigeminal nerve innervation areas. So intense is the elicited pain that TN has a significant effect on a sufferer's quality of life, rendering many patients unable to consider a future with the ongoing threat of recurrent pain. The aim of this article is to discuss the diagnosis and management of this disabling facial pain condition.

CPD/Clinical Relevance: As general medical practitioners may struggle differentiating TN from toothache, primary care dentists have an important role in excluding odontogenic cause of pain, diagnosing TN and referring patients to a facial pain clinic for further investigations and multidisciplinary team management.
Training plates: a solution for patients unable to tolerate a removable prosthesis
Authors: Laverty Dominic P , Walmsley A Damien
Published: August 2017

Dealing with patients who are unable to tolerate dentures can present a challenge to the general dental practitioner (GDP). Careful assessment of patients and their dentures will identify any causes of the intolerance to dentures. Training plates are a useful technique that can be used to allow patients to become accustomed to removable prosthesis but will inevitably lengthen the treatment process.

CPD/Clinical Relevance: Training plates offer a possible solution to general dental practitioners who treat patients who are struggling to tolerate dentures.
Antimuscarinics in older people: dry mouth and beyond
Authors: Bostock Clare , McDonald Christopher
Published: August 2017

Many common prescription and over-the-counter medications have antimuscarinic effects. Antimuscarinics are a well recognized cause of dry mouth, with potential to cause other physical and cognitive adverse effects. A comprehensive medication review in a patient presenting with dry mouth can lead to overall health improvements. Scoring systems can be helpful in identifying antimuscarinic drugs and their adverse effects.

CPD/Clinical Relevance: Antimuscarinic drug use is prevalent and a common cause of dry mouth. Older people are particularly susceptible to antimuscarinic adverse effects.
Rehabilitation of an edentulous maxilla in a patient with isolated cleft palate
Authors: Valizadeh Bardia , Barzanji S Agrin , Patel Mital , Shahdad Shakeel
Published: August 2017

This article aims to discuss the use of short dental implants in cleft patients, the construction of an implant-retained obturator and the use of a Createch® milled titanium bar with three Locator® overdenture attachments incorporated within the bar.

CPD/Clinical Relevance: Implant-retained obturators offer a possible solution for treating patients with isolated cleft palate who are struggling with dentures due to the unfavourable soft and hard tissue profile. This paper demonstrates how to manage such patients and shows all the clinical and laboratory stages involved.
Oral cancer red flags – a case of misdiagnosis
Authors: Lambeth Ruth E , Shaikh Zarina S , Adcock Stephen D
Published: August 2017

The clinical presentations of oral malignancy are diverse. This short article discusses a case of a late-presenting oral malignancy and signifies the importance of general dental and medical practitioners' knowledge in the diagnosis of oral malignancy.

CPD/Clinical Relevance: Oral malignancy is a life-threatening diagnosis. The importance of a structured systematic approach in the diagnosis is discussed.
Resin-bonded bridges – the problem or the solution? part 2: practical techniques
Authors: Gulati Jasneet Singh , Tabiat-Pour Sara , Watkins Sophie , Banerjee Avijit
Published: August 2017

This is the second part of this two-part series. The first paper discussed key aspects of case selection, planning and design of resin-bonded bridges (RBBs). This paper outlines the important clinical stages involved in the successful provision of RBBs, including communication with the dental laboratory, clinical protocols and management of the de-bonded RBB.

CPD/Clinical Relevance: This paper aims to provide the general dental practitioner with a practical guide to the successful provision of RBBs, highlighting common barriers to successful treatment and how these may be overcome.
A case series: the orthodontic management of central incisors with horizontal root fractures
Authors: Kneafsey Louise C , Hodges Samantha J
Published: August 2017

This case series illustrates the successful orthodontic management of previously root-fractured central incisors. Orthodontic treatment was carried out to correct the underlying malocclusion, remove traumatic occlusal forces and to provide a suitable occlusion for future restorative treatment should the root-fractured teeth be lost in the future.

CPD/Clinical Relevance: Dental trauma occurs commonly; having affected 10% of orthodontic patients. All practitioners should be able to discuss the possibility of orthodontic treatment with patients who have had previous trauma to their front teeth.
Mouth cancer for clinicians part 13: life after mouth cancer treatment
Authors: Kalavrezos Nicholas , Scully Crispian
Published: August 2017

A MEDLINE search early in 2015 revealed more than 250,000 papers on head and neck cancer; over 100,000 on oral cancer; and over 60,000 on mouth cancer. Not all publications contain robust evidence. We endeavour to encapsulate the most important of the latest information and advances now employed in practice, in a form comprehensible to healthcare workers, patients and their carers. This series offers the primary care dental team, in particular, an overview of the aetiopathogenesis, prevention, diagnosis and multidisciplinary care of mouth cancer, the functional and psychosocial implications, and minimization of the impact on the quality of life of patient and family.

Clinical Relevance: This article offers the dental team an overview of prognostication, quality of life and oral and dental healthcare.
Human factors and ergonomics for the dental profession
Authors: Ross Al
Published: August 2017

This paper proposes that the science of Human Factors and Ergonomics (HFE) is suitable for wide application in dental education, training and practice to improve safety, quality and efficiency. Three areas of interest are highlighted. First it is proposed that individual and team Non-Technical Skills (NTS), such as communication, leadership and stress management can improve error rates and efficiency of procedures. Secondly, in a physically and technically challenging environment, staff can benefit from ergonomic principles which examine design in supporting safe work. Finally, examination of organizational human factors can help anticipate stressors and plan for flexible responses to multiple, variable demands, and fluctuating resources.

CPD/Clinical Relevance: HFE is an evidence-based approach to reducing error rates and procedural complications, and avoiding problems associated with stress and fatigue. Improved teamwork and organizational planning and efficiency can impact directly on patient outcomes.
Mouth cancer for clinicians part 14: cancer prevention
Authors: Kalavrezos Nicholas , Scully Crispian
Published: August 2017

A MEDLINE search early in 2015 revealed more than 250,000 papers on head and neck cancer; over 100,000 on oral cancer; and over 60,000 on mouth cancer. Not all publications contain robust evidence. We endeavour to encapsulate the most important of the latest information and advances now employed in practice, in a form comprehensible to healthcare workers, patients and their carers. This series offers the primary care dental team in particular, an overview of the aetiopathogenesis, prevention, diagnosis and multidisciplinary care of mouth cancer, the functional and psychosocial implications, and minimization of the impact on the quality of life of patient and family.

Clinical Relevance: This article offers the dental team an overview of cancer prevention.
Frequently asked questions about vital tooth whitening
Authors: Mchantaf Emilie , Mansour Hicham , Sabbagh Joseph , Feghali Mireille , McConnell Robbie J
Published: August 2017

Improving patients' aesthetics is an important request in daily practice. Tooth whitening is a treatment option available for improving aesthetics. This paper will pose questions asked by our patients on bleaching techniques and outcomes and offer appropriate up-to-date answers.

CPD/Clinical Relevance: This paper addresses the most important questions raised by patients and colleagues concerning vital tooth whitening (VTW).
Head and neck cancer patients – information for the general dental practitioner
Authors: Noone Jennifer , Barclay Craig
Published: August 2017

Salivary gland damage is the most common adverse effect associated with radiation therapy to the head and neck. A combination of hyposalivation and dietary changes, with a reduced emphasis on oral hygiene practices can contribute to a massive increase in a person's caries risk status. This can be further complicated by limited mouth opening. To enable optimal dental care for head and neck cancer patients before, during and after radiation therapy, patients must be informed and educated about the potential risks of dental caries and the preventive strategies available. All patients should receive a pre-radiotherapy dental assessment by a Restorative Dentistry Consultant. This information will be delivered to the patient, often at an emotionally charged time, and can be lost amongst all the information related to other aspects of his/her cancer management. General Dental Practitioners (GDPs) are therefore in a pivotal position to reiterate this information post radiation therapy and ensure compliance with preventive strategies, with the overall aim to improve quality of life and avoid the need for future extractions and the resulting risk of osteoradionecrosis.

CPD/Clinical Relevance: This article highlights the GDP's role in the shared management of head and neck cancer patients who have received radiotherapy as part of their cancer treatment. The critical issue of dental caries, one of the late effects of radiation-induced hyposalivation, will be focused upon. Other side-effects, such as trismus and osteoradionecrosis, will also be discussed. This article aims to supply GDPs with accurate information to provide to their patients with post radiation therapy, whilst highlighting what treatment is within their remit and when it may be appropriate to refer.
The use of all-ceramic resin-bonded bridges in the anterior aesthetic zone
Authors: Shah Rupal , Laverty Dominic P
Published: August 2017

For several years, all-ceramic resin-bonded bridges (RBBs) have been considered an aesthetic treatment option for the replacement of missing teeth in the anterior region. With continued developments in technology, various different ceramic materials have been used to fabricate all-ceramic RBBs including zirconia, glass-reinforced, alumina-based ceramics, and lithium disilicate glass ceramics. The aim of this article is to provide an overview of all-ceramic RBBs, the advantages and disadvantages associated with these prostheses, as well as to demonstrate their application in replacing missing anterior teeth.

CPD/Clinical Relevance: To present the current literature and clinical application of all-ceramic resin-bonded bridges for replacing missing anterior teeth.
An update on current resuscitation council (UK) guidelines
Authors: McKernon Sarah L , Kaura Laura , Taylor Kathryn H , Reid Samantha , Balmer Mary C
Published: August 2017

On 15 October 2015, The Resuscitation Council (UK) published new resuscitation guidelines following the review of resuscitation science by the International Liaison Committee on Resuscitation (ILCOR). The 2015 guidelines emphasize the importance of interactions between the emergency medical dispatcher, the bystander who provides cardiopulmonary resuscitation (CPR) and the prompt deployment of an automated external defibrillator (AED); the co-ordination of these three elements is crucial to improving out-of-hospital cardiac arrest survival. Medical emergencies in dental practices are thought to occur on average once every 3–4 years per dentist in primary care. The GDC consider medical emergencies as a highly recommended topic for Continuing Professional Development (CPD) and recommend at least 10 hours in every CPD cycle.

CPD/Clinical Relevance: The publication of the updated guidelines serves as a reminder to the clinical team of the importance of being up to date with recognition and treatment of cardiac arrest and choking and how seamless interaction between members of both the dental and medical teams improves long-term outcomes for patients.
How to minimize repeat dental general anaesthetics
Authors: Lawson Jennifer , Owen Jayne , Deery Chris
Published: August 2017

This article aims to provide general dental practitioners (GDPs) with the knowledge to improve their referrals primarily for children who they feel require a dental general anaesthetic. It discusses the impact of a general anaesthetic (GA) on a child and the financial impacts of dental general anaesthetics (DGAs). The risks of DGAs are well recognized and the ways in which the dental team in primary, secondary care and service commissioners can reduce the risk of repeat DGAs are discussed.

CPD/Clinical Relevance: Dentists should be aware of the risks involved in GA and the importance of reducing repeat DGAs.
Diagnosis and management of chronic and aggressive periodontitis part 2: periodontal management
Authors: Chatzistavrianou Despoina , Blair Fiona
Published: August 2017

The first paper of this three-part series discussed periodontal disease pathogenesis and highlighted elements in the clinical assessment which will help the clinician to establish the diagnosis of chronic and aggressive periodontitis. This second paper will focus on the management of chronic and aggressive periodontitis. Finally, the diagnosis and management of chronic and aggressive periodontitis will be reviewed in the third part of the series using two clinical examples.

CPD/Clinical Relevance: This paper aims to provide the general dental practitioner with an understanding of the aim of periodontal treatment, the management of chronic and aggressive periodontitis and the prognosis of periodontally involved teeth.
Ceramic fracture in metal-ceramic restorations: the aetiology
Authors: Aslam Ayesha , Khan Danish Azeem , Hassan Syed Hammad , Ahmed Bilal
Published: August 2017

All dental restorations are liable to failure during function. Failure could be biologic, aesthetic, mechanical or a combination. Ceramic restorations in particular, including metal-ceramics, are prone to mechanical fracture, especially the fracture of veneering porcelain. Fracture of a metal-ceramic restoration jeopardizes function as well as aesthetics. It is equally onerous to manage for both patient and dentist. Optimal management of such cases requires a detailed knowledge of the aetiology behind this phenomenon. The current paper aims to highlight possible causative factors involved in the mechanical failures of metal-ceramic restorations.

CPD/Clinical Relevance: Ceramic fracture in metal-ceramic crowns and fixed partial dentures is routinely encountered in dental clinics. Knowledge of the aetiology is required to diagnose and manage such cases accurately as well as to avoid these errors in future.
Long-term complications of dental trauma
Authors: Burns Beth C , Crane Lynnsey E , Hannah Victoria E
Published: August 2017

Dental injuries are a relatively common occurrence and need to be managed well in general dental practice in order to produce the most favourable outcome for patients. Dental practitioners should familiarize themselves with the guidelines provided by the International Association of Dental Traumatology discussed herein. These guidelines clearly state how dental injuries should be managed, including suggested review. Dentists should be aware of injuries that are most likely to require input from specialist services and relative risks of long-term complications and how to identify these. Early identification of such complications should prompt referral to specialist services.

CPD/Clinical Relevance: The ability to treat dental trauma in light of knowledge of long-term complications is of importance to the general dental practitioner.
Book review
Authors: Turner John
Published: August 2017

An Introduction to Orthodontics 3rd edn. By Laura Mitchell. Oxford: Oxford University Press, 2007. (£42.99). ISBN 978-0-19-856812-4.