bluuebunny/crossref_metadata_2025 huggingface dataset:
Dental Dilemmas: Endodontics or Dental Implants?
Authors: Bateman Geoff , Barclay Craig W , Saunders William P
Published: August 2017

This narrative review explores treatment planning options in restorative dentistry. The growth of dental implants, as an accessible and predictable treatment option, gives practitioners a useful tool for managing the missing tooth or teeth with a hopeless prognosis. Traditionally, endodontics and fixed prosthodontics have been used to restore teeth and spaces where the outlook for such treatment appears reasonable. Practitioners may, however, question the predictability and cost effectiveness of such an approach where, at times, it might appear that replacement of a compromised tooth with a dental implant could be a more predictable option. The evidence base for these treatment options is explored and discussed, and suggestions are made for future management strategies.
A current update on osteonecrosis of the jaw and bisphosphonates
Authors: Arrain Yazdana , Masud Tahir
Published: August 2017

Bisphosphonates are effective drugs used to treat important medical conditions affecting the skeleton, such as malignancy and osteoporosis. Bisphosphonate-associated osteonecrosis of the jaw (BONJ) is a rare but painful condition that can affect quality of life. Healthcare professionals need to be aware of this potential side-effect of bisphosphonates, as well as ways to minimize its occurrence.

Clinical Relevance: This review addresses the definitions of BONJ, differential diagnosis and staging, prevention and also discusses a recently recognized non-exposed variant of BONJ. The possibility that a recently introduced anti-resorptive agent, denosumab, which is not a bisphosphonate, may cause jaw osteonecrosis is also discussed.
Defective dental restorations: to repair or not to repair? part 1: direct composite restorations
Authors: Blum Igor R , Jagger Daryll C , Wilson Nairn H F
Published: August 2017

The presentation of patients with failing dental restorations that exhibit minor defects is a common clinical situation in everyday dental practice. The repair of such restorations, rather than replacement, is increasingly considered to be a viable alternative to the replacement of the defective restoration. This first of two papers considers indications and techniques for the repair of defective direct composite restorations.

It is possible that some dental practitioners are unaware of the option of repair rather than replacement of composite restorations. This article provides an overview of contemporary knowledge and understanding of restoration repair in the clinical management of defective composite restorations.

Clinical Relevance: A sound understanding of the indications, benefits and techniques of direct composite restoration repair could allow the longevity of the existing restoration to be extended without unnecessarily sacrificing healthy tooth structure.
Periodontal disease in the older patient
Authors: Irwin Chris R
Published: August 2017

Population projections predict an increasing number of dentate older people who will require assessment and treatment of periodontal disease. Studies show that healthy, older patients show no increased risk of periodontal disease progression compared to younger individuals, while periodontal treatment can be equally successful in the older age group. However, co-morbidity can impact negatively on both the periodontal tissues and the dentition. These effects range from a reduced ability to maintain adequate plaque control, to the use of drug and other therapies directly affecting the periodontal tissues and salivary flow.

Clinical Relevance: An individualized treatment plan is required for older patients, taking account of all factors impacting on the periodontal tissues.
Domiciliary oral healthcare
Authors: Lewis Debbie , Fiske Janice
Published: August 2017

There is increasing demand for Domiciliary Oral Healthcare (DOHC) and the skills and equipment required to provide a quality, patient-centred service with careful assessment and management in a sometimes compromised situation. Commissioning of DOHC needs to be set in the context and current agenda of equality, diversity and human rights in both health and social care. Effective marketing and community engagement are required to promote awareness of how to access services amongst people confined to home and their families and carers.

Training for the whole dental team should be available in order to address the concerns and problems encountered regarding the provision of DOHC.

Clinical Relevance: Members of the dental team should be aware of the skills required for DOHC and be familiar with using effective care pathways in relation to the provision of DOHC.
Unexpected temporary mental nerve deficit after extraction of mandibular first molar: case report
Authors: Amailuk Paul , Badcock Mark , Chandu Arun
Published: August 2017

Temporary neurologic deficit affecting the distribution of the left mental nerve was reported in a warfarinized, diabetic patient who had a history of previous CVA with right-sided body weakness. The neurologic deficit was reported following routine extraction of a left mandibular first molar. Recovery of sensation began six weeks after the procedure. Possible mechanisms and preventive measures are discussed.

Clinical Relevance: The reader should understand that mental paraesthesia can be an unexpected outcome in the most routine of mandibular extractions.
Bleaching and bonding for the older patient
Authors: Kelleher Martin GD , Djemal Serpil , Al-Khayatt Ahmed S , Ray-Chaudhuri Arijit J , Briggs Peter FA , Porter Richard WJ
Published: August 2017

Older people who remain reasonably well may wish to maintain or enhance their dental and oral appearance, preferably at minimal biologic and financial costs. Bleaching and bonding represents a very good treatment option and a sensible strategy for this group. Bleaching addresses the discoloration, while direct composite bonding can improve the shape of worn, or otherwise unaesthetic, teeth without damaging the structure or health of the residual tooth tissue. This pragmatic treatment is well tolerated by older patients. The visual and functional improvements are greatly appreciated by this group, partly because of the non-destructive and affordable nature of the benefits.

Clinical Relevance: Bleaching and bonding represents a proven, sensible, pragmatic, affordable and practical approach to managing the aesthetic problems of older patients, and the benefits are achievable without destroying their residual sound tooth tissue.
Schwannoma presenting in the soft palate of a nine-year-old boy
Authors: Chawla Ourvinder , North Sarah , Yates Julian M
Published: August 2017

Swellings and tumours within the oral cavity are a common finding, however, benign intra-oral schwannoma or neurolemma is relatively uncommon, especially in younger patients. Involvement of the palate is a rare presentation although there have been a few reported cases relating to the lingual and other tissues.

Clinical Relevance: This paper reviews intra-oral schwannomas and presents a case of such a tumour of the soft palate in a paediatric patient and discusses the presenting features, differential diagnoses, along with the management of the condition.
Suturing: an update for the general dental practitioner
Authors: Sharif Mohammad Owaise , Coulthard Paul
Published: August 2017

Sutures are routinely used to achieve haemostasis and to approximate soft tissues after extractions, periodontal procedures, implant surgery and soft tissue biopsies. This paper provides the general dental practitioner with the knowledge and understanding of sutures to select the most appropriate for use. Common suturing techniques are also discussed.

Clinical Relevance: Suturing is an important aspect of dental practice, the selection of an appropriate suture and technique is integral to obtaining an optimal outcome.
Differential diagnosis for orofacial pain, including sinusitis, tmd, trigeminal neuralgia
Authors: Hegarty Anne M , Zakrzewska Joanna M
Published: August 2017

Correct diagnosis is the key to managing facial pain of non-dental origin. Acute and chronic facial pain must be differentiated and it is widely accepted that chronic pain refers to pain of 3 months or greater duration. Differentiating the many causes of facial pain can be difficult for busy practitioners, but a logical approach can be beneficial and lead to more rapid diagnoses with effective management. Confirming a diagnosis involves a process of history-taking, clinical examination, appropriate investigations and, at times, response to various therapies.

Clinical Relevance: Although primary care clinicians would not be expected to diagnose rare pain conditions, such as trigeminal autonomic cephalalgias, they should be able to assess the presenting pain complaint to such an extent that, if required, an appropriate referral to secondary or tertiary care can be expedited. The underlying causes of pain of non-dental origin can be complex and management of pain often requires a multidisciplinary approach.
Prosthodontic care for elderly patients
Authors: Allen P Finbarr , McKenna Gerald , Creugers Nico
Published: August 2017

For older patients, clinicians should consider maintaining teeth and using functionally-orientated treatment strategies as an alternative to removable prostheses. When the remaining dentition has a poor prognosis, key teeth should be preserved as overdenture abutments and a gradual transition to edentulousness planned. Where complete dentures are provided, these can be retained using dental implants to overcome many of the problems associated with conventional replacement dentures.

Clinical Relevance: The elderly population of today is better informed and more demanding of oral healthcare providers than previous generations. Clinicians should be aware of all the prosthodontic treatment options available for older patients.
Primary cutaneous cd8-positive t-cell lymphoma: a case report of a rare and aggressive disease with oral presentation
Authors: Geddes A , Savin J , White SJ , Gibson J
Published: August 2017

A case of a 66-year-old man, who was referred to the Oral Medicine service with persistent oral ulceration and widespread cutaneous rash is presented. Laboratory investigations confirmed a diagnosis of epitheliotropic, CD8-positive, cytotoxic, T-cell lymphoma.

Clinical Relevance: Oral ulceration represents a heterogeneous group of aetiologies: the patient with this more concerning pathology presented both to his general medical and dental practitioners.
Sickle cell disease, dentistry and conscious sedation
Authors: Bryant Catherine , Boyle Carole
Published: August 2017

The features of sickle cell disease (SCD) are described. Two case reports of patients treated in a Dental Institute are presented and the dental management of patients with SCD discussed. Since infection is one of the major risk factors for sickle cell crisis, the prevention of oral disease and infection is vital for this group of patients and there is no contra-indication to the delivery of dental treatment under local anaesthetic with inhalational sedation if required in the primary care setting. Since patients with sickle cell disease are particularly vulnerable to the effects of periods of hypoxia, which may produce significant morbidity, and because of the additional practical challenges in sedating this group of patients, intravenous sedation should be undertaken in a specialist unit.

Clinical Relevance: The increasing prevalence of sickle cell disease highlights the importance of dentists practising in multi-cultural communities having an understanding of this condition and its implications on their clinical practice. This will facilitate the safe management of patients with sickle cell disease.
Frequently asked questions in composite restorative dentistry
Authors: McConnell Robert J , Sabbagh Joseph , de la Macorra Jose C , Lund Arne , Cassidy Mike
Published: August 2017

With an increasing number of dental practitioners using composite resins as the restorative material of choice, knowledge of terminology, handling properties and restorative techniques are important.

Clinical Relevance: This paper addresses many of the questions raised by participants at lectures and courses given by the authors across Europe.
An interesting potential reaction to warfarin
Authors: Avinchey Grainne Mc , Swinson Brian
Published: August 2017

Warfarin is an oral anticoagulant, used routinely for patients with atrial fibrillation, deep vein thrombosis, pulmonary embolism and those with a mechanical prosthetic valve. There are several noted adverse reactions associated with its use, in particular the risk of haemorrhage. Other adverse reactions include: hypersensitivity, rash, alopecia, diarrhoea, unexplained drop in haematocrit, purple toes, skin necrosis, jaundice, hepatic dysfunction, nausea, vomiting and pancreatitis. In this case report, an interesting potential adverse reaction to warfarin is discussed. The reaction described affected the patient's tongue, without affecting any other aspect of the oral cavity or body.

Clinical Relevance: This case report highlights the potential problems that can be encountered by patients on warfarin therapy, specifically, the possibility for hypersensitivity type reactions.
Spontaneous fracture of the genial tubercles: a case report
Authors: Burnett Peter J , Nixon Paul P , Rogers Simon N
Published: August 2017

Spontaneous fracture of the genial tubercles is rare and, of the 13 reported cases in the literature, all involve the older edentulous patient. A case of genial tubercle fracture in a 62-year-old edentulous female is presented. The symptoms are pain and swelling of the floor of the mouth and restricted tongue movement. Surgical intervention was not required and a complete recovery without loss of function was made.

Clinical Relevance: This case aims to make practitioners aware of genial tubercle fracture as a possible diagnosis when the older edentulous patient presents with pain and swelling in the floor of the mouth.
Mouthwatering but erosive? a preliminary assessment of the acidity of a basic sauce used in many indian dishes
Authors: Ghai Nandini , Burke FJ Trevor
Published: August 2017

The aim of this study was to assess whether some types of Indian cuisine may contain erosive components. Indian dishes were prepared by a previously published method and their pH measured using a pH probe. The results indicated: (i) that some components of Indian cooking, such as tomatoes and red chilli powder, had the potential to erode enamel; (ii) that the pH of some foods was reduced with increasing temperature; and (iii) that all the basic masalas made and tested had a pH of less than 4.5.

Within the limitations of the study, it may be concluded that the basic sauce/masala used in north Indian dishes may have erosive potential.

Clinical Relevance: This information could be considered useful when advising patients who eat Indian curries about causes of acid erosion of their teeth.
Full-arch implant-retained prosthetics in general dental practice
Authors: Rosenbaum Nigel
Published: August 2017

The loss of all teeth from one or both dental arches is a significant disability affecting self-confidence, communication, masticatory function and aesthetics. Whilst missing teeth cannot be restored to the natural state, the development of a prosthetic dentition has been a goal of dental science throughout the centuries. Contemporary techniques allow for the replacement of missing dentition with fixed or removable solutions, solving many of the problems. Implant dentistry has transformed this area of medicine. This article provides dental practitioners with an overview of this important area of patient care.

Clinical Relevance: Dental practitioners in clinical practice will frequently see edentulism; a good understanding of the available options for rehabilitation is essential.
Successful removable partial dentures
Authors: Lynch Christopher D
Published: August 2017

Removable partial dentures (RPDs) remain a mainstay of prosthodontic care for partially dentate patients. Appropriately designed, they can restore masticatory efficiency, improve aesthetics and speech, and help secure overall oral health. However, challenges remain in providing such treatments, including maintaining adequate plaque control, achieving adequate retention, and facilitating patient tolerance. The aim of this paper is to review the successful provision of RPDs.

Clinical Relevance: Removable partial dentures are a successful form of treatment for replacing missing teeth, and can be successfully provided with appropriate design and fabrication concepts in mind.
Implant assessment
Authors: Barker Dean
Published: August 2017

Meticulous planning in implant dentistry is essential in order to achieve a predictable and successful outcome for both the operator and the patient. This paper summarizes the important aspects of planning, including factors related to clinical and radiographic examination and the use of study models.

Clinical Relevance: This paper has relevance to practitioners carrying out implant treatment and also to colleagues who are likely to refer patients for implants.
Avoiding and managing the failure of conventional crowns and bridges
Authors: Briggs Peter , Ray-Chaudhuri Arijit , Shah Kewal
Published: August 2017

The replacement of crowns and bridges is a common procedure for many dental practitioners. When correctly planned and executed, fixed prostheses will provide predictable function, aesthetics and value for money. However, when done poorly, they are more likely to fail prematurely and lead to irreversible damage to the teeth and supporting structures beneath. Sound diagnosis, assessment and technical skills are essential when dealing with failed or failing fixed restorations. These skills are essential for the 21st century dentist. This paper, with treated clinical examples, illustrates the areas of technical skill and clinical decisions needed for this type of work. It also provides advice on how the risk of premature failure can, in general, be further reduced. The article also confirms the very real risk in the UK of dento-legal problems when patients experience unexpected problems with their crowns and bridges.

Clinical Relevance: This paper outlines clinical implications of failed fixed prosthodontics to the dental surgeon. It also discusses factors that we can all use to predict and reduce the risk of premature restoration failure. Restoration design, clinical execution and patient factors are the most frequent reasons for premature problems. It is worth remembering (and informing patients) that the health of the underlying supporting dental tissue is often irreversibly compromised at the time of fixed restoration failure.
The prosthodontic pathway of the oral cancer patient
Authors: Siddall Krista Z , Rogers Simon N , Butterworth Chris J
Published: August 2017

Oral cancer patients undergo life-altering curative treatment that consists of surgery or a combination of surgery and radiotherapy. This can severely alter the functional anatomy of the oral cavity and create a challenging environment for successful oral rehabilitation. A multidisciplinary team approach is required to rehabilitate these patients successfully. It is essential to have assessment by an oral rehabilitation specialist before treatment, especially where primary rehabilitation interventions are being considered.

Following cancer treatment, patients may suffer from a range of difficulties, from dento-facial appearance, to chewing, speech and swallowing. This dysfunction often leads to psychosocial problems, such as reduced self esteem, social contact and quality of life. Conventional prosthodontics has a role to play in the management of these patients but osseointegrated implants (OII), can be required to overcome the anatomical and physiological barriers. OII can be used in an environment where there is poor soft tissue function or little bone support, and where there is a dry mouth.

Clinical Relevance: This paper introduces readers to the prosthodontic pathway taken by some oral cancer patients. It provides an overview of current oral rehabilitation techniques that supplement the supportive dental care provided by general dental practitioners and their team after cancer treatment.
Subepithelial connective tissue graft used with platelet-rich plasma in treatment of gingival recession
Authors: Kumar Ashish , Triveni MG , Mehta DS
Published: August 2017

This paper describes the use of subepithelial connective tissue graft with platelet rich plasma in the treatment of gingival recession. There was complete root coverage in both the cases and the coverage is still maintained after 4 years.

Clinical Relevance: Subepithelial connective tissue grafting with platelet-rich plasma may be an effective way to treat gingival recessions. Use of platelet-rich plasma provides the clinician with an autologous source of growth factors to accelerate healing.
Bleeding disorders seen in the dental practice
Authors: Dalati Mohamad Hani Nouri , Kudsi Zaki , Koussayer Lara Taher , Dalati Mohamad Fadi , Mawla Mohamad Fouad
Published: August 2017

Dentists may encounter patients with various types of bleeding disorders in their daily practice. Initial recognition of such bleeding disorders and their possible systemic causes, as well as knowing when to refer those cases to secondary care, plays a crucial and important role in reducing potential complications and negative side-effects. This article will give an account of the most common bleeding disorders that dentists might find in their daily dental practice. This will be followed by another article that will cover the management of congenital and acquired disorders found in the dental practice.

Clinical Relevance: Bleeding disorders are occasionally encountered in patients in dental practice. Dentists must be knowledgeable about these disorders and be aware of the impact of such conditions on the management of their patients.
Ethical marketing in ‘aesthetic’ (‘esthetic’) or ‘cosmetic dentistry’ part 1
Authors: Kelleher Martin G D , Djemal Serpil , Lewis Nicholas
Published: August 2017

Prior to undertaking any elective, ‘cosmetic’ dental procedures, it is vital for the treating dentist to discuss the merits and drawbacks of all viable options. It is important that the patient understands what the consequences and limitations of treatment are likely to be, and what the potential failures could entail later in his/her life. Informed consent should be obtained (preferably in writing) and the clinical notes and records should be clearly documented, with accurate and concise details provided of all the investigations carried out, and their findings, as well as including details of the various discussions that have taken place. Dentists need to be aware of the existence of heightened expectations in this group of patients and be cautious about accepting patients who have unrealistic ‘cosmetic’ expectations. Where possible, cosmetic or aesthetic dental treatment should be provided which is minimally destructive and, in the long term, be in the ‘best interests’ of the patient. Important matters such as the gaining of informed consent and maintaining meticulous, contemporaneous dental records will also be emphasized. It is hoped that the article will provide clear definitions of some commonly used terms such as ‘ethical marketing’, ‘ethics’, and ‘values’, which are often used in association with the marketing, planning and undertaking of supposedly ‘cosmetic’ dental procedures. The important role of less invasive alternative treatment options will also be emphasized.

Clinical Relevance: The aims of this article are to consider the common pitfalls that may arise when contemplating the marketing and provision of invasive, ‘cosmetic’, dental restorations and to discuss how best to avoid a dento-legal claim where such treatment plans may not fulfil the patient's desired outcome.
Endodontic ‘solutions’ part 2: an audit comparing current practice in belfast with uk and republic of ireland dental schools
Authors: Good M-L , El Karim IA , Hussey DL
Published: August 2017

Endodontic lubricants, irrigating solutions and medicaments help reduce the microbial load within root canals. Primary and secondary cases involve different microbes. Each ‘solution’ or combinations thereof could play a significant role but no detailed guidelines exist on their use. An audit was undertaken to compare current practice in Belfast Dental School to the others across the UK and Republic of Ireland (ROI). This audit highlighted three main differences between Belfast and other dental schools. Many other institutions utilized other irrigants besides sodium hypochlorite (NaOCl), different intracanal medicaments, including calcium hydroxide, and higher concentrations of NaOCl. Having gathered this information, we ask, ‘Is there sufficient evidence to change the endodontic regime currently used at Belfast Dental School?’. Using the findings from the literature review (Part 1), we introduce new evidence-based protocols for primary and secondary cases for use in Belfast Dental School.

Clinical Relevance: In the absence of detailed clinical guidelines on the use of endodontic lubricants, irrigants and medicaments in primary and secondary cases, it is important to be aware of current practice in UK and ROI dental schools where dentists and specialists are trained.
Implant-retained overdentures: a review
Authors: Vere Joe , Bhakta Shashwat , Patel Rajesh
Published: August 2017

Implant-retained overdentures represent a treatment option for many patients unable to tolerate conventional dentures. They may be specifically indicated in patients with altered anatomy, neuromuscular disorders, a pronounced gag reflex or severe residual ridge resorption. This article discusses the different ways in which implant overdentures can be retained, outlines some of the clinical stages involved in planning and providing these prostheses, and highlights long-term maintenance requirements associated with implant-retained overdentures.

Clinical Relevance: Patients with implant-retained overdentures are likely to present in general dental practice. Practitioners should be aware of issues associated with the design, treatment planning and maintenance of these prostheses.
First impressions count
Authors: Turner Jonathan W , Moazzez Rebecca , Banerjee Avijit
Published: August 2017

The art and craft of recording intra-oral anatomy successfully with dental impressions relies on the interaction of three critical factors – the ‘golden triangle of impression-taking’: an appreciation of the anatomical features to be recorded, the material used to take the impression and the clinical handling/operative technique applied. This paper aims to discuss the three factors and their inter-relationships, detailing clinical tips for successful, reproducible and consistent outcomes.

Clinical Relevance: Obtaining accurate dental impressions is the key to success in a wide range of clinical restorative procedures. This paper offers clinical advice to practitioners to plan and then take predictable, good quality impressions for their restorative cases.
Impacted maxillary canines – a perennial problem
Authors: Mittal Mohit , Murray Alison , Sandler Jonathan
Published: August 2017

Ectopic eruption with impaction of maxillary permanent canine teeth is a frequently encountered clinical problem. Surgical exposure and attachment of a gold chain to impacted maxillary canines is often required in order to bring them into the dental arch and to allow good alignment. The principle of radiographic parallax is employed to determine whether the impacted canine is placed buccal or palatal to adjacent teeth. Good flap design allows adequate access to the impacted tooth. Bone removal should be adequate to free the impacted crown to its greatest circumference. An orthodontic eyelet with a gold chain is then bonded to the crown of the impacted tooth. Use of a good bonding technique will minimize chances of bond failure necessitating a second surgical procedure. Atraumatic surgical procedure will allow minimal postoperative complications and a rapid recovery.

Clinical Relevance: This article describes a surgical technique to expose impacted maxillary canines and attach gold chains, to facilitate orthodontic alignment into the dental arch. The principle of radiographic parallax to determine the bucco-palatal position of impacted canines is also discussed.
Periodontal diseases in children and adolescents: a clinician's perspective part 2
Authors: Kumar Ashish , Masamatti Sujata Surendra , Virdi Mandeep Singh
Published: August 2017

The general dental practitioner and paediatric dentist are in a unique position to identify and distinguish between a seemingly innocuous condition that may be a normal physiological aberration or an early sign of severe destructive periodontal disease. Although severe destructive periodontal conditions are uncommon in children, it is essential that children receive a periodontal screening as part of their regular dental examination. Early diagnosis ensures a high likelihood of a successful therapeutic outcome, primarily by reduction of aetiologic factors, remedial therapy and development of an effective maintenance protocol. This prevents the recurrence and progression of disease and reduces the incidence of tooth loss. In the first article, we discussed the classification, plaque-induced and non plaque-induced gingival diseases, localized and generalized forms of chronic as well as aggressive periodontitis. In this second article, we discuss periodontitis as a manifestation of systemic disease, necrotizing periodontal diseases, periodontal screening and basic periodontal examination, and treatment of periodontal diseases in children and adolescents.

Clinical Relevance: Incorporation of periodontal screening in regular dental examination by dentists can help in early diagnosis and treatment of periodontal diseases. This could prevent further progression of disease and reduce the frequency of tooth loss.
Treatment of ectopic first permanent molar teeth
Authors: Hennessy Joe , Al-Awadhi EA , Dwyer Lian O , Leith Rona
Published: August 2017

Ectopic eruption of the first permanent molar is a relatively common occurence in the developing dentition. A range of treatment options are available to the clinician provided that diagnosis is made early. Non-treatment can result in premature exfoliation of the second primary molar, space loss and impaction of the second premolar. This paper will describe the management of ectopic first permanent molars, using clinical examples to illustrate the available treatment options.

Clinical Relevance: This paper is relevant to every general dental practitioner who treats patients in mixed dentition.
Thank you to our reviewers
Authors: Burke FJ Trevor
Published: August 2017

Every paper in Dental Update is considered by two reviewers. I would like to thank all those on the list below for giving their time and expertise in checking the validity of the papers published in Dental Update in 2012 and making suggestions on how papers might be improved.
Preventing dental caries: part 2. case studies in prevention
Authors: Blinkhorn Anthony S , Davies Robin M
Published: August 2017

This article seeks to bring together the preventive messages given in Paper 1 and apply them to specific individual patients. The key elements are the appropriate advice on fluorides, fissure sealants, diet and formulating advice in terms of an individual's educational background.

Clinical Relevance: This article offers practical advice on the prevention of dental caries using individual patient-based scenarios.
The role of a dentist in managing patients with dystonia
Authors: Watt Eileen , Sangani Indiya , Crawford Fiona , Gillgrass Toby
Published: August 2017

Oromandibular dystonia is a neurological condition where the muscles of the mouth and jaw contract in involuntary spasms. Dystonia currently has no cure, but there are treatment options to manage symptoms. This case report describes the treatment of a 41-year-old male who presented at University of Glasgow Dental Hospital and School with established oromandibular dystonia. The use of removable appliances as a treatment option for this condition will be discussed.

Clinical Relevance: This case highlights the potential role of the dental practitioner in providing oromandibular dystonia sufferers with an effective and relatively easy treatment modality in the form of a removable appliance.
Invisible orthodontics part 1: invisalign
Authors: Malik Ovais H , McMullin Ailbhe , Waring David T
Published: August 2017

This paper discusses the invisible orthodontic treatment modalities of Invisalign aligners, lingual appliances and aesthetic brackets. The first part of this three-part series will discuss Invisalign aligner treatment. The second part will discuss lingual appliance treatment and the third part will focus on aesthetic brackets. The benefits and drawbacks of Invisalign treatment are considered in detail, including examples of treated cases and a review of the literature to date.

Clinical Relevance: Patients are increasingly requesting more aesthetic forms of orthodontic treatment. Clinicians need to be aware of the indications and limitations of such invisible therapies so that they can fully inform their patients.
Minimally-invasive non-surgical periodontal therapy
Authors: Ower Philip
Published: August 2017

Periodontitis is a complex disease that has both oral and systemic consequences. The treatment of periodontitis may be both surgical and non-surgical but, in recent years, there has been a shift towards managing disease non-surgically in preference to surgery. Fundamental to all types of therapy is the patient's role in disease control, in the form of self-performed plaque control, and it is important that the patient understands this. Non-surgical periodontal therapy has a long history and has traditionally been carried out using a variety of hand and powered instruments, the objective being root surface disinfection by the removal of plaque, calculus and contaminated root cementum. However, over the last 30 years or so, it has become apparent that calculus does not cause disease, cementum does not become significantly infected and bacteria and their toxins are only loosely adherent to the diseased root surface. This has led to the development of less invasive instrumentation principles which may be better for patients, more cost-effective and more easily applied in different clinical settings.

Clinical Relevance: This paper aims to describe and justify a minimally-invasive approach to the management of the diseased root surface in periodontitis, to clarify the terminology used and to suggest how these principles may be applied in general practice.
Minimally-invasive tooth extraction: doorknobs and strings revisited!
Authors: Saund Daniel , Dietrich Thomas
Published: August 2017

References to ‘atraumatic’ tooth extraction pervade the recent dental literature. This has been largely driven by the increasing demand for bone preservation as osseo-integrated implants increasingly become a mainstay for dental prosthetic rehabilitation. This article introduces the reader to the concept of vertical tooth removal, which aims to avoid socket expansion and thereby minimize trauma to alveolar bone during tooth extraction. Several systems have recently become available and we present our experience with the Benex extractor in particular.

Clinical Relevance: Clinicians should be aware of minimally invasive extraction techniques, their indications and potential advantages.
Improving your image…then and now. digital photography in dentistry
Authors: Sharland Mike
Published: August 2017

Digital photography and its use in the busy dental practice is ever increasing. Correct choice of equipment will save many hours of staff time and expense and is essential if consistent images are to be achieved. Modern digital cameras and associated macro lenses and ringflash, can last 5–10 years if handled carefully, and therefore is a good investment as an additional facility within the practice. There are many uses of photography in dentistry, from documentation to quality before and after images of dental treatments.

Clinical Relevance: This article will keep practitioners updated on the photographic equipment and uses within dentistry, and help to make informed decisions regarding photography in their practices.
Twenty years of handling evaluations and practice-based research by the PREP panel
Authors: Burke FJ Trevor , Crisp Russell J
Published: August 2017

Dental materials which are user friendly make clinicians' lives simpler by facilitating their placement in patients' teeth: accordingly, the handling of materials is of relevance to the clinician. This paper traces the history of product handling evaluations and practice-based research by the PREP Panel, a group of practice-based researchers based in the UK.

Clinical Relevance: The ease of handling of dental materials is important in dental practice, given that practitioners may find that a material which is difficult to handle leads to suboptimal clinical results.
Update on coronectomy. a safer way to remove high risk mandibular third molars
Authors: Renton Tara
Published: August 2017

Abstract: Decoronation of high risk mandibular third molars (M3Ms) has become common practice in parts of UK and USA. With the introduction of Cone Beam CT scanning, there has been an evolution in the practice, with avoidance of unnecessary coronectomies based on CBCT findings. Also, additional anatomical features found only on CBCTs have introduced possible additional indications to undertake intentional coronectomy.

Trigeminal nerve injury is the most problematic consequence of dental surgical procedures with major medico-legal implications. Iatrogenic injuries to the third division of the trigeminal nerve remain a common and complex clinical problem. Altered sensation and pain in the orofacial region may interfere with speaking, eating, kissing, shaving, applying make-up, toothbrushing and drinking; namely just about every social interaction we take for granted. Usually after oral rehabilitation, the patient expects and experiences significant improvements, not only regarding jaw function, but also in relation to dental, facial, and even overall body image. Thus these injuries have a significant negative effect on the patient's self-image and quality of life and the iatrogenesis of these injuries lead to significant psychological effects.

Clinical Relevance: Coronectomy is an alternative procedure to complete removal of a mandibular third molar in situations where there is high risk of damage to the inferior alveolar nerve.
Early detection of oral cancer: how do I ensure I don't miss a tumour?
Authors: Ogden Graham R , Lewthwaite Rowena , Shepherd Simon D
Published: August 2017

The GDC recommend that early detection of oral cancer should form part of every dental surgeon's Continuing Professional Development. It is arguably the most serious condition that can arise within the oral cavity and regular screening practices may also help mitigate spurious claims of prior negligence for failure to detect the cancer at an early stage. Results for routine screening of the entire oral mucosa, together with risk status assessment, should be recorded in a patient's notes at every visit (both negative and positive findings).

Clinical Relevance: A knowledge of how to detect oral cancer early is an essential part of the dentist's armamentarium.
Domestic abuse – an under-reported problem in general dental practice?
Authors: Hardwick Lauren , James Richard
Published: August 2017

‘Child abuse’ is a topic about which clinicians will be well informed. There are protocols relating to the management of patients suspected of having sustained non-accidental injuries and clinical staff will be expected, as part of mandatory training, to receive education in this area. Domestic abuse (DA) is an under-reported, but relatively common problem and has many implications in the management of traumatic injuries in adults. The objective of this paper is to discuss the aetiology, history and presentation of patients who have been subjected to domestic abuse, and to help provide a strategy for their management.

Clinical Relevance: Domestic abuse is a relatively common problem and, as such, dentists should be aware of this important area and how to manage patients they suspect of having been abused, or who inform them that they have been subjected to DA.
The application of clinical audit to improve pain control following third molar surgery
Authors: Bryant Catherine , Rood J Phil
Published: August 2017

A telephone survey was used to assess adequacy of pain control after third molar removal in a series of three audits. After each audit, factors contributing to failure to control pain adequately and poor patient compliance with our analgesic regimen were identified. Changes in practice were then introduced to remedy areas of weakness and improve outcome. Despite an apparently sound protocol for the prescription of analgesics for patients having third molar surgery, the first audit revealed that 53% of patients experienced moderate to severe pain. After the introduction of written patient instructions to clarify the use of post-operative analgesics, the second audit demonstrated that 86% had their pain managed successfully. After subsequently increasing the post-operative Ibuprofen doses from 400 mg to 600 mg, the third audit showed that 96% of patients had satisfactory pain control. The use of clinical audit with an evidence-based analgesic regimen and clear, written patient instruction has improved post-operative pain control.

Clinical Relevance: This paper demonstrates the usefulness of clinical audit for the monitoring and improvement of pain control and analgesic prescribing regimens following oral surgery, which in turn may improve patient experience and outcome.
The influence of patients' decisions on treatment planning in restorative dentistry
Authors: Kalsi Jagdip S , Hemmings Kenneth W
Published: August 2017

As part of treatment planning, options are presented to patients by dentists. An informal discussion takes place involving a cost-benefit analysis and a treatment plan is agreed. Evidence-based dentistry takes into account the best available literature, clinical experience and patient factors to guide the dentist. Dentists exert considerable influence on which treatment modality is selected.

This paper focuses on the importance of patient factors which lead to less than ideal, clinically acceptable, treatment plans that nevertheless give patient satisfaction over the long term. Though no universally accepted healthcare model exists for restorative dentistry, patients' decisions are most influenced by their relationship with their dentist over factors such as time, access and cost. Letters should be sent to patients clarifying the nature of all proposed options, including advantages and disadvantages, complications, success rates, biological and financial costs and what happens if no treatment is carried out.

Clinical Relevance: Many psychological and social determinants influence patients' values and decision-making when planning for restorative dentistry. These lead to a treatment plan agreed between the patient and the dentist. Often an element of compromise is considered acceptable to both parties when the evidence would suggest an alternative treatment to be preferable.
A guide to skin cancer of the face for the dental team
Authors: Main Barry , Felstead Andrew , Hughes Ceri , Thomas Steve
Published: August 2017

The incidence of skin cancer in the United Kingdom is increasing and is associated with an ageing population and increasing lifetime exposure to sunlight. The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma and malignant melanoma, all three of which may present on the skin of the face. The dental team are, therefore, well-placed to recognize suspicious lesions and arrange for further advice or assessment. This paper outlines the epidemiology, important clinical features and principles of modern management of facial skin cancers to aid dental practitioners in the recognition of suspicious lesions. In addition, some of these treatments have side-effects which have the potential to affect a patient's oral health or its management and these aspects are also discussed.

Clinical Relevance: The dental surgeon is ideally placed to recognize malignant or potentially malignant lesions on patients' faces and to advise on seeking further advice or refer for assessment, as appropriate. Dental practitioners will increasingly encounter patients who have undergone surgical or non-surgical management of facial skin cancer and should understand the potential oro-facial side-effects of such treatment.
Quality assurance tests for digital radiography in general dental practice
Authors: Greenall Chris , Drage Nicholas , Ager Matthew
Published: August 2017

Quality assurance (QA) is essential in dental radiography. Digital radiography is becoming more common in dentistry, so it is important that appropriate QA tests are carried out on the digital equipment, including the viewing monitor. The aim of this article is to outline the tests that can be carried out in dental practice.

Clinical Relevance: Quality assurance for digital equipment is important to ensure consistently high quality images are produced.
Implant-supported mandibular denture: planning to delivery – a case report
Authors: Patel Upen S , Walmsley A Damien
Published: August 2017

Restoring the edentulous mandible with a removable prosthesis can be a challenging prospect for both the dentist and patient during and after treatment. Poor retention and support are the major problems reported with a mandibular complete denture and these can be significantly improved with the use of implants and retentive attachments. Utilizing implants requires careful planning from both the surgical and restorative aspects to ensure that the intended treatment aim and outcome is achieved.

Clinical Relevance: This case highlights the importance of both restorative and surgical considerations when planning the rehabilitation of the mandible with dental implants.
How we view complainants; an ethical dilemma?
Authors: Holden Alexander C L
Published: August 2017

All too often, those patients who complain are thought to be unreasonable. Healthcare professionals often feel that patients do not have an understanding of the pressures and hardships that they struggle with on a day-to-day basis. When a patient complains, it is seen by the professional complained about as a wholly negative event, leading to loss of confidence and leaving that professional feeling demoralized. Often complaints are due to a breakdown in communication. Sometimes a patient is unhappy with a treatment charge or simply there is a perception that he/she has been poorly treated. The General Dental Council and Primary Care Trusts (and now their successors) take a dim view of dental practitioners who deal with complaints poorly. This article sets out to offer a different perspective on complaints, so that the complaint system can be used to build trust between dental professionals and patients, instead of instilling demoralization and fear of litigation into those on the receiving end of a complaint.

Clinical Relevance: This article is relevant to all dental professionals as complaints are an inevitability of practice.
The management of risk part 2: good consent and communication
Authors: Collier Andrew
Published: August 2017

Valid consent is an absolute requirement of ethically correct treatment. This second article, in a series covering the management of risk, defines consent but also describes the role that appropriate consent, through good communication, plays in clinical and ethical risk management and the reduction of complaints.

Clinical Relevance: Valid consent is fundamental to the ethical and legal treatment of patients.