bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Oral Health a Risk for Malignant Disease?
Authors: Seymour Robin A
Published: August 2017

Poor oral health has been associated with a variety of systemic diseases. More recent evidence suggests that the extent and severity of periodontal disease and tooth loss may be associated with an increased risk of malignant disease. An association between poor oral health, smoking, increased alcohol consumption as a risk for oral cancer is well established. Associations between oral health and tooth loss with gastric, lung and pancreatic cancers are explored. Some of the associations need further evaluation before patients are warned about their periodontal health increasing the risk of malignant changes elsewhere in the body. The smoking factor may have a commonality linking oral health with an increased risk for malignant disease.
Management of Periodontal Disease in General Dental Practice
Authors: Gadhia Kushal , Karir Naveen , Milward Mike
Published: August 2017

This paper reviews the important parameters deemed useful in the diagnosis and management of periodontal disease in general dental practice. We aim to highlight the importance of these when making a diagnosis and the necessary treatment undertaken in general dental practice before considering referral to specialist services. We also provide guidelines to assist the referral of patients for periodontal treatment in specialist care settings.
Cone Beam Computed Tomography (CBCT) in Endodontics
Authors: Patel S , Kanagasingam S , Mannocci F
Published: August 2017

Cone beam computed tomography (CBCT) is an extra-oral imaging system which produces 3-dimensional scans of the maxillofacial skeleton. It is useful in overcoming the limitations of conventional radiography. CBCT is a valuable aid in providing additional information for diagnosis and enabling more predictable management of complex endodontic problems compared to using intra-oral radiographs alone.
Neurofibromatosis-1 and the Provision of Dental Care
Authors: Moosajee Sukina , Boyle Carole
Published: August 2017

The general features of Neurofibromatosis-1 are outlined and the oral and maxillofacial features described. Two case reports of patients treated in the Department of Sedation and Special Care Dentistry at King's College London Dental Institute are presented, and the dental management of patients with Neurofibromatosis discussed.
Gerodontology in Context
Authors: Burke Francis M
Published: August 2017

The impact of ageing on society, the patient and his/her oral state is summarized, with one case being outlined as an example.
Medics against Violence – The Development of a New Violence Prevention Intervention for Schools
Authors: Goodall Christine A , Devlin Mark F , Koppel David A
Published: August 2017

This article outlines the rationale, evidence base and development of a new anti-violence intervention for schools delivered in the school setting by healthcare professionals. It is an example of multi-professional and mutli-disciplinary working and demonstrates how all healthcare professionals can be involved in wider healthcare issues.
Occlusal Considerations in Implantology: Good Occlusal Practice in Implantology
Authors: Davies Stephen J
Published: August 2017

This article is concerned with implants that are being used for fixed crown and bridgework rather than removable prostheses. The huge increase in the provision of implants over the past two decades is set to continue. Most of the research is related to avoiding failures in implants. This research, in the main, has concentrated on the essential interface between the artificial implant and living bone: osseointegration. The other interface, which is worthy of our full attention, is the one between the implant-supported crown and the antagonist tooth: the occlusion.
A composite approach to the management of worn maxillary first molar teeth
Authors: Kalsi Jagdip S , Wilson Paul HR
Published: August 2017

A lady with extrinsic acid erosion was referred to the restorative department at Bristol Dental Hospital by her General Dental Practitioner (GDP) for restoration of worn maxillary first molar teeth. These teeth were both causing symptoms of dentinal sensitivity and two attempts had been made to restore them with composite by her GDP. The restorations failed because there was insufficient space to bond the composite in place, which was due to dento-alveolar compensation of the first molars into the space created by the wear. Following relevant preventive advice, the maxillary first molar teeth were restored with ‘high’ direct composite resin, which allowed for adequate strength in bulk for retention while acting as fixed intrusion devices. These cured the patient's sensitivity and within four months her occlusion compensated for the composites and had re-established.

Clinical Relevance: Direct composite can be used as both a fixed intrusion orthodontic appliance and routine restoration if placed to act under compression.
Indications for fissure sealants and their role in children and adolescents
Authors: Mejàre Ingegerd
Published: August 2017

The aim of this article is to summarize and interpret present knowledge and evidence on the effect of fissure sealing permanent first and second molars in children and adolescents with two commonly used materials: resin sealants and glass ionomer sealants. Also, to identify important gaps in our knowledge. The results show that the conclusions from systematic reviews differ in several aspects, and that important knowledge gaps still exist, such as the costs and benefits of sealing low-versus high-risk populations. The effect of sealing non-cavitated caries lesions is uncertain and possible differences in effect between resin sealants and the high viscosity glass ionomers need to be investigated.

Clinical Relevance: This article gives the reader a summary of the present evidence regarding fissure sealing. It also gives recommendations based on interpretation of available knowledge.
Case report of a family with benign familial neutropenia and the implications for the general dental practitioner
Authors: Casey Christine , Brooke Tony , Davies Rebecca , Franklin Deborah
Published: August 2017

Benign familial neutropenia (BFN) is a condition where there is a decrease in circulating neutrophils in the blood and patients suffer from oral manifestations which include: persistant periodontal disease, recurrent neutropenic ulceration and candidal infections. This report discusses a family affected by BFN and the effects on their oral health.

Clinical Relevance: Benign familial neutropenia is a rare condition and this article aims to raise awareness among general dental practitioners so that prompt referral and management in secondary care can be arranged.
Oromandibular dystonia treatment following a loss of vertical dimension
Authors: Chidiac José Johann
Published: August 2017

Oromandibular dystonia is a rare condition of hyperkinetic motor dysfunction in the orofacial area. It is a centrally mediated disorder of unknown aetiology and manifested by a sustained contraction of masticatory muscles, involving one or both lateral pterygoids, and pushing the mandible forward. The prognosis is poor and the treatment is symptomatic. This paper describes a case of a 38-year-old woman referred for a locked left TMJ who was diagnosed as having an oromandibular dystonia. A step-by-step diagnosis and treatment procedure is described.

Clinical Relevance: Knowledge of oromandibular dystonia may be valuable as rare medical diseases can be masked by common dental problems.
Fluoride in the media: a review of newspaper articles from 1999 to 2009
Authors: Howard Alan
Published: August 2017

The effects of fluoride are regularly discussed in newspapers. This paper reviews this coverage over a ten-year period and compares the content with contemporary scientific evidence. The reporting used in a sample of daily newspapers when the subject of fluoride and its effects were mentioned was analysed and factual statements within the articles were compared with contemporary scientific studies, to assess the accuracy of reporting.

Clinical Relevance: Practitioners may face questions from patients regarding the evidence base for the safety and efficacy of the use of fluoride in dentistry.
Toothwear and the older patient
Authors: Burke Francis M , McKenna Gerald
Published: August 2017

Toothwear is commonly observed in dentate older patients and may be physiological or pathological in nature. Toothwear can be caused by abrasion, attrition, erosion or a combination of aetiologies. Where treatment is required, a number of options exist, including the use of adhesive materials and fixed and removable prosthodontics.

Clinical Relevance: With patients retaining natural teeth into old age, physiological and pathological toothwear amongst dentate older patients is an increasingly common presentation.
Importance of quality in referral letters sent for potentially malignant oral, head and neck lesions
Authors: Patel Mital , Khan Adeel Qutub , Thiruchelvam Janavikulam
Published: August 2017

Early diagnosis of oral, head and neck cancer is very important. Delay in diagnosis and referral to a specialist unit can result in an enlarged tumour with an increased chance of metastatic spread which will result in upstaging of the tumour, thus worsening the five year survival rate. There is a great need for early identification and referral of potentially malignant lesions by general dental and medical practitioners. Referral letters are the standard and, typically, the sole method of communicating confidential information between two professionals. It is vital that the referral letters sent for potential malignant lesions are of good quality, clearly marked as urgent and contain adequate administrative and clinical data. An audit was undertaken at the Oral and Maxillofacial Department at Barnet and Chase Farm NHS Trust, to examine the quality of referral letters sent for potentially malignant oral, head and neck lesions. The outcome is discussed and a standard referral letter is also proposed if not referring using the standard local cancer network referral proforma.

Clinical Relevance: A good quality referral letter should minimize delay in diagnoses and management of a patient with an oral, head and neck lesion.
Practical considerations for treatment of patients taking bisphosphonate medications: an update
Authors: Brock Gareth , Barker Kate , Butterworth Christopher J , Rogers Simon
Published: August 2017

Osteonecrosis of the jaw – bisphosphonate-related (ONJ-BR) is an established clinical entity associated with both oral and intravenous (IV) bisphosphonate therapy. An update for the general practitioner on the indications for bisphosphonate therapy and both risk assessment and prevalence of ONJ-BR is provided. Management philosophy within a local unit is illustrated through four brief case studies. It is not uncommon to encounter patients on bisphosphonate therapy in the dental practice environment; the vast majority of these will be on oral bisphosphonates as part of their management for osteoporosis. The risk of developing ONJ-BR is rare in these patients compared with those receiving treatment for skeletal complications associated with cancer, many of whom will be managed with IV bisphosphonates. Although rare, it is important to recognize the potential risk of ONJ-BR. Whilst most patients on oral bisphosphonates can be managed no differently from other patients, it should be appreciated that the relative risk of long-term cumulative exposure, comorbidity and other factors are still to be determined. Surgical intervention and extractions can place the patient at risk of ONJ-BR and vigilance is necessary to ensure that healing progresses satisfactorily. Early referral to the local hospital should be sought if there is cause for concern.

Clinical Relevance: Although the risk of ONJ-BR is low in non-oncological indications, it is important to be aware that it exists and to know how the risk may be minimized.
Recurrent intra-oral herpes simplex 1 infection
Authors: Westley Suzanne , Seymour R A , Staines Konrad
Published: August 2017

Human herpes simplex 1 virus (HSV-1) is a DNA virus that has the ability to lie latent and be subsequently re-activated at any point during a patient's life. In the immunocompetent patient, resolution of clinical signs and symptoms usually occurs spontaneously after 14 days. In the immunocompromised patient, healing is often delayed and the effects are much more debilitating. Indications for therapeutic regimes of systemic antiviral treatment are discussed.

Clinical Relevance: Recurrent oral ulceration caused by HSV-1 may be seen by the general dental practitioner and can cause significant morbidity.
Fabrication of an auricular prosthesis: a case report
Authors: Prabhu Nayana , Kumar Sandeep , Gupta Seema
Published: August 2017

The fabrication of ear prosthesis is considered by many prosthetists to be one of the more difficult replacements in maxillofacial reconstruction. The severe undercuts and pronounced convolutions of the ear's surface present a challenge in simulating a natural proportioned prosthesis. The mould for the ear is generally made by creating a three surface die to reproduce the unique configuration adequately and to allow retrieval of the finished prosthesis without damage. This article presents an outlined procedure in the basic fabrication of a prosthetic ear by a conventional technique where the wax pattern is fabricated from the impression of an individual with a similarly proportioned ear.

Clinical Relevance: Fabricating an auricular prosthesis may be part of the work of a maxillofacial department.
Contemporary adhesive bonding: bridging the gap between research and clinical practice
Authors: Green DJB , Banerjee A
Published: August 2017

The dawn of minimally invasive dentistry has led to the development of materials which rely on the use of effective adhesion to bond to remaining tooth tissue. Successful adhesive bonding is dependent upon appreciating the quality of the dental substrate, appropriate clinical handling of the material and patient, together with an appreciation of the chemistry of the adhesive. This paper outlines the current status of contemporary bonding, with particular emphasis on translating laboratory-based evidence into clinical practice. Using laboratory-based evidence, the ability of a bond to achieve a seal to enamel appears to be the best predictor of clinical performance.

Clinical Relevance: This article discusses the issues raised when translating research data about adhesive bonding from the laboratory to clinical dental practice.
Anterior open bite: aetiology and management
Authors: Sandler Paul Jonathan , Madahar Arun K , Murra Alison
Published: August 2017

Anterior open bite has a multi-factorial aetiology comprising: genetically inherited skeletal pattern, soft tissue effect and digit-sucking habits. To formulate an appropriate treatment plan, accurate diagnosis is essential. Simple open bites may sometimes resolve completely during the transition from mixed to permanent dentition, if the digit-sucking habit is broken. More significant open bites, however, sometimes extending right back to the terminal molars, rarely resolve spontaneously and will often require complex orthodontic treatment, involving active molar intrusion or even major orthognathic surgery. Unfortunately, surgery has associated risks attached, including pain, swelling, bruising, altered nerve sensation and, occasionally, permanent anaesthesia, as well as involving significant costs, as with any major surgical procedure under general anaesthesia.

The introduction of Temporary Anchorage Devices (TADs) has expanded the possibilities of orthodontic treatment, beyond traditional limitations of tooth movement. Molar intrusion can be successfully carried out without the need for major surgical intervention, thus avoiding all the attendant risks and disadvantages. This paper provides an overview of anterior open bite and uses an illustrative case where open bite was successfully treated with a combination of fixed appliance therapy and TADs.

Clinical Relevance: Anterior open bite is commonly seen in general practice. A knowledge of the possible aetiological factors and their potential management should be understood by general dental practitioners. The increased popularity of TADS allows a new and less invasive approach to management of these cases.
A review of root fractures: diagnosis, treatment and prognosis
Authors: Malhotra Neeraj , Kundabala M , Acharaya ShashiRashmi
Published: August 2017

Tooth fractures (crown or root fractures) are commonly encountered emergencies in a dental clinic. Root fractures are defined as fractures involving the dentine, cementum and pulp. They are broadly classified as horizontal and vertical root fractures. They may be clinically challenging cases to treat as, usually, treatment of such cases requires an interdisciplinary/multidisciplinary approach for complete rehabilitation of teeth. For a successful outcome, it is imperative to arrive at an appropriate diagnosis and design a treatment plan accordingly as soon as possible. This review article discusses the various types of root fractures, their diagnosis and treatment, along with the factors affecting their healing and prognosis.

Clinical Relevance: Treatment of root fractures depends on a number of factors such as, position of fracture line, mobility of tooth and pulpal status. Thus clinicians must have thorough knowledge and adequate clinical experience to treat them properly.
Dislodged lower right third molar tooth into the parapharyngeal space
Authors: Ogadako Rhiyoma Monique , Woods Martin , Shah Neil
Published: August 2017

Lower third molar teeth can be dislodged into fascial tissue spaces when they are extracted or elevated out of their sockets. Thankfully, this rarely occurs. We present a case report on a lower right wisdom tooth dislodged into the right parapharyngeal space on its removal from the socket and the subsequent management of this rare complication.

Clinical Relevance: Though a rare complication, clinicians have to be aware that lower third molars can be dislodged into tissue spaces and the importance of prompt appropriate management.
Sedation for patients with movement disorders
Authors: Curl Charlotte , Boyle Carole
Published: August 2017

The general features of the movement disorders are outlined and the effects of inhalational sedation with nitrous oxide and oxygen and intravenous sedation, using midazolam, are described. Two case reports of patients with cerebral palsy treated in a community care setting are presented, and the advantages of intravenous and inhalational sedation are explained.

Clinical Relevance: Inhalational sedation (IS) with nitrous oxide and intravenous sedation (IVS) with midazolam can be useful aids to reduce unwanted movements in patients with movement disorders during dental treatment.
The role of the general dental practitioner in managing the oral care of head and neck oncology patients
Authors: Moore Suzanne , Burke Mary C , Fenlon Michael R , Banerjee Avijit
Published: August 2017

The general dental practitioner (GDP) plays a critical role in managing head and neck cancer patients. The first and most important role is to offer preventive services, particularly to smokers and to patients who drink alcohol to excess. It is of critical importance that every patient has a systematic examination of oral soft tissues when seen by a GDP. All patients with suspicious lesions should be referred for urgent attention to a specialist centre. Once oral cancer has been diagnosed, GDPs may be presented with patients requiring urgent dentistry, including extractions before commencement of treatment, requiring palliation of symptoms during treatment, or requiring general dentistry after treatment. Radiotherapy provides increased survival but has serious adverse consequences, which may be lifelong, including dry mouth, radiation caries, limitation of mouth opening and high risk of osteonecrosis after extractions. Extraction of teeth in irradiated bone should be referred to specialist centres. Improving survival rates and an ageing population mean that GDPs will see many more survivors of head and neck cancer in the future, with an increased burden of dental care in the longer term and an increased need for monitoring and secondary prevention.

Clinical Relevance: The management of patients with head and neck cancer is complex and involves a multi-disciplinary team, both in the primary treatment but also in the long-term care. This paper reviews the consequences of treatment for head and neck cancer and gives practical advice for GDPs and their team in the long-term care of these patients.
Should deciduous teeth be restored? reflections of a cariologist
Authors: Kidd Edwina
Published: August 2017

Whether deciduous teeth should be restored has caused controversy for at least 150 years and the argument rages on. Dental caries is a controllable process. The role of operative dentistry and restorations, as far as caries control is concerned, is to make cavitated, uncleansible lesions accessible to plaque control. However, deciduous teeth are exfoliated and perhaps non-operative treatments (plaque control, fluoride, diet) are all that are required to take cavitated teeth pain-free to exfoliation. Are such techniques child-friendly, obviating the need for anaesthesia or the use of handpieces? Alternatively, are they wanton neglect? This paper is written by a cariologist who never treated children, to present alternative managements and rehearse these arguments from a cariological perspective.

Clinical Relevance: This paper might serve as a discussion document for a group of dentists deciding practice policy with regard to the management of caries in deciduous teeth.
Aphasia – the hidden disability
Authors: Orchardson Robert
Published: August 2017

Aphasia is an acquired language disorder due to brain damage and which may include difficulty in producing or comprehending spoken or written language. Stroke is the commonest cause and each year 50,000 new patients develop aphasia. People with aphasia differ in their speech output and in their fluency. Some people communicate reasonably well, while others have very limited powers of expression. This review will describe the neurology of speech and aphasia, and will focus on the role of the speech and language therapist in dealing with people with aphasia.

Clinical Relevance: Dentists and their staff should be aware that after a stroke some people are unable to talk or have limited powers of expression. Comprehension might be impaired and people with aphasia may be unable to grasp some common language, such as appointment letters and patient information.
The ovate pontic for fixed bridgework
Authors: Gahan Matthew J , Nixon Peter J , Robinson Stephen , W-Y Chan Martin F
Published: August 2017

The provision of fixed prosthodontic restorations that meets the patient's functional and aesthetic demands can be challenging, especially in the anterior maxilla. It requires close communication with the technician and knowledge of the available options. This article will outline the options for pontic design and focus on the ovate pontic, which has the potential to provide the most aesthetic outcome. This should equip the practitioner with the knowledge as to which pontic to prescribe if such a challenge arises.

Clinical Relevance: Fixed bridgework is a commonly prescribed prosthesis for the replacement of missing teeth. In order for this to be provided successfully, the practitioner should have a working knowledge of the available options for pontic design. This is especially important in cases where aesthetic demands are high.
Reducing the risk of failure in complete denture patients
Authors: Critchlow SB , Ellis JS , Field JC
Published: August 2017

This paper aims to review the factors associated with an increased risk of failure in complete denture patients, based on the strength of the available evidence base. These include accuracy of jaw relations, a poorly formed mandibular ridge, poor quality dentures and patient neuroticism. Clinical strategies for overcoming these issues are described with particular reference to impression-taking and jaw relations.

Clinical Relevance: Identifying potential problems will help to improve outcomes for edentulous patients treated with conventional complete dentures.
The role of the general dental practitioner (GDP) in the management of abuse of vulnerable adults
Authors: Moore R , Newton J T
Published: August 2017

Abuse of vulnerable adults is largely under reported. The most common forms of abuse amongst this group are neglect and financial abuse, although an individual may be at risk of any or all forms of abuse. Certain individuals are at an increased risk of abuse due to their domestic environment and any physical or mental disability they may have.

Clinical Relevance: Vulnerable adults constitute a significant proportion of the population. GDPs should be aware of the signs of abuse, to be able to identify those individuals at risk, and how and when to raise concerns of abuse to social services.
The potential for resin infiltration technique in dental practice
Authors: Paris Sebastian , Meyer-Lueckel Hendrik
Published: August 2017

Caries infiltration is a micro-invasive treatment to arrest non-cavitated caries lesions. The method is based on the penetration of low-viscosity light-curing resins, so called infiltrants, into the pores within the enamel lesion. That way, diffusion pathways for cariogenic acids are occluded, resulting in a reduction or even arrest of lesion progression. A positive side-effect of caries infiltration is that lesions change their optical properties and appear similar to sound enamel. Therefore, caries infiltration can also be used to camouflage aesthetically disfiguring white spot lesions on buccal surfaces.

Clinical Relevance: Resin infiltration is a micro-invasive treatment to arrest and to camouflage non-cavitated proximal caries lesions that virtually bridges non-invasive and restorative treatment options.
An ectopic tooth concealing an odontogenic myxoma
Authors: Singh Parmjit , Davies Huw Teifion
Published: August 2017

This case report presents a 13-year-old girl who attended an orthodontic clinic for an ectopic UR5. After investigation, a diagnosis of an odontogenic myxoma was made and the tumour was excised. A panoramic radiograph taken almost two years earlier for another dental problem was found to show an ectopic UR5 associated with a subtle radiolucency.

Odontogenic myxomas may be of higher frequency than once thought in the paediatric population and therefore should always be considered in the differential diagnosis of any intraosseous radiolucency. Any radiolucent area associated with an unerupted tooth should be investigated further or closely followed up.

Clinical Relevance: The odontogenic myxoma is a rare but potentially serious benign tumour of the jaws.
The long and winding road – the journey of a cleft lip and palate patient part 1
Authors: Madahar Arun K , Murray Alison , Orr Robert , Sandler Paul Jonathan
Published: August 2017

Patients with a cleft lip and palate (CLP) deformity require the highest standard of care that can be provided and this requires multidisciplinary care from teams located in regional cleft centres.

Care of these cases is from birth to adulthood and requires several phases of intervention, corresponding to the stages of facial and dental development. Management ideally starts pre-natally, following the initial diagnosis, and occasionally pre-surgical appliances are prescribed. The lip is ideally repaired within three months, followed by palate closure between 12 and 18 months. Careful monitoring is required in the first few years and ENT referral, where necessary, will diagnose middle ear infection, which commonly affects CLP patients. Speech therapy is an integral part of the ongoing care. Excellent oral hygiene is essential and preventive dietary advice must be given and regularly reinforced. Orthodontic expansion is often needed at 9 years of age in preparation for a bone graft and, once the permanent dentition erupts, definitive orthodontic treatment will be required.

Maxillary forward growth may have been constrained by scarring from previous surgery, so orthognathic correction may be required on growth completion. Final orthodontic alignment and high quality restorative care will allow the patients to have a pleasing aesthetic result. CLP patients and their families will need continuing support from medical and dental consultants, specialist nurses, health visitors, speech and language specialists and, perhaps, psychologists. These two articles outline the principles of care for the CLP patient and, secondly, illustrate this with a case report, documenting one patient's journey from birth to 21 years of age.

Clinical Relevance: A successful outcome for CLP patients requires a sound dentition. The general dental practitioner role is vital to establish and maintain excellent oral hygiene, a healthy diet and good routine preventive and restorative care. Understanding the total needs of CLP patients can help the dentist to provide high quality care as part of the multidisciplinary management.
Overview of paediatric dental sedation: 2. nitrous oxide/oxygen inhalation sedation
Authors: Wilson Katherine E
Published: August 2017

The use of conscious sedation for the management of anxious paediatric dental patients is extremely beneficial. Inhalation sedation with nitrous oxide and oxygen remains the mainstay for paediatric sedation in the UK.

Clinical Relevance: Dentists carrying out inhalation sedation for dental treatment must be fully conversant with the technique and the principles of patient management.
Dental fluorosis in the paediatric patient
Authors: Atia Gahder-Sara , May Joanna
Published: August 2017

Exposure to excessive fluoride intake during the early childhood years can disrupt the normal development of enamel, resulting in dental fluorosis. This varies in severity, ranging from white opacities in mild cases to more severe black and brown discoloration or enamel pitting. This article aims to give the reader a better understanding of the aetiology, diagnosis and subsequent treatment of dental fluorosis in the paediatric patient.

Clinical Relevance: Fluorosis can have a marked effect on dental aesthetics. The prevalence of fluorosis in the United Kingdom may increase following the publication of Delivering Better Oral Health, published by the Department of Health in 2007, 1 which suggested changes to fluoride levels in children's toothpastes. This article highlights the importance of accurate diagnosis of fluorosis and also explains the treatment options available to paediatric patients.
Dental materials – what goes where? the current status of glass ionomer as a material for loadbearing restorations in posterior teeth
Authors: Burke FJT
Published: August 2017

Glass ionomer materials have been available for 40 years, but have not been indicated for loadbearing restorations, other than when used in the ART concept. However, there is anecdotal evidence that dentists are using the reinforced versions of this material in posterior teeth, possibly as a result of demands from patients to provide them with tooth-coloured restorations in posterior teeth at a lower cost than resin composite. This paper reviews the existing literature on reinforced glass ionomer restorations in posterior teeth, concluding that, under certain circumstances (which are not fully elucidated) these materials may provide reasonable service. However, the patient receiving such restorations should be made aware of the minimal amount of evidence for the success of these restorations and the potential need for the restorations to be re-surfaced in due course.

Clinical Relevance: Reinforced glass ionomer restorations may provide patients with tooth-coloured restorations in posterior teeth, but their survival may not equate to restorations in resin composite in loadbearing situations.
Posts – when it all goes wrong! part 1: case assessment and management options
Authors: Rollings Sam , Stevenson Brian , Ricketts David
Published: August 2017

Posts have been used for many years to retain restorations or cores for extra-coronal restorations in endodontically treated teeth. This article discusses the variety of post systems that are available and the incidence and reasons for failure of teeth that have been restored with posts. The treatment options available for the management of such failures are considered, in addition to the indications for both non-surgical and surgical management of endodontic failures. The attitudes of dentists and the perceived complications of attempting post removal are reviewed, along with the evidence to support the prevalence of complications.

Clinical Relevance: Failure of post-retained restorations is a relatively frequent finding due to failure of the restoration itself or the endodontic treatment. It is therefore important to understand and be aware of the various treatment options available, their indications and associated risks.
Pacifiers: a review of risks vs benefits
Authors: Gederi Arian , Coomaraswamy Kristian , Turner P John
Published: August 2017

Pacifiers, otherwise known as dummies, have been around for many centuries. They have, however, taken many different forms, shapes and sizes. Their use is increasing and has remained controversial, with both potential risks and benefits identified in the medical and dental literature. The purpose of this article is to review some of the evidence available for and against the use of pacifiers and make recommendations for their application, maintenance and weaning.

Clinical Relevance: Dental healthcare professionals need to consider the evidence available for and against pacifiers when making recommendations to patients and their parents.
Techniques for effective management of periodontitis
Authors: Turani Duaa , Bissett Susan M , Preshaw Philip M
Published: August 2017

The treatment of periodontitis is a complex process that can last for many years. Successful management of this common inflammatory condition necessitates team work by the patient, dental hygienist and dentist. A variety of complex skills are required including, not only the necessary clinical skills, but also excellent communication, education and motivation of patients. Above all, time is required to treat the condition properly, and successful outcomes depend heavily on engaging with and empowering the patient to manage his/her condition. Patients need to be active partners in the management of their periodontitis (supported by the dental team), and this will only happen if the time is spent to educate them on their role. Communication is essential for successful management, and behaviour change is always required of patients. Strategies for working effectively with a dental hygienist, and a suggested treatment protocol are presented to help dentists develop more effective methods of treating periodontitis.

Clinical Relevance: This article gives practical guidance on how to manage patients with periodontitis as well as working within the dental team to achieve the best clinical outcomes.
Are dentine pins obsolete?
Authors: Bonsor Stephen J
Published: August 2017

Dentine pins have been used in operative dentistry for many years to retain a non-adhesive restorative material (such as dental amalgam) in a cavity which has little or no inherent mechanical retention. However, dentine pin placement can be a hazardous procedure and there are a number of problems associated with their use. Alternative techniques have been described which may be utilized and are effective at retaining the restorative material without the shortcomings of dentine pins. There is a strong argument therefore that dentine pins have no place in contemporary dental practice and have consequently become obsolete.

Clinical Relevance: Auxiliary retention may be required to retain direct intra-coronal dental restorations in unretentive cavities.
Dental materials – what goes where? class I and II cavities
Authors: Burke FJ Trevor , Mackenzie Louis , Sands Peter
Published: August 2017

Dental amalgam has helped maintain dental public health in the developed world for over a century. However, its days appear to be numbered. Notwithstanding the environmental consideration, there is an ever increasing demand from dental patients for non-metallic and tooth-coloured restorations in their posterior teeth. This paper gives a brief history of dental amalgam and critically appraises the alternative materials, the principal of these being resin-based composite.

Clinical Relevance: The majority of practitioners carry out large numbers of Class I and II restorations, so an appraisal of the pros and cons of the alternatives may assist in decision-making.
Changing concepts in cariology: forty years on
Authors: Kidd Edwina , Fejerskov Ole
Published: August 2017

The caries lesion is a sign or symptom resulting from numerous pH fluctuations in biofilms on teeth. The lesion may or may not progress and lesion progression can be controlled, slowed down or arrested. Control of the biofilm is the treatment of caries, the most important measure being to disturb the biofilm mechanically using a fluoride-containing toothpaste. The informed patient controls caries and the role of the dental professional is to advise how this should be done. This is the non-operative treatment of caries and it is worthy of payment. It should be mandatory as part of any operative treatment to ensure that the patient understands, and is able to perform, adequate plaque control.

Clinical Relevance: It is very unfortunate that the current remuneration scheme (Unit of Dental Activity) in Health Service practice in England and Wales prevents practitioners adopting a modern biological approach to caries control.
Direct anterior composites: a practical guide
Authors: Mackenzie Louis , Parmar Dipesh , Shortall Adrian CC , Burke FJ Trevor
Published: August 2017

For more than 40 years dentists worldwide have been using directly placed resin-bonded composite to restore damaged anterior teeth. While such techniques are invariably more conservative of tooth tissue than indirect procedures, operative techniques using direct composite can be challenging and are considered technique sensitive. Clinicians require both technical and artistic skill to provide composite restorations that restore function and aesthetics to blend seamlessly with the residual dentition. This paper provides an update on the aesthetic considerations involved in the restoration of anterior teeth with directly placed composite and outlines the contemporary materials, equipment and techniques that are available to optimize every clinical stage.

Clinical Relevance: Successful restoration of anterior teeth with direct composite is an integral component of contemporary clinical practice.
Veterinary dentistry: a clinician's viewpoint
Authors: Baxter Colin J K
Published: August 2017

Abstract: This is a clinician's view of the current state of veterinary dentistry at the level of the general practitioner across the different species. An indication of the work done and the hazards commonly encountered are covered.

Clinical Relevance: To increase awareness within the dental profession of the current state of veterinary dentistry.
Reducing white spot lesion incidence during fixed appliance therapy
Authors: Greene LE , Bearn DR
Published: August 2017

Fixed orthodontic appliances are commonly used in contemporary orthodontic treatment and can be associated with the development of white spot lesions on the teeth. These lesions can be detrimental to both the aesthetics and health of the teeth so prevention is better than cure and patient selection is critical. This paper discusses predictors of development in addition to methods to help prevent white spot lesions during fixed appliance therapy. Recommendations for oral hygiene regimes during fixed orthodontic appliance treatment are given, the development of white spot lesions (WSLs) described and ways to predict their occurrence identified.

Clinical Relevance: Most general dental practitioners will have patients who are considering orthodontic treatment or are wearing fixed orthodontic appliances and so are at increased risk of developing WSLs. It is therefore important they are aware of predictors and ways to prevent WSLs.
Can oil lubricated dental handpieces be sterilized?: part 1. the problem
Authors: Kudhail Ravinder Singh
Published: August 2017

HTM 01-05 guidelines state that decontamination of handpieces remains a challenge, in particular the lumen, due to oil impeding access for steam sterilization. This paper discusses important aspects of cleaning and sterilization of the handpiece lumen and critically appraises the literature found on this topic. The paper is not intended to cover precleaning methods in detail.

Clinical Relevance: The complex structure of handpiece lumens makes them difficult to sterilize. Current knowledge of this subject is necessary for general dental practitioners to decide on investment in new equipment correctly, which has been validated by the manufacturer, in order to comply with HTM 01-05 guidelines.
Preventing dental caries: part 1. the scientific rationale for preventive advice
Authors: Davies Robin M , Blinkhorn Anthony S
Published: August 2017

This article highlights the fundamental issues which the primary care team should consider when developing preventive dental advice for their patients. Although it is important to have a clear understanding of the carious process, this knowledge must take account of social influences on health when assessing the preventive strategy for individuals. A key factor is that caries is a lifelong process involving fluctuations in demineralization and remineralization. The dental team should ensure that the oral environment favours remineralization and avoids irreversible loss of enamel and dentine. An understanding of this ‘see-saw’ process will influence not only our preventive philosophy but how we, as health professionals, diagnose and treat dental caries.

Clinical Relevance: Preventing dental caries is an essential skill for all dental professionals. This article brings together the scientific basis of the appropriate advice.
The risk of bisphosphonate-related osteonecrosis of the jaw in children. a case report and literature review
Authors: Ngan Kwok-Kit , Bowe John , Goodger Nicolas
Published: August 2017

Bisphosphonate use has been described in children diagnosed with osteogenesis imperfecta (OI), fibrous dysplasia, neuromuscular disorders, bone dysplasia, idiopathic juvenile osteoporosis, rheumatologic disorder and even Crohn's disease. In OI patients, bisphosphonates have become an important symptomatic therapy for moderate and severe forms of the disease, because their inhibitory effect on osteoclasts increases bone mineralization and density, thereby reducing the risk of bone fractures. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) has become an increasingly common complication as the use of these drugs is becoming more widespread in adults. However, the evidence for BRONJ in paediatric patients is scarce. We present a case of a patient with OI on IV bisphosphonate therapy who required dental extractions and review the literature of the risk of BRONJ in this group of patients.

Clinical Relevance: Dental clinicians need to be aware of the potential risk of BRONJ in paediatric patients who have had intravenous bisphosphonate therapy. It is important that these patients are identified and managed appropriately.
Guidelines for the assessment of the impacted maxillary canine
Authors: Counihan Kate , Al-Awadhi EA , Butler Jonathan
Published: August 2017

Canine impactions are frequently encountered, occurring in 1.7% of the population. The aim of this paper is to provide guidance on the assessment and management of cases which present in general dental practice. Canine position is considered in four categories; canine overlap with adjacent incisor, vertical canine height, angulation to midline and position of canine root apex. Good, average and poor prognostic outcomes are considered for each category and a brief outline of their management is included.

Clinical Relevance: Canine impactions frequently present during routine examination. Appropriate recognition, investigation and referral, if necessary, are paramount to successful treatment.
The importance of early intervention in the treatment of dental infection
Authors: Paterson Paul , Nichols Elizabeth Hannah , Watson Katie , Boyd Deborah
Published: August 2017

With recent reports of increasing hospital admissions relating to dental infection, the authors believe it is time to re-visit the importance of its effective early treatment. A series of three cases is used to illustrate the potentially life-threatening progression of what, in the early stages, is an easily treatable condition.

Clinical Relevance: The principles of effective management of dental infection are highlighted in the first instance and then indications for specialist maxillofacial referral are discussed.
The state-of-the-art of ART sealants
Authors: Frencken Jo E
Published: August 2017

Sealing caries-prone pits and fissure systems is an effective caries-preventive measure. There are basically two types of sealant materials: glass-ionomer and resin-based materials. Low-and medium-viscosity glass-ionomers were initially used and showed a low level of retention. With the advent of the ART approach in the mid-nineties, high-viscosity glass-ionomers were introduced as sealant material and the retention rate of ART sealants increased substantially. As the effectiveness of a sealant is measured by its capacity to prevent (dentine) carious lesion development, sealant retention is considered a surrogate endpoint. The ART sealant protocol is described. Systematic reviews and meta-analysis covering low-medium-and high-viscosity glass-ionomer (ART) sealants have concluded that there is no evidence that either glass-ionomer or resin-based sealants prevent dentine carious lesions better. The annual dentine carious lesion development in teeth with high-viscosity glass-ionomer ART sealants over the first three years is 1%. These ART sealants have a high capacity of preventing carious lesion development. Because no electricity and running water is required, ART sealants can be placed both inside and outside the dental surgery.

Clinical Relevance: High-viscosity glass-ionomer ART sealants can be used alongside resin-based sealants.
Aspects of dento/medico-legal report writing
Authors: Wood Geoff D
Published: August 2017

This paper offers some guidance on aspects of dento/medico-legal report writing, citing anonymized examples from the author's caseload for clarification of the points made, and also serves to illustrate that sometimes not everything is as straightforward as it may initially appear. It provides reference to the current Civil Procedure Rules in England and Wales and its relevance in report writing.

Clinical Relevance: To provide guidance on aspects of dento/medico-legal report writing.
Metastatic involvement of the maxillary antrum from an uncommon source
Authors: Elledge Rokhsareh , Elledge Ross OC , Raskauskiene Diana
Published: August 2017

Metastatic involvement of the jawbones is uncommon, particularly in the maxilla. Case reports of such metastases from renal cell primaries are few, making a consensus on treatment difficult to establish. We present a case of metastatic involvement of the maxilla two years following a nephrectomy for renal cell carcinoma. The case exemplifies the broad range of symptoms attributable to metastases in the maxilla and the management dilemmas.

Clinical Relevance: The case highlights the role of practitioners in primary dental care in identifying the potential for such pathology based on clinical and radiographic features.