bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolution of surgical guidance in implant dentistry
Authors: Kalra Manav , IN Aparna , B Dhanasekar
Published: August 2017

The optimal positioning of oral implants ensures good biomechanical, functional, aesthetic and phonetic results. The concept of surgical guidance in implant dentistry has been developed to bridge the gap between pre-operative treatment planning and surgical site preparation. This article discusses its evolution, from the early surgical guide systems which used only diagnostic casts as reference, to the latest in computer-assisted navigation.

Clinical Relevance: Surgical guidance allows the accurate transfer of information from the pre-operative treatment planning phase to the surgical field. It assists the operator in placing the implant in the most ideal position and angulations, with regards to the final prosthesis.
Taking the trauma out of trauma: an easy to follow guide for the management of trauma to the permanent dentition
Authors: White Ian , Spiers Gareth
Published: August 2017

Treatment of dental trauma can be an infrequent, unpredictable and stressful experience for a dental practitioner. Correct diagnosis and management of such cases is of primary importance in the prognosis of the affected dentition. We have therefore constructed a number of easy to follow algorithms in management, both short and long term, for the range of traumatic injuries that can affect the permanent dentition.

Clinical Relevance: Immediate as well as longer term management of dental trauma cases can be difficult, therefore a clear treatment plan is of great importance in successful results.
The characteristics of bisphosphonate patients developing bisphosphonate-related osteonecrosis of the jaw attending an OMFS department
Authors: Serrant Paul S , Clark Stuart
Published: August 2017

This case series considers the incidence of patients taking bisphosphonate medication that suffer with bisphosphonate-related osteonecrosis of the jaw (BRONJ) following an exodontia procedure. Forty five such patients who attended the Wigan Royal Albert Edward Infirmary (RAEI) Oral and Maxillofacial Surgery (OMFS) department for an exodontia procedure were examined. A patient's age, gender, exodontia technique, bisphosphonate route (Oral/IV), smoking status and reason for taking the bisphosphonates, eg osteoporosis/cancer/arthritis was considered. All of the patients that experienced BRONJ were smokers.

Clinical Relevance: Bisphosphonates are now widely accepted for the management of medical conditions, including arthritis, osteoporosis and various forms of cancer. Such patients are regularly referred to OMFS departments for dental extractions.
Conservative temporomandibular disorder management: what DO i do? – frequently asked questions
Authors: Gray Robin JM , Al-Ani Ziad
Published: August 2017

There are many myths and fallacies surrounding the conservative or non-surgical management of patients with temporomandibular disorders (TMD). This paper is not a treatise on splint design and does not champion any one particular treatment philosophy. It is, however, produced as the outcome of many years of lecturing and talking to fellow practitioners and represents the most frequently asked questions and common misconceptions encountered by the authors, who have addressed the topics raised with the intention of helping to avoid pitfalls.

The common symptoms encountered in general dental practice are pain, either from muscles or the temporomandibular joint (TMJ) itself, limitation or deviation of mandibular movement, and joint sounds, and the authors have attempted to separate fallacy and fact. When appropriate examples are given.

There are general treatment guidelines but, while some methods apply to an individual, there is no panacea – individual patient treatment needs vary.

Clinical Relevance: It is important that all treatments delivered to a TMD patient should be evidenced-based and should always be in the patient's best interests. Many treatment modalities are proposed that do not fulfil these parameters and can lead to confusion in management. A reference and reading list will be given which will direct the reader to an evidence-based approach to treatment. Some treatment suggestions are founded on the extensive clinical experience of the authors. There will not always be evidence from a randomized, controlled clinical trial to substantiate support for a specific treatment, but the reader should be directed by what the majority of clinicians would undertake as a responsible approach.
Traditional and contemporary techniques for optimizing root canal irrigation
Authors: Holliday Richard , Alani Aws
Published: August 2017

Canal irrigation during root canal treatment is an important component of chemo-mechanical debridement of the root canal system. Traditional syringe irrigation can be enhanced by activating the irrigant to provide superior cleaning properties. This activation can be achieved by simple modifications in current technique or by contemporary automated devices. Novel techniques are also being developed, such as the Self-adjusting File (Re-Dent-Nova, Ra'anana, Israel), Ozone (Healozone, Dental Ozone, London, UK), Photo-activated Disinfection and Ultraviolet Light Disinfection.

This paper reviews the techniques available to enhance traditional syringe irrigation, contemporary irrigation devices and novel techniques, citing their evidence base, advantages and disadvantages.

Clinical Relevance: Recent advances in irrigation techniques and canal disinfection and debridement are relevant to practitioners carrying out root canal treatment.
A CAD/CAM designed, semi-fixed, high strength, all-ceramic prosthesis for maxillary rehabilitation – a case report
Authors: Bhakta Shashwat , Deakin Karl , Joshi Rajendra
Published: August 2017

The clinical and laboratory steps involved in rehabilitating the maxillary arch following the loss of several teeth due to periodontal disease are outlined in this case report. This article illustrates the use of a laboratory based CAD/CAM system (Sirona In-Lab) and a copy milling technique in the fabrication of a fixed-movable bridge, high strength, all-ceramic, cross-arch bridge.

Clinical Relevance: Adopting a semi-fixed approach in cross-arch rehabilitation has conventionally involved the use of porcelain fused to metal (PFM) components but the demands placed by patients and clinicians have led to the development of novel techniques in order to achieve highly aesthetic and functional results.
Recurrent parotitis of childhood or juvenile recurrent parotitis – a review and report of two cases
Authors: Adeboye Solape O , Macleod Iain
Published: August 2017

Recurrent parotitis of childhood is an uncommon condition which affects children of variable age. The condition may be misdiagnosed so delaying treatment. These two case reports highlight the variable signs and symptoms of this unusual condition and the value of ultrasound as an aid to diagnosis.

Clinical Relevance: This is to improve awareness of recurrent parotitis of childhood and aid early diagnosis.
Hypnosis for dental anxiety
Authors: Griffiths Mark
Published: August 2017

Dental anxiety can be a hindrance to treatment. It is prevalent, so helping patients to overcome it should not be regarded as the province of a specialist. Hypnosis can be effective but is underused. A comparison of the conscious, alert state and hypnosis/nitrous oxide sedation is shown by electroencephalogram examples. The benefits and drawbacks of the use of hypnosis are discussed and suggestions of ways of learning and using hypnosis outlined.

Clinical Relevance: This paper is an overview of the common problem of dental anxiety and a pragmatic approach to overcoming it using hypnotherapy.
Hypodontia: aesthetics and function part 2: management
Authors: Holliday Richard , Lush Nichola , Chapple Jonathan , Nohl Francis , Cole Ben
Published: August 2017

Patients with hypodontia present clinical challenges in relation to function and aesthetics. In this two part series we will explore the clinical features of hypodontia (part 1) and will move on to discuss the interdisciplinary management of hypodontia (part 2).

Clinical Relevance: Hypodontia can cause functional and aesthetical concerns. This paper discusses the interdisciplinary management of hypodontia. Dent Update 2014; 41: 891–898
Dental handpieces – an update
Authors: Akuji Nazma , Shah Shilpa , Ashley Martin
Published: August 2017

The dental handpiece is a frequently used instrument in the clinician's armamentarium. Dental handpieces were first introduced in the nineteenth century as primitive hand-operated devices. Advances in technology have enabled modern handpieces to evolve into sophisticated, engineered precision instruments. The most common handpieces are operated by compressed air or by electric motors. The current market offers a variety of handpieces to suit specific clinical needs. Care and maintenance of all dental handpieces is essential to ensure maximum efficiency and longevity. This paper offers a brief insight into the history of dental handpieces and illustrates what the current market has to offer, with recommendations on care and maintenance to avoid the common problems encountered by clinicians.

Clinical Relevance: Selection, knowledge and maintenance of the dental handpiece are key for effective clinical practice.
The multidisciplinary use of intranasal/intravenous conscious sedation: four case reports
Authors: Wray Lucy , Manley Graham
Published: August 2017

Conscious sedation provides the dentist with the opportunity to provide dental treatment for patients unable to accept care in the usual way. Often these challenging patients are in need of other medical interventions which they are also unable to accept. The use of conscious sedation utilizing intranasal midazolam improves access to dental care for those with profound needle phobia, movement disorders or a learning disability. The following four case reports describe the use of conscious sedation to provide dental treatment in conjunction with other necessary medical treatment. All four cases were treated in primary care by experienced dental sedationists who were familiar with treating this patient group.

Clinical Relevance: Experienced dental sedation teams may wish to consider combining dental treatment with other necessary medical interventions during the treatment window which sedation provides.
The management of risk part 1: why complaints happen and how to prevent them
Authors: Collier Andrew
Published: August 2017

There is increasing concern amongst dentists, and dental care professionals (DCPs), about the risks associated with complaints from patients and the possibility of escalation to legal action or referral to the General Dental Council (GDC). This is the first of a series of four articles considering the management of risk. It will describe why complaints happen, how to identify problems at an early stage and strategies for preventing complaints occurring.

Clinical Relevance: The prevention of complaints will reduce stress and anxiety for all members of the dental team.
Quality of life issues in head and neck cancer
Authors: Semple Cherith J , Killough Simon A
Published: August 2017

Head and neck cancer (HNC) constitutes approximately 3% of all cancers in the UK, with in excess of 8500 new cases annually. Management of HNC depends on site, extent, histology, previous medical history and patient choice. A multidisciplinary approach is required to optimize patient wellbeing, owing to the significant functional and psychosocial implications that can impact on quality of life. Members of the dental team, to include the general dental practitioner, have a key role in patient care; therefore the dental team should be knowledgeable in the short-term and longer-term implications and how this impacts on quality of life.

Clinical Relevance: This article offers the dental team with an overview of how HNC and the various treatments, such as surgery, radiotherapy and chemotherapy, impact upon quality of life, both in the short term and longer term.
How good are our impressions? an audit of alginate impression quality in the production of removable prostheses
Authors: Horwitz Richard
Published: August 2017

Impressions are taken regularly in practice giving vital information to the dental laboratory, but are there quality assurance systems in place to make sure that they are up to a sufficient standard? As dental professionals we have to appreciate that dental technicians can only work with the information given to them. This makes the skill of taking a good impression vital in order for us as clinicians to provide prostheses of good quality. This paper outlines an audit of alginate impressions and their quality in the making of removable prostheses.

Clinical Relevance: To record the quality of impression taking, and how one's own ability to critique an impression may differ from that of our colleagues.
Abstract
Authors: Morgan Anne
Published: August 2017

The findings of this trial carried out in general dental practice suggest that desensitizing toothpastes and professionally applied dentine bonding agents reduce the pain associated with dentine hypersensitivity, with dentine-bonding agents resulting in the greatest improvement.
The management of risk part 4: resolving complaints
Authors: Collier Andrew
Published: August 2017

Patient complaints invariably cause concern and distress. Whilst prevention should be the primary objective, this is not always possible. This final article in the series describes strategies for the management and resolution of complaints, as well as the advantages of good complaint handling.

Clinical Relevance: Early and efficient resolution of complaints will reduce stress to all members of the dental team.
Medication-related tooth discoloration: a review
Authors: Thomas Manuel S , Denny Ceena
Published: August 2017

Tooth discoloration is a common problem for which patients seek dental care. Various medications can directly or indirectly result in tooth discoloration. As clinicians, it is our responsibility to know these therapeutic drugs which can cause tooth discoloration and educate our fellow colleagues to take necessary precautions when prescribing these medications. Therefore, the objective of this paper is to give an overview of the various medications that can be linked to tooth discoloration and to suggest the precautionary measures that can be taken to avoid or minimize it.

Clinical Relevance: Dental discoloration potential of medications always needs to be considered before prescribing them.
Midline diastema and its aetiology – a review
Authors: Abrahams Reji , Kamath Geetha
Published: August 2017

Maxillary midline diastema is a common aesthetic complaint of patients. Treating the midline diastema is a matter of concern for practitioners, as many different aetiologies are reported to be associated with it. The appearance of midline diastema as part of the normal dental development makes it difficult for practitioners to decide whether to intervene or not at an early stage. The aim of this article is to review the possible aetiology and management options which will help the clinician to diagnose, intercept and to take effective action to correct the midline diastema. The available data shows that an early intervention is desirable in cases with large diastemas. Treatment modality, timing and retention protocol depends on the aetiology of the diastema. Therefore, priority needs to be given to diagnosing the aetiology before making any treatment decisions.

Clinical Relevance: This article aims to determine and evaluate the aetiology and possible treatment options of midline diastema.
The ‘anatomically difficult’ denture case
Authors: Friel Tim
Published: August 2017

Complete loss of teeth from one or both arches is a disabling condition which is usually managed by a conventional removable denture. Rehabilitation may be poorly tolerated by patients, particularly in the lower jaw, and is more difficult in situations when the anatomy of the denture-bearing area is less favourable. These situations may require specific prosthodontic or surgical techniques, or a combination of both. Prosthodontic solutions involve special impression techniques and the use of soft linings and it is vitally important to manage patient expectations in such cases. This article describes prosthodontic management options for dealing with the fibrous (flabby) anterior ridge and bony exostoses.

Clinical Relevance: Although tooth loss in the UK is diminishing, it is nevertheless important that dental practitioners are able to demonstrate good prosthodontic skills for managing an ageing population. Surgical correction of anatomical defects may occasionally be employed.
The role of hemisection in the prosthetic management of a distal extension ridge – a case report
Authors: Pai AR Vivekananda , Babu V Mohan , Kundabala M
Published: August 2017

This case report illustrates the use of hemisection to minimize the distal extension span. The LR6 was the only molar next to a distal extension of the lower Kennedy's Class II ridge. Its unrestorable distal root was removed and its mesial portion was retained to serve as an effective antagonist and abutment tooth and lessen the extent of right distal extension.

Clinical Relevance: Regarding the prosthetic rehabilitation of distal extensions, hemisection can be advantageous and offered as an alternative to other treatment modalities.
Is there a relationship between increased tooth number and increased tooth size? a case report
Authors: Seehra Jadbinder , Harrison Mike , Cobourne Martyn T
Published: August 2017

A unifying theory has been proposed that links anomalies of tooth size and number. Application of this theory suggests that anomalies of tooth size and number may share a common aetiology but could also be predicted. This article highlights an association between macrodontia and hyperdontia as demonstrated by two clinical cases. These cases demonstrate a localized association and effect on the dentition and highlight the possible predictive application of this theory.

Clinical Relevance: Clinicians should be made aware of the possibility of supernumeraries associated with macrodont teeth.
Skin cancer and some common mimics of skin cancer
Authors: Rees Jonathan L , Naysmith Lisa
Published: August 2017

Skin cancer is the commonest malignancy in most European populations, and is highly treatable. The highest density of tumours is on the face, ears and – if the patient is bald – the scalp. There are two main varieties of skin cancer with very different consequences: melanoma is uncommon but has a significant case-fatality of ~20%, whereas keratinocyte tumours, such as basal cell carcinoma and squamous cell carcinoma, are more common, but have a much better prognosis than melanoma. Diagnosis of skin cancer relies on clinical suspicion and the ability to distinguish the morphologies typical of cancer from the far larger number of benign mimics of skin cancer. Clinical suspicion is paramount in achieving early diagnosis.

Clinical Relevance: Dentists, although their principal activities are confined to the mouth, should be in a position to recognize suspicious skin lesions on the face and other exposed surfaces.
Post removal techniques part 2
Authors: Dickie Jamie , McCrosson John
Published: August 2017

Failed root canal treatment is best addressed primarily with the provision of repeat endodontic treatment with thorough irrigation under isolation. If a post is present in the root of the tooth it needs to be removed first. This paper is the second in a series of two which provide an overview of techniques for post removal. Specifically designed post removal devices and the removal of fibre posts are described. Post removal device techniques are illustrated with a series of clinical case figures.

Clinical Relevance: Endodontic re-treatment has a more successful long-term outcome than surgical treatment for failed root canal treatment. This approach may involve the removal of existing post restorations.
Intracranial meningioma as a cause of orofacial paraesthesia: a case report
Authors: Patel Anish , Murugaraj Vaidayanathan , Patel Mohan
Published: August 2017

Meningiomas are the most common benign intracranial tumour and show a rising incidence with age. They present with a wide array of symptoms and, in this paper, we discuss a case report of an intracranial meningioma presenting as paraesthesia of the lower left lip and chin region. Coincidentally, the symptoms manifested soon after a course of routine dental treatment, further complicating the diagnosis of the lesion. This case highlights the importance, to clinicians at all levels, of the wide array of causes of nerve paraesthesia within the orofacial region and how less frequently occurring conditions must be considered at an early stage.

Clinical Relevance: Intracranial lesions should be included in the differential diagnosis of paraesthesia or anaesthesia of a localized area.
Restorative aspects of periodontal disease: an update part 2
Authors: Puri Nikhil , Puri Komal , Masamatti Sujata Surendra , Dodwad Vidya
Published: August 2017

Along with the biologic considerations regarding crown placement, restorative margin location and implications for soft tissue stability, as explained in the first part of this two part series, there are various restorative dentistry procedures and restorations which, if neglected, may aggravate periodontal disease. This second article describes the surgical techniques for correction of biologic width, correction of interproximal embrasure form, crown preparation and pontic design, and thereafter covers the restorative aspects that may damage the periodontal tissues. Some of the special cases, like splinting, restoration of root resected or bicuspidized tooth, root caries or external resorption cases leading to periodontal tissue damage have also been explained.

Clinical Relevance: Knowledge of the maintenance of the periodontium and how it can be affected by restorative procedures is important for both the clinician and the patient in order to preserve the aesthetics and health of the dentition as a whole.
Calcium silicate materials in endodontics
Authors: Dutta Arindam , Saunders William P
Published: August 2017

Calcium silicate materials have been recently introduced to dentistry and have found wide applications in endodontics because of their favourable biological properties. This review discusses materials that have become available commercially as well as those that are currently experimental. The compositional aspects of Mineral Trioxide Aggregate (MTA) are discussed with modifications and the development of newer materials. Based upon this information, a definition and classification for calcium silicate materials has been proposed. Calcium silicate materials have properties that make them suitable for use in endodontics. Research with hybrid materials may lead to the development of a cement with more desirable characteristics.

Clinical Relevance: Dentists should be aware of the chemistry of the calcium silicate group of materials that includes Mineral Trioxide Aggregate and several newer materials.
Embracing an evidence-based toolkit for prevention – personal accounts
Authors: Hagan-Brown Esther , Gallagher Jennifer E
Published: August 2017

Recent changes in healthcare include a shift from mainly restorative or operative-focused healthcare towards more preventive models of patient care. Oral diseases are common and yet largely controllable, thus it is increasingly a priority for dental professionals to support patients in order to promote good health and control disease in an evidence-informed manner.

The publication of the first edition of Delivering Better Oral Health – An Evidence-based Toolkit for Prevention, in England in 2007, 1 was an important milestone in this process. It provided dental practitioners in England with a clear synthesis of contemporary evidence. These practical guidelines, now updated, offer the potential for consistency in practice and emphasize the importance of delivering preventive dentistry for everyone in the population, together with special measures for high-risk patients.

Clinical Relevance: This article provides an overview of the key messages in Delivering Better Oral Health and explores how these evidencebased guidelines may be implemented by dental professionals across education, policy and practice, based on personal examples from previous editions. 1 , 2 This article is of relevance for all dental professionals and can act as a guide to implementing the recently published updated Toolkit. 3
Complete denture impressions: a simplified impression technique vs conventional technique for edentulous patients
Authors: Krishna Ravishankar , Guttal Satyabodh S , Shetty Saritha M , Shetty Vibha , Singh Meera , Neeraja B
Published: August 2017

The purpose of the study was to use a simplified impression technique, which is an alternative to the conventional method for complete denture fabrication. This was introduced to reduce the number of patient visits, operator time, as well as to compare the efficacy of a simplified impression technique (single appointment impression) with the conventional method (two appointments – primary and final impression).

Clinical Relevance: The simplified edentulous impression technique reduces the number of patient visits when compared with the conventional technique, without compromising the principles of definitive impression-taking.
Challenges in treating traumatically intruded and ankylosed permanent incisors: a case report with a multidisciplinary approach
Authors: Djemal Serpil , Kärki Teresa , Mack Gavin
Published: August 2017

This report discusses the challenges, complications and management of traumatic intrusion injuries affecting the permanent dentition. A case is described where trimming of the incisal edge of a severely intruded and ankylosed upper lateral incisor resulted in an unexpected re-eruption of the tooth. It is suggested that the vibrations from drilling may have disrupted the ankylosis, initiating spontaneous re-eruption and this approach could provide a minimally invasive and conservative pathway to treating ankylosed teeth.

Clinical Relevance: To date no effective treatment has been described to reverse the development of replacement root resorption leading to the loss of the affected tooth. The hypothesis proposed here suggests that mechanical vibrations, if strong enough, may disturb the ankylosis and allow re-eruption of the intruded tooth.
Materials for paediatric dentistry part 1: background to the treatment of carious primary teeth
Authors: Jenkins Natalie
Published: August 2017

Dental caries is a disease that affects many people, including children, and presents numerous challenges to healthcare providers. As clinicians it is important that we consider the advantages and disadvantages of treating carious primary teeth, and make an informed decision about when it is appropriate or not. This paper describes the background to the treatment of carious primary teeth, looking at the differences between primary and permanent teeth, and the relevance of this. It also suggests points to consider when looking at restoration survival studies, as the ability to appraise the literature critically is important for us all in this ‘evidence-based’ age.

CPD/Clinical Relevance: Our early life experiences have the ability to shape our future attitudes and behaviour. Children with carious teeth require careful management so that pain and suffering is minimized, and positive attitudes towards dentistry are fostered.
An overview of preformed metal crowns part 2: the hall technique
Authors: Hyde Amy C , Rogers Helen J , Batley Haris A , Morgan Annie G , Deery Chris
Published: August 2017

Part 2 of this series of two articles addresses the Hall Technique for preformed metal crowns. It will discuss the need for an effective child and dentist friendly method to restore carious primary molars. The technique is described in detail and the evidence for its effectiveness and acceptance by children, parents, dentists and dental educators is presented.

CPD/Clinical Relevance: Dentists and dental care professionals should be aware of the evidence to support the adoption of the Hall Technique.
The francis report – implications for the education and training of dental professionals
Authors: Bissell Vince , Felix David H
Published: August 2017

This paper explores the implications of the Francis Report for education of the dental team. It considers selection of candidates for training, issues relating to the curriculum itself, including assessment and the importance of listening to trainees. The overriding importance of the ‘informal’ or ‘hidden’ curriculum, through which students and trainees observe their teachers and develop a sense of the professional and ethical culture within an educational institution, is stressed.

Clinical Relevance: Sound education, rooted in the recognized ethical principles highlighted in the Francis Report, is essential to the delivery of a dental work force that will deliver care according to the fundamental standards laid down by the GDC.
An update on crown lengthening part 2: increasing clinical crown height to facilitate predictable restorations
Authors: Kalsi Harpoonam Jeet , Bomfim Deborah Iola , Darbar Ulpee
Published: August 2017

This is the second paper in this two-part series. Paper one provided an overview of managing gingival tissue excess and paper two will focus on increasing clinical crown height to facilitate restorative treatment. Crown lengthening is a surgical procedure aimed at the removal of gingival tissue with or without adjunctive bone removal. The different types of procedure undertaken will be discussed over the two papers. In order to provide predictable restorations, care must be taken to ensure the integrity of the margins. If this is not taken into account it can lead to an impingement on the biologic width, which may in turn lead to chronic inflammation resulting in recession or the development of periodontal problems which can be hard to manage.

Clinical Relevance: This paper aims to reinforce the need for thorough diagnosis and treatment planning and provides an overview of the various procedures that can be undertaken.
Pain part 2a: trigeminal anatomy related to pain
Authors: Renton Tara , Egbuniwe Obi
Published: August 2017

In order to understand the underlying principles of orofacial pain it is important to understand the corresponding anatomy and mechanisms. Paper 1 of this series explains the central nervous and peripheral nervous systems relating to pain.

The trigeminal nerve is the ‘great protector’ of the most important region of our body. It is the largest sensory nerve of the body and over half of the sensory cortex is responsive to any stimulation within this system. This nerve is the main sensory system of the branchial arches and underpins the protection of the brain, sight, smell, airway, hearing and taste, underpinning our very existence. The brain reaction to pain within the trigeminal system has a significant and larger reaction to the threat of, and actual, pain compared with other sensory nerves. We are physiologically wired to run when threatened with pain in the trigeminal region and it is a ‘miracle’ that patients volunteer to sit in a dental chair and undergo dental treatment.

Clinical Relevance: This paper aims to provide the dental and medical teams with a review of the trigeminal anatomy of pain and the principles of pain assessment.
Mouth cancer for clinicians part 1: cancer
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 a simplified overview of carcinogenesis, and a review of cancers that affect the oral region.
Osteochondroma of the mandibular condyle: an unusual case of dentofacial asymmetry
Authors: Power Andrew , Carter Lachlan
Published: August 2017

An osteochondroma of the mandibular condyle is a rare tumour of the maxillofacial region that could first present to the general dental practitioner. This case report describes an osteochondroma of the posterio-medial mandibular condyle presenting with marked facial asymmetry and trismus over a six-month period. Appropriate referral and investigation enabled successful removal of the tumour, recontouring of the condyle and an uncomplicated, positive outcome for our patient.

Clinical Relevance: Temporomandibular joint disorders can be a cause of dento-facial asymmetry. Pathology of the temporomandibular joint should be considered in the differential diagnosis when such a patient presents.
Denosumab, an alternative to bisphosphonates but also associated with osteonecrosis of the jaw – what is the risk?
Authors: Sidhu Harlene Kaur
Published: August 2017

Most dental professionals will have, or will soon, encounter patients prescribed this novel alternative antiresorptive drug to bisphosphonates, denosumab (Prolia®, Xgeva®). Denosumab is licensed in the UK for the prevention of osteoporotic fractures in postmenopausal women and the prevention of skeletal-related events (SRE) in adults with bone metastases. The presence of osteonecrosis of the jaw in patients receiving non-bisphosphonate antiresorptives has led to the introduction of the term antiresorptive-related osteonecrosis of the jaw or ARONJ. This paper discusses the basic physiology of bone remodelling, the pharmacology of bisphosphonates and denosumab, and the risk of ARONJ.

CPD/Clinical Relevance: What is the potential risk of ARONJ arising from dental treatment that we should be advising for our patients?
An unusual extranodal presentation of mycobacterium tuberculosis in the upper lip
Authors: Taute Rachel B , Wylie Jennifer , Carter Lachlan
Published: August 2017

Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide, with a peak incidence in South-East Asia and Sub-Saharan Africa. A significant number of patients in the UK are affected. Extra-pulmonary TB presentation varies, and includes head and neck manifestations that can present on routine examination in the dental practice setting. We report an unusual case of extra-nodal TB in the upper lip, and provide some guidance to general dental practitioners on the presenting features of such lesions, and what to refer for further investigation where TB is included in the differential diagnosis.

CPD/Clinical Relevance: This case report highlights important factors in TB diagnosis, with particular emphasis on presenting features relevant to general dental practitioners, and informs on the accepted and current treatment regimen.
Mouth cancer for clinicians part 3: risk factors (traditional: tobacco)
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.

CPD/Clinical Relevance: This article offers the dental team an overview of the main cancer risk factors, tobacco and alcohol, betel and other chewing habits, and environmental factors.
Decision-making for residual periodontal pockets after aetiological treatment
Authors: Bouziane Amal , Benrachadi Latifa , Ennibi Oumkeltoum
Published: August 2017

The practitioner may have difficulties making decisions regarding the most appropriate therapeutic approach in the case of the persistence of periodontal pockets after initial periodontal treatment. Several options may be considered: aetiologic retreatment, maintenance, surgery of the pocket or extraction of the tooth for strategic reasons or when the conservation of the tooth is impossible. There are no clear guidelines for the treatment decision. The aim of this article is to present the main factors involved in making a treatment decision. An algorithm and its background rationale are presented to help the practitioner make a decision about residual periodontal pockets after aetiological treatment.

CPD/Clinical Relevance: Many factors need to be considered in making a treatment decision for residual periodontal pockets: depth of the pocket, presence of signs of infection, difficulty of access to deposits and the type of periodontal lesion.
Oral ulceration in newly diagnosed leukaemic patient with undiagnosed sweet's syndrome
Authors: Brierley Daniel , Slater David N , Snowden John , Holt Debbie , Hegarty Anne
Published: August 2017

Sweet's syndrome is a relatively rare but important skin condition which can affect the oral cavity. Awareness of this reactive condition is important for dentists who work in hospitals, where it is most likely to present. This report summarizes one such case and aims to introduce the reader to Sweet's syndrome.

CPD/Clinical Relevance: Oral ulceration is a common condition occurring in medical inpatients for which oral and maxillofacial surgery and medicine senior house officers and specialists are often asked to review on the ward. An awareness of Sweet's syndrome is important as it is most likely to occur in this setting and may present with oral ulceration.
Modern endodontic planning part 1: assessing complexity and predicting success
Authors: Jawad Sarra , Taylor Carly , Roudsari Reza Vahid , Darcey James , Qualtrough Alison
Published: August 2017

Following a diagnosis of irreversible pulpal disease, periapical disease or failed endodontic therapy, the options for the tooth are extraction or root canal treatment. There is increasing evidence that certain factors may allow the clinician to predict the likely outcome of root canal therapy (RCT) and thus better inform the patient of the possible success rates. Should the patient choose root canal treatment, the clinician must also be able to gauge the potential difficulties that may be encountered and consequently determine whether it is within their competency.

CPD/Clinical Relevance: Assessing outcomes and complexity of care is an essential part of informed consent. Knowing when to refer is an essential component of best clinical practice.
Dental abrasion of incisor caused by a babies' dummy clip: a case report
Authors: Doğramacı Esma J , Rossi-Fedele Giampiero
Published: August 2017

Tooth surface loss (TSL), the non-carious loss of tooth tissue, is considered pathological if the teeth involved experience sensitivity and pain, are functionally compromised or they detract from the patient's appearance. TSL is a common clinical finding in many patient groups, although differences between the primary and permanent dentition contribute to TSL occurring at a faster rate and with worse outcomes in the primary dentition. This case report presents localized abrasion and associated apical periodontitis affecting a single primary tooth in a 2-year-old infant following the misuse of a babies' dummy clip whilst teething. Abrasion is rare in the primary dentition.

CPD/Clinical Relevance: This article highlights an unusual presentation of dental abrasion affecting the primary dentition caused by a previously unreported foreign object; abrasion in this case was a side-effect of soothing the discomfort of teething.
Mouth cancer for clinicians part 6: potentially malignant disorders
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 oral potentially malignant disorders.
Periodontal disease, dental implants, extractions and medications related to osteonecrosis of the jaws
Authors: Shah Neha P , Katsarelis Helen , Pazianas Michael , Dhariwal Daljit K
Published: August 2017

Patients taking bisphosphonates and other anti-resorptive drugs are likely to attend general dental practice. The term ‘bisphosphonate’ is often immediately associated with osteonecrosis of the jaws (ONJ). Risk assessment and subsequent management of these patients should be carried out taking into account all the risk factors associated with ONJ. The introduction of newer drugs, also shown to be associated with ONJ, demands increased awareness of general dental practitioners about these medications.

CPD/Clinical Relevance: This paper provides an update on medication-related ONJ and considers the effects of anti-resorptive drugs on the management of patients needing exodontia, treatment for periodontal disease and dental implant placement.
A case of undiagnosed harlequin syndrome presenting in general dental practice
Authors: Edwards Kathryn , Schaefer Andrew , Greenwood Mark , Staines Konrad
Published: August 2017

Harlequin syndrome is a rare, clinically striking syndrome characterized by distinctly demarcated asymmetric facial flushing and sweating. It may be of idiopathic aetiology or caused by demonstrable ipsilateral damage to the sympathetic nervous system. 1 A case is described where a patient presented to her general dental practitioner complaining of distinctly demarcated unilateral facial flushing and sweating. Onward referral resulted in a diagnosis of Harlequin syndrome.

CPD/Clinical Relevance: This article highlights the neurological signs and symptoms of Harlequin syndrome, making it easier to recognize if it presents in general dental practice.
A review of the available guidance regarding management of medical emergencies in primary dental care
Authors: Lello Suzanne , Burke Julie , Taylor Kathryn
Published: August 2017

This article provides an overview of the recent changes in guidance relating to the management of medical emergencies in primary dental care in the UK. The guidance relating to automated external defibrillators is also presented. The expectations of our regulatory bodies are discussed, as are the requirements for continued professional development. The potential shortcomings of the changes to the guidance are also discussed, as well as proposed solutions, such as the development of algorithms to use in a dental practice setting.

CPD/Clinical Relevance: All dental practitioners should be able to deal with medical emergencies in their practice.
An interesting case of oral inverted ductal papilloma
Authors: Berridge Natasha , Kumar Mahesh
Published: August 2017

Ductal papillomas are rare benign papillary tumours of the minor salivary glands. Previously they have been classified into three subtypes: inverted ductal papilloma (IDP), sialadenoma papilliferum and intraductal papilloma. The oral inverted ductal papilloma is the least common of these lesions, with 48 cases reported to date in a search of the English-language literature. We describe an interesting case of oral IDP and highlight the pertinent clinical and histopathological features. Importantly, unlike the histologically similar inverted papilloma (IP) of the nose and paranasal sinuses, oral IDP is a completely benign lesion and is not associated with malignant change.

CPD/Clinical Relevance: This case report aims to raise awareness of the lesion, oral inverted ductal papilloma (IDP). We outline the clinical features and unique histopathology of oral IDP so that clinicians may correctly diagnose such a lesion and implement appropriate treatment.
A festive case series of emergencies, admissions and friendship at a busy oral and maxillofacial unit
Authors: Keat Ross , Leavy Paul , Thomas Mathew
Published: August 2017

The festive season presents oral and maxillofacial surgery (OMFS) dental core trainees (DCTs) with the challenges of managing an eclectic mix of emergencies. We present three such patients in this case series. First, Patient A, a 39-year-old homeless male who presented with a maxillary extra-oral draining sinus. Secondly, Patient B, a 38-year-old intra-venous (IV) drug user who suffered pan-facial fractures following an alcohol-fuelled assault. Finally, Patient C, a 38-year-old male who sustained a left zygomatic complex fracture a week previously, in attendance for corrective surgery. Despite the hardship, there was still festive cheer to be had by these individuals.

CPD/Clinical Relevance: Primary and secondary care practitioners should be aware of the advanced clinical presentation of dental and maxillofacial emergencies that occur over holiday periods.
A guided, conservative approach for the management of localized mandibular anterior tooth wear
Authors: Mehta Shamir B , Francis Selar , Banerji Subir
Published: August 2017

The successful management of the worn mandibular anterior dentition may present an awkward challenge to the dental operator. The purpose of this article is to describe a case report illustrating the use of a guided, three-dimensional protocol for the ultra-conservative and predictable restoration of the worn lower anterior dentition using direct resin composite. This technique utilizes information based on established biomechanical and occlusal principles to fabricate a diagnostic wax-up, which is duplicated in dental stone. This is used to prepare a vacuum-formed modified stent, assisting the clinician to place directly bonded resin composite restorations to restore the worn lower anterior dentition. The technique, described in 2012 and referred to as ‘injection moulding’ has the potential to offer optimal form, function and an aesthetic outcome in an efficient manner.

CPD/Clinical Relevance: This article aims to describe an alternative technique to simplify the processes involved with restoration of worn lower anterior teeth.
Indications for cuspal coverage
Authors: MacInnes Andrew , Hall Andrew F
Published: August 2017

Cuspal-coverage restorations are important to preserve the integrity of a weakened tooth against the forces of occlusion. This article discusses the clinical indications for both direct and indirect cuspal-coverage restorations and the evidence supporting their use. Factors that modify a tooth's ability to dissipate normal occlusal forces and the effect cuspal-coverage restorations have on force distribution are examined. Clinical criteria, choice of restorative material and methods for tooth preparation are also discussed.

CPD/Clinical Relevance: Re-enforcement of weakened teeth with cuspal-coverage restorations provides a minimally invasive alternative to conventional crowns.
Dear editor
Authors: Coyne Barbara
Published: August 2017

Mouth Cancer for Clinicians Part 7 (Dent Update 2016; 43: 50–65)