bluuebunny/crossref_metadata_2025 huggingface dataset:
The multidisciplinary conservative management of a vital crown root fracture
Authors: O'Toole Saoirse , Garvey Thérèse , Hashem Atef
Published: August 2017

This case study reports on the multidisciplinary management of a maxillary canine which sustained an unusual labial crown root fracture, resulting in a large veneer-like fragment. The canine was extruded orthodontically and the fragment was re-attached using adhesive materials. This multidisciplinary solution prevented impingement on the biological width, loss of vitality and loss of tooth structure, leading to an optimal soft and hard tissue aesthetic result. Successful clinical and radiographic results after three years were observed, despite canine protected occlusion.

Clinical Relevance: Multidisciplinary management can result in an improved prognosis of the tooth and, in time, may be the most cost-effective solution for the patient. When discussing treatment options with the patient, utilization of all dental specialties should be considered and offered to the patient.
Printed radiographs – is what you see what you get?
Authors: Gerrard Greg
Published: August 2017

Digital dental radiography allows for exchange of images between primary and secondary care. However, it is common practice for radiographs to be printed out and attached to referrals. This study investigates the loss of diagnostic information of printed radiographs compared to the on-screen digital image. The best quality was achieved with images printed onto radiographic film or onto photographic paper with an inkjet printer. Laser and inkjet printer output onto 80 gsm office paper resulted in a loss of diagnostic information. Wherever possible, radiographs should be transmitted digitally between clinicians to maintain image integrity.

Clinical Relevance: This paper illustrates the potential pitfalls of printing radiographs to be sent with referrals.
Giant cell arteritis affecting the tongue: a case report and review of the literature
Authors: Grant SWJ , Underhill HC , Atkin PA
Published: August 2017

Giant cell arteritis (GCA) is a systemic vasculitis with symptoms that could cause a patient to present to a general dental practitioner. A case of GCA that presented as headache, jaw claudication, unilateral visual loss and tongue ulceration leading to necrosis is reported and the literature reviewed, with an emphasis on dentally relevant aspects. It is vital that GCA is not overlooked in patients over the age of 50 with unexplained dental pain, tissue necrosis or jaw pain which may be misdiagnosed as a temporomandibular joint disorder. Early diagnosis and prompt treatment is the key to preventing visual loss. Early referral in such cases would be warranted.

Clinical Relevance: Dental clinicians may play a part in the early diagnosis of GCA by having a high index of suspicion for its symptoms in patients, so that devastating ischaemic consequences, such as irreversible visual loss, can be prevented.
Appraisal for general dental practitioners
Authors: Miller Alasdair G , Kemp Timothy
Published: August 2017

Appraisal has been a key component of staff management of most organizations for more than a decade. This article explores the principles, benefits and stages for effective appraisal in primary dental care.

Clinical Relevance: Reviewing what works and what does not and reflection on these points are key to developing professional skills. Appraisal is a formalized way of reflecting on the past to help a professional plan for his/her future and thereby, ideally, improve patient care.
Management of microdont maxillary lateral incisors
Authors: Khan Sadaf , Gill Daljit , Bassi G Steve
Published: August 2017

Maxillary microdont lateral incisors can have significant implications on the development of the permanent dentition in terms of the eruption of maxillary permanent canines, as well as on the aesthetics of the upper labial segment and the overall occlusion, depending on the extent of microdontia. This paper describes the aetiology, clinical implications and management of the maxillary microdont lateral incisor.

Clinical Relevance: The definitive management of the maxillary microdont lateral incisor may involve either a restorative or orthodontic approach or, in some cases, a combined orthodontic-restorative approach.
Management of patients with non-syndromic clefts of the lip and/or palate part 3: from age 10 until adulthood
Authors: McIntyre Grant T
Published: August 2017

Parts 1 and 2 of this article addressed the care of children with cleft of the lip and/or palate until age 10. The third part of this article discusses their care until adulthood.

Clinical Relevance: Dentists should be aware of the different types of cleft lip and/or palate that occur and the role of the dentist in the overall management of patients who have clefts.
The role of dental implants in the management of dento-alveolar trauma part 1
Authors: Shahdad Shakeel , Gamble Eugene
Published: August 2017

Patients who suffer dento-alveolar trauma present a unique challenge for the dentist. There are numerous options to consider when attempting to restore the dentition. This article reviews the role of dental implants in replacing lost or damaged teeth. It also describes some of the options available to maintain the alveolar bone between tooth removal and implant placement, as well as techniques used to recreate the deficient hard and soft tissue after a tooth has been avulsed or extracted.

Clinical Relevance: Knowledge of the role of dental implants and techniques for the preservation of the hard and soft tissues will assist the clinician to reduce patient morbidity and achieve an optimal restorative result.
What makes a good dentist? a pilot study
Authors: Chandarana Priya V , Hill Kirsty B
Published: August 2017

This study investigates the attributes of a ‘good dentist’ with respect to the opinions of dental patients, dental students and qualified dentists and determines whether the dental profession and its patients are in agreement with the standards published by the General Dental Council (GDC) in 2005. A questionnaire was circulated amongst the above groups at the University Of Birmingham, School of Dentistry. Each participant was asked to rank 14 attributes for a dentist in order of their importance. The results indicated that generally there was no consensus between individual participants. There was, however, significant overlap between the top six attributes chosen by dental care professionals and the GDC standards. Patients tended to rank other non-GDC mentioned attributes more frequently. Attributes which were considered important by all were ‘putting patient interests first and acting to protect them, respecting a patient's dignity and choices and having good technical ability.’

Clinical Relevance: It is important to gain an insight into patient attitudes and to be knowledgeable of the GDC professional standards, in order to improve overall conduct and performance as a dental practitioner.
An update on optical coherence tomography in dentistry
Authors: Clarkson D McG
Published: August 2017

An update and overview of the use of optical coherence tomography (OCT) in dentistry is described. Specific aspects discussed include the evolution of the technology and the basic process of light beam interference used to obtain OCT images. In addition, aspects of the optical properties of dentine and enamel and the range of current diagnostic applications of OCT in dentistry are reviewed.

Clinical Relevance: The technique of optical coherence tomography is considered to be significant since the technology involved allows imaging using light to around 2–3 mm in teeth and can, for example, allow the extent and progression of carious lesions to be determined.
The state-of-the-art of ART restorations
Authors: Frencken Jo E
Published: August 2017

ART is less anxiety-and pain-provoking than traditional restorative treatments; administration of local anaesthesia is rarely required. Systematic reviews have provided evidence of the high level of effectiveness of high-viscosity glass-ionomer ART restoration in restoring single-surface cavities, both in primary and permanent posterior teeth, but its survival rates in restoring multiple-surface cavities in primary posterior teeth needs to be improved. Insufficient information is available regarding the survival rates of multiple-surface ART restorations in permanent teeth. Evidence from these reviews indicates no difference in the survival rates of single-surface high-viscosity glass-ionomer ART restorations and amalgam restorations in primary and permanent posterior teeth.

Clinical Relevance: Where indicated, high-viscosity glass-ionomer ART restorations can be used alongside traditional restorations. ART provides a much more acceptable introduction to dental restorative care than the traditional ‘injection, drill and fill’.
Complete dentures revisited
Authors: McCord J Fraser , Smith Philip , Jauhar Sachin
Published: August 2017

The aim of the article is to assist practitioners in the diagnosis and management of complete denture problems by addressing the problems from a theoretical viewpoint and in a clinically diagnostic way.

Clinical Relevance: To assist practitioners and undergraduates to understand the clinical basis of complete denture prosthodontics.
Frequently asked questions in direct pulp capping of permanent teeth
Authors: Mouawad Stéphanie , Artine Simon , Hajjar Pétra , McConnell Robert , Fahd Jean-Claude , Sabbagh Joseph
Published: August 2017

Direct pulp capping is a proven method of preserving tooth vitality of a mature permanent tooth in cases of pulp exposures. The indications for this treatment, treatment modalities and materials are discussed in this paper.

Clinical Relevance: This paper answers many of the frequently asked questions by general practitioners, dental students and specialists about direct pulp capping.
Abstract
Authors: Morgan Anne
Published: August 2017

Probiotic are live micro-organisms which when administered in adequate amounts confer a health benefit. It has been suggested that the ingestion of probiotics could also be beneficial to oral health. This study demonstrated that daily dietary supplementation with Lactobacillus paracasei F19 between 4 to 13-months-old had no effect on caries experience at 3, 6 or 9-years-old.
Periodontal disease in general practice - an update on the essentials
Authors: Wadia Reena
Published: August 2017

Periodontal disease has a wide spectrum of presentation, any of which can have an effect on the patient's dental well-being and overall quality of life. This sporadic but sometimes rapidly progressing condition can easily be missed in a busy general practice setting. It is essential that the correct diagnosis is made and our duty of care to the patient fulfilled. If the condition, along with the treatment options and appropriate advice, is not explained to the patient, the individual may well feel that he/she has been let down by the professional person trusted over many years.

Clinical Relevance: This article discusses the screening and referral of periodontal patients, taking into account the medico-legal challenges that are currently faced by general dental practitioners (GDPs).
Orofacial viral infections – an update for clinicians
Authors: Nair Raj G , Salajegheh Ali , Itthagarun Anut , Pakneshan Sahar , Brennan Michael T , Samaranayake Lakshman P
Published: August 2017

Orofacial viral infections may be less common but appear in different clinical forms. Often these infections get initially treated by antibiotics which obviously will have limited or no effect. The authors review the current concepts of orofacial viral infections, causative agents, their classification and clinical manifestations and a basis for treatment.

Clinical Relevance: Most viral infections do not require any specific treatment except in patients who are immunosuppressed or immunodeficient. Appropriate diagnosis and timely management of orofacial viral lesions are important irrespective of whether it is localized or a manifestation of a systemic infection.
Effective analgesia for patients undergoing dental conscious sedation
Authors: Virdee Parminder , Roelofse James
Published: August 2017

Effective pain control is a basic requirement for patients undergoing dental treatment, particularly under conscious sedation as patients are usually nervous. In order to achieve adequate pain management, clinicians must have an understanding of the physiology of pain, the various pain control modalities and be aware of the evidence base relating to analgesia in dentistry. This article focuses on how to provide effective pain control using analgesic drugs for patients undergoing dental conscious sedation, whilst also considering other available pain control modalities.

Clinical Relevance: Dentists have a duty to provide, and patients have a right to expect, adequate and appropriate pain and anxiety control.
Low level light therapy (LLLT) for the treatment and management of dental and oral diseases
Authors: Milward Michael R , Holder Michelle J , Palin William M , Hadis Mohammed A , Carroll James D , Cooper Paul R
Published: August 2017

Abstract: Low Level Light (Laser) Therapy (LLLT) is the direct application of light to stimulate cell and tissue responses (photobiomodulation) to promote healing, reduce inflammation and induce analgesia. Studies have demonstrated its application and efficacy for the treatment of a range of injuries and diseases at many sites within the body. However, its application in dentistry and for oral disease treatment has been limited. This review aims to provide background information on LLLT which relates to its current application in medicine, its mechanism of action and delivery parameters, while considering its potential for dental and oral therapeutic applications.

Clinical Relevance: Low level light therapy has the potential to have substantial impact for the treatment and management of oral diseases and pain.
Hypodontia: aesthetics and functions part 1: aetiology and the problems
Authors: Lush Nichola , Holliday Richard , Chapple Jonathan , Nohl Francis , Cole Ben
Published: August 2017

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

Clinical Relevance: Hypodontia can cause functional and aesthetical concerns.
Vacuum-formed retainers: an overview
Authors: Meade Maurice J , Millett Declan T
Published: August 2017

The need for long-term retention following orthodontic treatment is now considered essential to prevent post-orthodontic treatment relapse. The vacuum-formed retainer (VFR) has gained popularity in recent times. This paper describes briefly the characteristics of VFRs and summarizes the evidence in relation to their effectiveness.

Clinical Relevance: VFRs are now widely used after orthodontic treatment and it is important that clinicians adopt an evidenced-based approach to their use.
Functional crown lengthening surgery in the aesthetic zone; periodontic and prosthodontic considerations
Authors: Patel Rajiv M , Baker Paul
Published: August 2017

Crown lengthening surgery aims to increase the amount of supragingival tooth tissue by resection of the soft and/or hard tissues to enable otherwise unrestorable teeth to be restored by increasing the retention and resistance forms of the teeth. Restoration of the worn dentition may require significant prosthodontic knowledge and skill. A prosthodontist should be involved from the beginning of the management of the patient. A number of key stages should be considered for correct management. Although the periodontist may guide the prosthodontist with regards to what may or may not be possible surgically, the overall treatment plan should be prosthodontically driven.

Clinical Relevance: Toothwear of the anterior dentition provides a unique challenge to restore not only function but also to manage the aesthetic demands of the patient. To ensure that the correct outcome is reached, clinicians should be familiar with the normal anatomical proportions and relationships to enable planning and treatment to take place.
The role of dental implants in the management of dento-alveolar trauma part 2
Authors: Gamble Eugene , Shahdad Shakeel
Published: August 2017

Patients who suffer dento-alveolar trauma present a unique challenge for the dentist. There are numerous options to consider when attempting to restore the dentition. This article reviews the role of dental implants and how thorough planning and execution of such treatment could result in an optimal outcome.

Clinical Relevance: Knowledge of the role of dental implants and factors imperative for a successful treatment outcome will assist the clinician in achieving optimal restorative results.
Ebola: a very dangerous viral haemorrhagic fever
Authors: Scully Crispian
Published: August 2017

Ebola is a highly dangerous infectious disease seen mainly in West Africa or travellers from there. All healthcare workers should check the recent travel history of their patients and follow formal guidance issued.

Clinical Relevance: This article discusses the relevance of the Ebola virus in dentistry.
Materials for paediatric dentistry part 2: the evidence
Authors: Jenkins Natalie
Published: August 2017

Which materials should be used to restore primary teeth? The second part in this series summarizes the current evidence base relating to this question, and describes the biological approach to caries management.

CPD/Clinical Relevance: Our decisions regarding material choices should be based, where possible, on up-to-date evidence. This will help to ensure that the appropriate material is placed in the appropriate clinical scenario.
Globodontia in the otodental syndrome: a rare defect of tooth morphology occurring with hearing loss in an eight-year-old
Authors: Enright Sinead , Humphrys A Karen , Rea Gillian , James Jacqueline A
Published: August 2017

Otodental syndrome is a hereditary disorder comprising globodontia and sensorineural hearing loss. Globodontia is characterized by distinctively bulbous, enlarged crowns of molar and primary canine teeth. Anomalies including taurodontism and hypodontia also occur. We report on the dental treatment and multidisciplinary management of an eight-year-old girl with this rare condition. Referral to Clinical Genetics and Oral Pathology was instrumental in establishing a diagnosis of otodental syndrome for this young patient and her mother, who had similar dental defects.

CPD/Clinical Relevance: To increase awareness among practitioners of this rare dental disorder and highlight the need for multidisciplinary management of such cases.
The value of cone beam CT in assessing and managing a dilated odontome of a maxillary canine
Authors: Wall Aoibheann , Ng Suk , Djemal Serpil
Published: August 2017

A case of an unusual anomaly in a maxillary canine is described. A deep enamel invagination resulted in pulpal necrosis, longstanding infection and development of an associated radicular cyst. Diagnostic X-ray imaging was invaluable in demonstrating the complex root anatomy of the dilated odontome. In particular, a cone beam CT scan helped in the formulation of an appropriate treatment plan.

Clinical Relevance: Three-dimensional imaging using cone beam CT was valuable in this case to demonstrate the complicated anatomy of a rare dental anomaly, and to help plan treatment.
Why, what and how: caries control for erupting molars
Authors: Rogers Helen J , Morgan Annie G , Batley Haris , Deery Chris
Published: August 2017

This article aims to update the practitioner on the various techniques and interventions available to prevent or control caries during this high-risk period. The evidence to support provision of toothbrushing advice, placement of fissure sealants and fluoride varnish application is considered, along with more novel methods. An evidence-based protocol is suggested to help the practitioner determine when further intervention is required and what action to undertake.

Clinical Relevance: This article aims to reinforce the need for rigorous caries prevention in an erupting permanent molar and provides an update on the evidence behind a range of clinical techniques used for this purpose.
Peri-implant diseases: an overview
Authors: Warreth Abdulhadi , Boggs Shane , Ibieyou Najia , El-Helali Ruaa , Hwang Soohyun
Published: August 2017

The use of dental implants in replacing missing teeth is proven to be a valid treatment with a high success rate. To achieve the best treatment outcome in all implant systems, the implant has to be able to integrate with the surrounding tissue. However, dental implants are affected by peri-implant diseases and may fail as a result. As the number of implants placed continues to increase, the prevalence of peri-implant disease will also increase. This requires preventive measures to inhibit the development of the disease and stop its progression.

Clinical Relevance: Understanding how to maintain healthy peri-implant tissue as well as diagnosis and treatment of disease are vital for every dentist and dental student.
The francis report – why it matters to the dental team
Authors: Bagg Jeremy , Welbury Richard
Published: August 2017

The Francis Report into the deaths at Mid-Staffordshire NHS Trust highlighted the problems facing the NHS when patients, families, clinicians and nurses are not heard, and where the management, leadership and ensuing culture are focused on the system's business, not patient care. This paper, the first in a series based on the implications of the Francis Report, provides the background and context for the subsequent ‘perspective’ articles from a range of relevant stakeholders and care-providers. The overriding message is that in all areas of healthcare, dentistry included, the quality of patient care, especially patient safety, must be placed above all other aims.

Clinical Relevance: The overriding importance of patient-centredness and quality of care, above all other aims, is the key message of clinical relevance from the Francis Report.
Assessment and management of halitosis
Authors: Singh Vijendra P , Malhotra Neeraj , Apratim Abhishek , Verma Madhu
Published: August 2017

Halitosis is an unpleasant condition that may be the origin of concern not only for a possible health condition but also for frequent psychological alterations which may lead to social and personal isolation. The most frequent sources of halitosis that exist in the oral cavity include bacterial reservoirs such as the dorsum of the tongue, saliva and periodontal pockets. Volatile sulphur compounds (VSCs) are the prominent elements of oral malodour. Genuine halitosis and pseudo-halitosis should be in the treatment realm of dental practitioners.

Clinical Relevance: Halitosis can be a symptom of underlying systemic disease, therefore the exact diagnosis and its source (oral or non-oral) is important in the proper approach to its management.
Pain part 3: acute orofacial pain
Authors: Khawaja Nadine , Renton Tara
Published: August 2017

Acute trigeminal pain is a common presentation in the dental surgery, with a reported 22% of the US adult population experiencing orofacial pain more than once during a 6-month period. 1 This article discusses the mechanisms underlying the pain experience, diagnosis and subsequent management of acute trigeminal pain, encompassing pre-, peri- and post-operative analgesia. The dental team spend most of their working lives managing patients and acute pain. The patient may present to the clinician in existing pain, which may often provide a diagnostic challenge. Prevention and managing intra-operative and post-surgical pain are implicit in providing your patient with optimum care.

CPD/Clinical Relevance: This paper aims to provide an overview of conditions that may present with acute orofacial pain and their management using the most recent evidence base. Intra-operative and post-surgical pain management are also scrutinized and evidence-based treatment is recommended.
Dementia and dentistry
Authors: Edwards Julie A , Ford Liz , Boyle Carole
Published: August 2017

Dementia is increasing in prevalence: by 2025 it is estimated that there will be over a million people in the UK with this diagnosis. The condition is likely to affect us all as healthcare providers, whether in our patients, our relatives or ourselves. This article gives an overview of dementia: causes, treatment, how it affects people and provides advice on how to manage patients with dementia who require dental care.

CPD/Clinical Relevance: By identifying the patient with dementia and being aware of the challenges in providing care the clinician can provide better treatment and reduce the chance of dental problems as the condition progresses.
Current applications and future prospects of stem cells in dentistry
Authors: Surendran Sharmila , Sivamurthy Gautham
Published: August 2017

Stem cells are defined as clonogenic, unspecialized cells capable of both self-renewal and multi-lineage differentiation, contributing to regenerating specific tissues. For years, restorative treatments have exploited the lifelong regenerative potential of dental pulp stem cells to give rise to tertiary dentine, which is therapeutically employed for direct and indirect pulp capping. Current applications of stem cells in endodontic research have revealed their potential to continue root development in necrotic immature teeth and transplanted/replanted teeth. Successful application of pulp revascularization is highlighted here with support of a clinical case report. This article also discusses the role of dental stem cells as a promising tool for regeneration of individual tissue types like dentine, pulp and even an entire functional tooth.

CPD/Clinical Relevance: This article will help practising dental surgeons understand the significance of stem cells in dentistry. Clinicians can harness the potential of stem cells using procedures like pulp regeneration/revascularization in endodontics and improve their knowledge on the recent advances in tissue engineering and future applications of dental-derived stem cells.
Management of recurrent aphthous stomatitis in children
Authors: Montgomery-Cranny Jodie A , Wallace Ann , Rogers Helen J , Hughes Sophie C , Hegarty Anne M , Zaitoun Halla
Published: August 2017

Recurrent oral ulceration is common and may present in childhood. Causes of recurrent oral ulceration are numerous and there may be an association with underlying systemic disease. Recurrent aphthous stomatitis (RAS) is the most common underlying diagnosis in children. The discomfort of oral ulcers can impact negatively on quality of life of a child, interfering with eating, speaking and may result in missed school days. The role of the general dental practitioner is to identify patients who can be treated with simple measures in primary dental care and those who require assessment and treatment in secondary care. Management may include topical agents for symptomatic relief, topical corticosteroids and, in severe recalcitrant cases, systemic agents may be necessary.

CPD/Clinical Relevance: Children and young people frequently suffer from recurrent oral ulceration; with recurrent aphthous stomatitis being the most common diagnosis.
An unusual allergic response to orthodontic treatment
Authors: Shargill Inderjit , Asher-McDade Catherine
Published: August 2017

This paper describes a case of a 13-year-old patient with a systemic hypersensitivity reaction to orthodontic treatment. Her allergy was investigated resulting in a provisional diagnosis of pressure urticaria. The aetiology, diagnosis and clinical management of allergic reactions to dental procedures are discussed.

CPD/Clinical Relevance: A significant underlying medical condition may be revealed by dental procedures. Appropriate liaison with medical professionals is essential so that appropriate diagnostic measures may be taken and treatment instigated. This paper shows the importance of patient safety both with regard to the taking of accurate medical and dental histories and the management of untoward reactions to dental procedures.
Class ii resin composites: restorative options
Authors: Patel Minesh , Mehta Shamir B , Banerji Subir
Published: August 2017

Tooth-coloured, resin composite restorations are amongst the most frequently prescribed forms of dental restoration to manage defects in posterior teeth. The attainment of a desirable outcome when placing posterior resin composite restorations requires the clinician to have a good understanding of the benefits (as well as the limitations) posed by this material, together with a sound knowledge of placement technique. Numerous protocols and materials have evolved to assist the dental operator with this type of demanding posterior restoration. With the use of case examples, four techniques available are reported here.

CPD/Clinical Relevance: This article explores varying techniques for the restoration of Class II cavities using resin composite.
Mouth cancer for clinicians part 5: risk factors (other)
Authors: Kalavrezos Nicholas , Scully Crispian
Published: August 2017

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

Clinical Relevance: This article offers the dental team an overview of other cancer risk factors agents, such as human papilloma viruses (HPV) and irradiation.
Infected dentine revisited
Authors: Kidd Edwina , Fejerskov Ole , Nyvad Bente
Published: August 2017

Dentine becomes infected as a result of caries lesion formation on root surfaces and when lesions progress following cavitation of enamel lesions. However, this infection is unimportant because the driving force for lesion formation and progression is the overlying biofilm. This explains why root surface caries can be controlled by mechanical plaque control and fluoride, and restorations are not needed to arrest these lesions. Similarly, the infected dentine in cavitated coronal lesions does not have to be removed to arrest the lesion. If the lesion is either accessible or opened for cleaning by the patient or parent, the lesion can be arrested. Sealing of infected dentine within the tooth, either by a Hall crown in the primary dentition or by partial caries removal prior to placing a well-sealed filling, will also arrest the lesion. When restoring deep lesions in symptomless, vital teeth, vigorous excavation of infected dentine is likely to expose the pulp and make root canal treatment necessary. Thus ‘complete excavation’ is not needed and should be avoided.

CPD/Clinical Relevance: Root surface caries can be arrested by cleaning and fluoride application. Restorations are not essential. Vigorous excavation of softened dentine in deep cavities of symptomless, vital teeth is contra-indicated. It is not needed and increases the risk of pulp exposure.
Coronectomy; good or bad?
Authors: Sarwar Humera , Mahmood-Rao Sameer
Published: August 2017

The removal of mandibular third molars can be complicated by injury to the inferior alveolar nerve (IAN). Coronectomy retains the tooth root; this method has been found to be preferable to extraction in the context of mandibular third molars. A failed coronectomy may cause mobilization of these roots, thereby requiring a subsequent extraction. Having undergone a previous coronectomy, extraction is then safer as the roots usually migrate away from the IAN. Computed tomography is more accurate than radiography when imaging mandibular third molars pre-operatively owing to its three-dimensional nature. Longer studies need to be conducted to evaluate the long term benefits of coronectomy.

CPD/Clinical Relevance: The removal of mandibular third molars can be complicated by the presence of the close lying inferior alveolar nerve. Coronectomy can be useful in this setting and therefore it is important to be aware of the pros and cons of this technique.
Modern endodontic principles part 4: irrigation
Authors: Darcey James , Jawad Sarra , Taylor Carly , Roudsari Reza Vahid , Hunter Mark
Published: August 2017

The complex anatomy of the tooth limits the ability to eradicate pathogens by mechanical means alone. Irrigation is the key to solving this problem. This paper highlights the importance of irrigation, the key irrigants available and methods of improving the performance of irrigants within the canal.

CPD/Clinical Relevance: To provide advice on which irrigants to use, how to use them effectively and safely and what to do if irrigants are extruded beyond the apex.
Nutrition and periodontal disease
Authors: Raindi Devan
Published: August 2017

The identification of inflammatory periodontal disease and education in local and systemic risk factors and their management forms the foundation of the treatment of this disease. Nutrition is potentially a modifiable risk factor that could drive or abrogate the underlying oxidative stress in periodontitis. As research in this area is still in its infancy, clinical guidance on the delivery of dietary advice for susceptible patients is scarce. This paper will explain the possible mechanisms linking nutrition and periodontal disease, as well as the guidelines currently available to the dental profession.

CPD/Clinical Relevance: With a growing evidence base, an appreciation of the links between nutrition and inflammatory periodontal disease can help guide clinicians in educating patients on this potentially important modifiable risk factor.
Extra-oral appliances in orthodontic treatment
Authors: Almuzian Mohammed , Alharbi Fahad , McIntyre Grant
Published: August 2017

Extra-oral appliances are used in orthodontics to apply forces to the jaws, dentition or both and the popularity of these appliances is cyclical. Although the use of retraction headgear for the management of Class II malocclusion has declined over the last 20 years with the refinement of non-compliance approaches, including temporary anchorage devices, headgear still has a useful role in orthodontics. The use of protraction headgear has increased as more evidence of its effectiveness for the treatment of Class III malocclusion has become available. This paper describes the mechanics and contemporary uses of headgear in orthodontics for primary care dentists and specialist orthodontists.

CPD/Clinical Relevance: Extra-oral appliances have specific uses in orthodontic biomechanics. Clinicians using retraction headgear and protraction headgear should be familiar with their clinical indications, the potential problems and how these can be avoided.
The dental update readers' panel
Authors: Burke FJ Trevor
Published: August 2017

Readers will be aware of the names of the Editorial Board of Dental Update, given that these appear in each issue, with the Board being responsible, along with myself, for the quality of the publication. Their other role is to suggest articles to be commissioned for future issues and authors who might write them. Given that the majority of published articles are written by dental academics (despite encouragement from me aimed at involving general dentists in the writing process), it is therefore not a surprise to note that the majority of the Editorial Board are academics.

The Readers' Panel was formed by me in 1998, with a view to seeking the views of a representative sample of the varied readership on the appropriateness of the content of Dental Update to their needs and to suggest topics which they feel should be covered. Readers may therefore be interested to read the varied backgrounds of the members of the Readers' Panel, as this has changed over the years, but with this short piece hopefully demonstrating that the Panel represents the workplace within dentistry of the majority of readers. The most recent addition is a student member, given the popularity of Dental Update among dental students.
Provisional restorations – a permanent problem?
Authors: Keys William F , Keirby Naomi , Ricketts David
Published: August 2017

Provisional restorations play an important role when providing indirect restorations. There are a number of materials and techniques available for their construction. Careful planning and construction can protect the prepared tooth surface, improve the periodontal condition and help plan for the definitive restoration. A good provisional restoration can save time, money and effort.

CPD/Clinical Relevance: Provisional restoration construction is an integral part of the indirect restorative process for inlays, onlays, crowns and bridges.
The restorability assessment and endodontic access cavity interface
Authors: Quilligan Graham , McKenna Gerald , Allen P Finbarr
Published: August 2017

Successful root canal treatment requires management of the bacterial infection within the root canal space and protection of residual tooth structure with direct/indirect restorations. Long-term success depends upon prevention of re-infection of the root canal space as well as ensuring favourable distribution of the occlusal forces throughout the residual tooth structure. Appropriate planning and design of the final restoration prior to initiating root canal treatment is paramount in achieving this objective. This article describes simultaneous restorability assessment and access cavity preparation to optimize outcome of both endodontic and prosthodontic treatment of the endodontically involved tooth.

CPD/Clinical Relevance: This paper proposes a method to improve visibility and reduce iatrogenic errors whilst simultaneously facilitating effective design of the definitive restoration based on the quantity and distribution of residual tooth structure.
Aetiological, histopathological, clinical, diagnostic and therapeutical features of idiopathic cervical resorption
Authors: Gijón Virginia Robles , Martín Cristina Lucena , Encinas Rosa M Pulgar , Navajas José Manuel
Published: August 2017

Root resorption is the loss of hard dental tissue as a result of odontoclastic action involving vital and pulpless teeth. Cervical root resorption (CRR) is a type of external resorption which usually occurs immediately below the epithelial attachment of the tooth in the cervical region. The idiopathic cervical resorption (ICR) refers to a clinical situation in which all other causes, whether local or systemic, have been ruled out as the origin of the disease. The early stage is asymptomatic and might be diagnosed by a routine radiograph or a clinical examination. In this study, the aetiological, histological, clinical and radiological analysis is undertaken; a review is made concerning the pathologies to which the differential diagnosis should be applied; and the different therapeutical options are discussed. This lesion sometimes demands the management of a broad field of multidisciplinary techniques such as restorative dentistry, endodontics, surgery, implants and prosthesis.

CPD/Clinical Relevance: Cone-beam computed tomography (CBCT) may be a useful tool to determine the true extent of external cervical resorption lesions.
A pathological fracture of the mandible due to osteomyelitis following a full dental clearance
Authors: Jauhar Preeti , Handley Thomas , Hammersley Nicholas
Published: August 2017

Orofacial infections following dental extractions are a common referral to an oral and maxillofacial department as an emergency, especially when combined with swelling and limited mouth opening. The case presented demonstrates a rare complication of chronic suppurative osteomyelitis with bilateral pathological fractures of the mandible, which occurred following a staged dental clearance.

CPD/Clinical Relevance: Dental extractions are one of the most common treatments carried out by oral surgeons and general dental practitioners. This case highlights a rare but encountered complication of routine oral surgery and demonstrates when it is necessary to make an immediate referral to the local oral and maxillofacial surgery unit.
Mouth cancer for clinicians part 8: referral
Authors: Kalavrezos Nicholas , Scully Crispian
Published: August 2017

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

Clinical Relevance: This article offers the dental team an overview of referral procedures; oral diagnosis is not always simple and a second opinion can be valuable to all concerned in cases of doubt.
Relevance of bisphosphonate therapy in osteoporosis and cancer – no cause for alarm in dentistry
Authors: Moore Amelia Elizabeth , Renton Tara , Taylor Talli , Popat Shina , Jasani Mukundrai Kris
Published: August 2017

This report provides important background information on osteoporosis (OP) and bone complications of cancer for the dental team, and discusses why bisphosphonate (BP) therapy is vital for patients with the two conditions. It also addresses several questions, including in particular: ‘Is withholding BP therapy the best way to prevent osteonecrosis of the jaw (ONJ) occurrence?’ Also, ‘Of the two, which is more important: ONJ or OP fracture prevention?’

CPD/Clinical Relevance: BP therapy offers OP patients the promise of a fracture-free life and the prevention of fracture-related pain, disability, loss of qualify of life (QOL) and the shortening of life. Without BP therapy, the lifetime risk of fracture occurrence in OP patients is as high as 1 in 2 women and 1 in 5 men; whilst using it, the relative risk of ONJ occurrence is as low as between 1 in 10, 000 and 1 in 100, 000. To cancer patients with bone complications, it offers the much needed pain relief and improvement in QOL. In cancer patients, the risk of ONJ is almost 100 times higher but, despite that, oncologists advocate BP therapy for virtually all the patients. Therefore, when prescribed, BP therapy merits the whole-hearted support of the dental team.
How neurolinguistic psychotherapy (NLPt) could help to improve psychological wellbeing within the dental profession
Authors: Taylor Joanna
Published: August 2017

This article is an exploration of some of the causes of stress within the dental profession and a discussion on how some of the models and philosophies of NLPt could help improve the levels of psychological wellbeing within the profession. Some of the fundamental concepts of NLPt are explored, with particular reference to their application in regard to stress. It is concluded that NLPt could provide a robust methodology for reducing psychological distress within the profession, by helping dentists to understand the concept of unuseful constructs, to improve behavioural choice and to discover the possibility of a more resourceful way of being.

CPD/Clinical Relevance: Dentists under stress do not perform well; judgement is impaired, motivation is reduced and poor decisions can be made which impact directly on patient care.
Pain part 9: trigeminal autonomic cephalalgias
Authors: Abu Bakar Norazah , Matharu Manjit , Renton Tara
Published: August 2017

The trigeminal autonomic cephalalgias are a group of rare, highly disabling, primary headache syndromes distinctly characterized by the unilaterality of their attacks and presence of cranial autonomic symptoms. Although pain is often localized to the peri-orbital and temporal regions, it is not uncommon for pain to radiate to tooth-bearing areas and mimic toothache or jaw pain. Hence, dental practitioners should be aware of these syndromes to enable appropriate referral and avoid unnecessary, and often irreversible, dental treatments. Many dentists will not have heard of these conditions but must remain vigilant, and ensure that they are not confused with trigeminal neuralgia, so that their patients are appropriately advised and referred.

CPD/Clinical Relevance: The dental practitioners may be the first line of healthcare providers consulted by these patients in the hope of obtaining pain relief. Lack of familiarity with an uncommon condition may lead to poor patient management.
The prosthetic management of an infra-occluded first permanent molar: case report
Authors: Sehra Beshandeep , Johnson Joanna
Published: August 2017

This report describes the prosthetic management of a 15-year-old patient with an infra-occluded first permanent molar due to primary failure of eruption (secondary retention). An indirect composite onlay restoration was used to stimulate the periodontal fibres, improve function and restore occlusal stability. This paper describes the clinical technique involved.

CPD/Clinical Relevance: Early detection, diagnosis and management of infra-occluded permanent molar teeth is important to avoid occlusal complications, in addition to improving function and stimulating the periodontal fibres.
Non-pulmonary tuberculosis – a case report: importance and pitfalls of diagnosis
Authors: Pepper Hannah , Davies Rebecca , Hughes Ceri , Thomas Steve , Pring Miranda , Hetzel Martin
Published: August 2017

A case of tuberculosis presenting as a neck lump is highlighted. Tuberculosis is on the increase. There are national and international strategies to improve the management of tuberculosis in the United Kingdom, and raising clinical awareness of tuberculosis is an important part of that strategy. Neck lumps can present in the dental setting and the differential diagnosis should include tuberculosis, with referral to an appropriate multidisciplinary team. Special tests to aid diagnosis are helpful but not completely discriminating. Tuberculosis is a notifiable disease and it must be treated by a designated specialist medical team.

CPD/Clinical Relevance: Tuberculosis is a differential diagnosis for a persistent neck lump and clinicians should understand the problems of diagnosis and the importance of appropriate referral for treatment in the national and international strategy to reduce this disease.
Managing the unstable mandibular complete denture – tooth placement and the polished surface
Authors: Clarke Peter , Leven A Johanna , Youngson Callum C
Published: August 2017

Constructing satisfactory conventional mandibular complete dentures is often challenging in comparison to the upper counterpart partially due to differences in the anatomy of the denture-bearing area. This problem is exaggerated in the atrophic mandible, where supporting structures are frequently ill-defined and suboptimal in quality. Implant-retained prostheses offer well recognized benefits but are not always a feasible options, so conventional methods must be relied upon. The importance of impression quality and registration has been reviewed previously. This article aims to discuss the influence of tooth placement, the polished surfaces and the neutral zone on the success of lower dentures.

CPD/Clinical Relevance: This article highlights the importance that polished surface contouring and tooth prescription can have on the outcome of lower dentures. Techniques for assessing and recording the neutral zone are explained, along with alternative occlusal schemes.