bluuebunny/crossref_metadata_2025 huggingface dataset:
A contemporary update on ‘soft’ linings
Authors: McCord J Fraser , Donaldson Alan C , Lamont Thomas James
Published: August 2017

This article presents a contemporary overview of soft or compliant denture lining materials. It does not focus on denture bases, which are intrinsically flexible, and suggests some clinical options which readers might wish to consider.

Clinical Relevance: The aim of this article is to update clinicians on the types of compliant linings currently available and to advise on how some might be used.
Routine and emergency management guidelines for the dental patient with renal disease and kidney transplant part 1
Authors: Saif Imran , Adkins Angela , Kewley Victoria , Woywodt Alexander , Brookes Vanita
Published: August 2017

The number of kidney patients is increasing in all developed countries, mainly due to the increase in patients with type II diabetes. These patients may be asked by their renal physician to attend their general dental practitioner for an oral review prior to undergoing further renal treatment.

Dental surgeons working in the primary care setting will be required to manage patients who are at various stages of renal support, whether pre-dialysis patients with chronic kidney disease (CKD), dialysis patients, and also those who have had a kidney or kidney and pancreas transplant. In addition, dental practitioners may be faced with having to deal with the emergency management of such patients attending their practices in acute pain.

Clinical Relevance: This paper aims to provide the general dental practitioner with the necessary knowledge to manage renal patients, and outlines the guidance regarding the criteria for referral, work up procedure and dental management of such patients.
Chronic periapical periodontitis containing mature human hair shaft: a case report
Authors: Sharif Mohammad Owaise , Yar Riaz , Oliver Richard
Published: August 2017

A case is reported of a 44-year-old male who was referred with persistent pus discharge associated with his UL2 which had been root treated on two occasions. Radiographic examination revealed a radiolucency of approximately 8 mm diameter. An apicectomy was performed and histopathological examination revealed the presence of mature birefringent hair-shaft structures within a chronic periapical periodontitis.

Clinical Relevance: This article presents a rare occurrence, the presence of human hair in the periapical tissues.
The ‘secret’ of success part 2
Authors: Busby Mike
Published: August 2017

Practice success is defined across the four ‘dimensions’ of oral health, patient satisfaction, job satisfaction and financial profit. It is suggested that the ‘secret’ of success in dental practice is to make patient (customer) satisfaction the primary focus. Not a very earth shattering or surprising ‘secret’ perhaps! This is hardly a new idea, and not a concept restricted to dental practice. This principle applies to all businesses. This series of articles reviews evidence from across a broad spectrum of publications: from populist business publications through to refereed scientific papers, this ‘secret’ seems to be confirmed. The evidence for which aspects of our service are most important in achieving patient satisfaction (and therefore success) is explored.

Clinical Relevance: Good oral health outcomes for patients are defined as the primary purpose of dental practice and, therefore, an essential dimension of success. The link between positive patient perceptions of general care and their own oral health to practice success is explored.
Bonded amalgams and their use in clinical practice
Authors: Bonsor Stephen J
Published: August 2017

There has been a move in recent years for operative dentists to use the benefits of adhesive technology when placing dental amalgam restorations. This paper describes the potential advantages of the bonded amalgam technique. These benefits include decreased microleakage between the cavity wall and the restorative material. This, in turn, may decrease post-operative sensitivity, pulpal inflammation and the incidence of recurrent caries. Extra retention for the restoration may also be provided and the need for cavities to rely on traditional retention and resistance form may be decreased or even eliminated, thus conserving precious tooth tissue. If the restoration is bonded then flexure during function in teeth may be decreased and, in the case of teeth exhibiting a cracked cusp, this may alleviate or eliminate symptoms. Bonding may also provide support to weakened tooth tissue which otherwise would have to be removed, so rendering cavities more conservative, and may increase the fracture resistance of the tooth. Clinical examples are included to illustrate some of these benefits.

Clinical Relevance: The use of adhesives to bond amalgam to tooth tissue offers potential advantages, although some of the current evidence is equivocal about their routine use.
The ‘secret’ of success part 3
Authors: Busby Mike
Published: August 2017

Practice success is defined across the four ‘dimensions’ of oral health, patient satisfaction, job satisfaction and financial profit. It is suggested that the ‘secret’ of success in dental practice is to make patient (customer) satisfaction the primary focus. Not a very earth shattering or surprising ‘secret’ perhaps! This is hardly a new idea, and not a concept restricted to dental practice. This principle applies to all businesses. This series of articles reviews evidence from across a broad spectrum of publications: from populist business publications through to refereed scientific papers, this ‘secret’ seems to be confirmed. The evidence for which aspects of our service are most important in achieving patient satisfaction (and therefore success) is explored.

Clinical Relevance: Good oral health outcomes for patients are defined as the primary purpose of dental practice and, therefore, an essential dimension of success. The link between positive patient perceptions of general care and his/her own oral health to practice success is explored.
The ‘secret’ of success part 4
Authors: Busby Mike
Published: August 2017

Practice success is defined across the four ‘dimensions’ of oral health, patient satisfaction, job satisfaction and financial profit. It is suggested that the ‘secret’ of success in dental practice is to make patient (customer) satisfaction the primary focus. Not a very earth shattering or surprising ‘secret’ perhaps! This is hardly a new idea, and not a concept restricted to dental practice. This principle applies to all businesses. This series of articles reviews evidence from across a broad spectrum of publications: from populist business publications through to refereed scientific papers, this ‘secret’ seems to be confirmed. The evidence for which aspects of our service are most important in achieving patient satisfaction (and therefore success) is explored.

Clinical Relevance: Good oral health outcomes for patients are defined as the primary purpose of dental practice and, therefore, an essential dimension of success. The link between positive patient perceptions of general care and their own oral health to practice success is explored.
Aesthetic smile evaluation - a non-invasive solution
Authors: Kovacs Boglarka O , Mehta Shamir B , Banerji Subir , Millar Brian J
Published: August 2017

Enhancement of the aesthetic zone is a common reason for patients to seek dental care. This article describes a protocol for the examination, assessment and treatment planning for a patient seeking a solution to an aesthetic concern. The technique of undertaking an intra-oral ‘mock-up’ using resin composite as a diagnostic approach can be particularly helpful when planning for future prosthodontic rehabilitation. The latter can allow the operator and patient to visualize crudely what is aesthetically and functionally possible, given the constraints imposed by that patient. The patient has ultimately managed in a minimally invasive manner.

Clinical Relevance: It can be very tempting for a dental operator to impose his/her concepts of the ‘artistic ideal’ when planning for care in the smile zone. Such ideals are largely based on established universal aesthetic principles of tooth colour, size, shape, form, position, symmetry and proportion. However, beauty is a very subjective matter. It is essential for the operator to listen attentively to his/her patient's concerns. Meticulous patient examination and assessment are absolutely critical factors in attempting to attain a successful outcome. The use of reversible, chairside intra-oral mock-up techniques can not only help with the transference of essential information to the dental technician when planning for restorative intervention in the smile zone, but can also allow the patient to gain an insight and indeed contribute his/her views to the possible restorative endpoint, respectively.
‘Simultaneous technique’ and a hybrid microseal/pacmac obturation
Authors: Malagnino Vito Antonio , Rossi-Fedele Giampiero , Passariello Paola , Canullo Luigi
Published: August 2017

In these endodontic case reports we present a root canal preparation protocol using the Mtwo Ni-Ti rotary files according to the ‘simultaneous technique’ which is a ‘crown-down’ approach, where every instrument in the sequence is used to the full working length.

A hybrid Microseal/PacMac obturation (consisting of three stages: master cone compaction, backfill with pre-plasticized gutta-percha and vertical compaction) is proposed in order to: maintain the obturation length control associated with the Microseal system; use preheated gutta-percha to backfill the canal rapidly with the PacMac condensor; and to reduce potential voids in the obturation material with the final vertical compaction.

Clinical Relevance: The ‘simultaneous technique’ followed by apical preparation using Mtwo apical files allows obturation using the proposed hybrid Microseal/Pacmac method, aiming to overcome some of the shortcomings of the Microseal and Pacmac obturation methods, such as length control difficulty and sealer pooling.
Aesthetic resin onlay restorations: ‘rationale and methods’
Authors: Panchal Neel , Mehta Shamir B , Banerji Subir , Millar Brian J
Published: August 2017

Resin composite restorations have gained increasing popularity over the past two decades. This has been largely driven by a patient-orientated demand for the use of aesthetic restorative materials. It has occurred concomitantly with an improvement in the mechanical properties of available materials, and advances in our knowledge of resin bonding. Onlay restorations are advocated for a plethora of clinical applications. This paper considers the role of adhesive onlay restorations fabricated in resin composite in contemporary restorative practice, including the presentation of two case reports.

Clinical Relevance: This case report describes a minimally invasive, aesthetic solution to provide cuspal coverage by means of either a direct or indirect resin composite onlay restoration, respectively.
An in vitro investigation of the initial ph and titratable acidity of a selection of fruit smoothies
Authors: Blacker Suzanne M , Creanor Stephen L , Creanor Siobhan
Published: August 2017

Four commercially-available fruit smoothie drinks were assessed for both initial/baseline pH and titratable acidity. A commercially-available smooth orange juice drink was used as a positive control. Baseline pH and titratable acidity were measured by titrating each fruit smoothie with 0.5 mL increments of 1M sodium hydroxide (NaOH), and measuring the pH following the addition of each increment, until pH 7 and pH 10 were reached. Each of the fruit smoothies investigated demonstrated a low baseline pH and had relatively high titratable acidity. Owing to both their low pH and high titratable acidity, it would be advisable to limit the consumption of such fruit smoothies to meal times.

Clinical Relevance: Fruit smoothies, which are made from pure fruit blended with 100% fruit juice, are a relatively new addition to the soft drinks market. It is recommended that they be consumed through a straw, similar to the advice given for other acidic soft drinks.
Infective endocarditis: the impact of the nice guidelines for antibiotic prophylaxis
Authors: Thornhill Martin H
Published: August 2017

Infective endocarditis (IE) is a serious, life-threatening disease and oral bacteria are implicated in 35-45% of cases. This has led to the development of guidelines recommending the use of antibiotic prophylaxis (AP) prior to invasive dental procedures in patients at risk of IE. There is considerable controversy about the value of AP in preventing IE, resulting in guideline changes and different guidelines in different parts of the world. In March 2008, NICE recommended the complete cessation of AP prior to dental procedures in the UK. The effects of this controversial change were not entirely as anticipated and may provide important lessons about the role of AP in preventing IE.

Clinical Relevance: The debate over the value of providing antibiotic prophylaxis to prevent infective endocarditis in patients undergoing invasive dental procedures is of importance to dentists worldwide. The effect of the NICE guidelines on antibiotic prophylaxis prescribing and incidence of infective endocarditis in the UK has contributed important new evidence to this ongoing debate.
Oral and dental management for head and neck cancer patients treated by chemotherapy and radiotherapy
Authors: McCaul Lorna K
Published: August 2017

The incidence of head and neck cancer is rising. The attendant oral complications of cancer management make oral health maintenance a lifelong challenge for these patients. Holistic management in the context of a core multidisciplinary team is essential in optimizing outcomes. Predicting the risk of adverse oral outcomes is difficult. Effective communication between healthcare professionals in the core and extended teams and with the patient is essential.

Clinical Relevance: Primary care dental teams will be involved in the long-term management of oral care for head and cancer patients. A broad understanding of the management of head and neck cancer, consequences of treatment and the need for good communication is key to good quality patient care.
Tooth surface loss: tools and tips for management
Authors: Satterthwaite Julian D
Published: August 2017

Tooth surface loss is becoming increasingly prevalent. Many cases can be managed with preventive measures, although there remain a number of patients for whom restorative intervention is indicated. Traditional treatment modalities have entailed extensive ‘full-mouth’ indirect restoration, although this approach has a number of disadvantages. Contemporary restorative techniques allow for a broader range of treatment options: this paper presents an overview of common issues and clinical techniques to overcome these.

Clinical Relevance: Treatment options and guidance for managing patients who present with tooth surface loss.
Endodontic ‘solutions’ part 1: a literature review on the use of endodontic lubricants, irrigants and medicaments
Authors: Good M-L , Karim IA El , Hussey DL
Published: August 2017

Endodontic lubricants, irrigants and medicaments help prepare and disinfect root canal systems (RCS) but primary and secondary cases involve different microbes and therefore it is unlikely that one protocol will be effective for both case types. Each individual ‘solution’ or sequence of ‘solutions’ could play a significant role in each case type, but there are no detailed published guidelines in existence. To help inform clinical practice it was decided to undertake a literature review followed by a UK and Republic of Ireland wide audit on current endodontic ‘solution’ usage within dental schools. The literature review was undertaken under the following headings: pre-op oral rinse; file lubricants; root canal irrigants and intracanal medicaments and provides an evidence base for protocol development for both primary and retreatment cases. The audit project and the protocols developed from the findings of both the literature review and audit will be presented in Part 2.

Clinical Relevance: As our clinical practice should reflect evidence-based dentistry, it is important to be aware of the current literature on endodontic lubricant, irrigant and medicament use.
Interdisciplinary management in the paediatric patient: restoration of a complicated crown-root fracture
Authors: Hand Darren , Burbridge Lucy , Cole Ben OI
Published: August 2017

Complicated crown-root fractures in permanent teeth present both patient-centred and restorative problems when treating the adolescent. This case highlights an alternative and conservative technique for the management of a traumatically involved maxillary left central incisor in a 12-year-old boy. The injury was successfully managed through an interdisciplinary approach using a combination of endodontics, minor oral surgery and orthodontics. The approach resulted in utilizing the patient's own tooth fragment to facilitate restoration back into successful function and aesthetics with the absence of any pathological changes.

Clinical Relevance: Severely compromised teeth can be successfully managed by a combination of modern adhesive, endodontic and orthodontic treatment in the co-operative paediatric patient.
Dental olympians, 2012
Authors: Burke FJ Trevor
Published: August 2017

Olympian – person of great attainment 1
Ionizing radiation regulations and the dental practitioner: 3. quality assurance in dental radiography
Authors: Rout John , Brown Jackie
Published: August 2017

This is the last in a series of three articles on X-ray dose reduction and covers aspects of quality assurance. The first outlined radiation physics and protection and the second the legislation relating to radiation safety.

Clinical Relevance: Quality assurance is an essential part of dental radiography and is required to produce images of a consistently high standard, necessary for accurate diagnosis.
Dental local anaesthetics and latex: advice for the dental practitioner
Authors: McEntee Joanne
Published: August 2017

Natural rubber latex (NRL) is present in many medical products, including disposable gloves, adhesive tape and bungs in medicine vials. People sensitized to NRL are at risk of developing allergic reactions, which can present with delayed symptoms such as a localized red itchy rash, or with immediate symptoms such as itching of the skin and eyes, sneezing, bronchospasm or anaphylactic shock. People sensitized to NRL should avoid contact with all products that contain it, either in the product itself, in the packaging or introduced during the manufacturing process or storage. This paper highlights the implications of latex allergy in patients for dental healthcare staff, and provides a list of local anaesthetic preparations used in dentistry in the UK which are latex free.

Clinical Relevance: All dental staff need to be aware of latex allergy and know where to find information on latex content of dental local anaesthetics.
Layering composites for ultimate aesthetics in direct restorations
Authors: Beddis Hannah P , Nixon Peter J
Published: August 2017

A number of modern materials are available which allow placement of highly aesthetic anterior restorations. However, some systems are complex and technique sensitive. The authors describe a layering technique for the provision of direct aesthetic anterior composite restorations suitable for a general practice setting.

Clinical Relevance: Aesthetic restorations can be provided directly and in a conservative manner using composite resin, often avoiding the need for more destructive indirect techniques.
Management of patients with dental disease and mitochondrial disorders
Authors: Shakir Adam A , Turnbull Doug M , Adams James R
Published: August 2017

This case report describes dental disease associated with mitochondrial disease (Leigh's disease) in a young adult. Normal preventive dentistry is difficult in these groups of patients and often leads to management required in secondary care. An awareness of the background pathology is needed when managing these groups of patients. Management of dental pathology in this particular patient often required input from other specialties to ensure a successful outcome.

Clinical Relevance: To raise awareness of the dental pathologies patients with mitochondrial disease may experience as they present to the general dental practitioner, and what treatments may be appropriate.
‘hubble-bubble leads to trouble’ – waterpipe smoking and oral health
Authors: Shah Savan B , Chestnutt Ivor G , Lewis Michael AO
Published: August 2017

Waterpipes are used to smoke tobacco by more than 100 million people worldwide. Use is not restricted to any single racial, ethnic, or cultural group, and dentists are almost certain to encounter waterpipe users amongst their patients. This article describes what the practice involves and seeks to inform members of the dental team of the significantly detrimental impacts of waterpipe smoking on both general and oral health and how ‘hubble-bubble really can lead to trouble’. Advising patients on ceasing waterpipe use is also discussed.

Clinical Relevance: This paper explains what smoking a waterpipe involves, the associated misconceptions of safety amongst users and the dangers to health.
Special care dentistry: part 3. dental management of patients with medical conditions causing acquired bleeding disorders
Authors: Nizarali Najla , Rafique Sobia
Published: August 2017

The second paper in this three part series discussed the dental management of patients with drug-related acquired bleeding disorders. This paper will discuss and outline the dental management of patients with acquired bleeding disorders that can result from medical conditions. Again, these may be associated with vascular defects, platelet defects or coagulation defects. In an age when people are living longer, and medical interventions are continually becoming more advanced, clinicians will need to be aware of systemic disorders and treatments that may cause complications in the dental setting.

Clinical Relevance: Being able to recognize which medical conditions, including their management, may cause bleeding problems at an early stage will lead to good patient management, particularly in planning and delivering treatment involving any invasive dental procedures that can cause bleeding. Whilst most patients can be successfully treated in general dental practice, the clinician may need to make a decision on whether or not to refer a patient to specialist services for all dental treatment, or to share care between primary care and specialist services.
Long and short term management of implant-supported mandibular overdentures
Authors: Parmar Sabrina , Karir Naveen , Walmsley Damien , Patel Upen
Published: August 2017

Common problems with the long term clinical use of implant-supported mandibular overdentures (ISMDs) include fractures of dentures, bars and clips, and reactivation of clips. Many general dental practitioners (GDPs) are reticent to be involved in the maintenance of ISMDs, especially if they have not had any further training or are unfamiliar with implant components and systems. This article highlights the need for the training of GDPs in maintenance and management of ISMDs as an increasing number of edentulous patients are being provided with ISMDs, resulting in an increasing need for the maintenance of the prosthesis in the primary care setting at a possible cost to the patient.

Clinical Relevance: Implant-supported overdentures are becoming a common treatment option for edentulous patients, however, they are not without their clinical challenges, many of which can be easily rectified in a primary care environment, such as general practice.
Posts – when it all goes wrong! part 2: post removal techniques
Authors: Rollings Sam , Stevenson Brian , Ricketts David
Published: August 2017

Many different techniques for the removal of posts have been proposed over the years, including the development of a number of different instruments and systems. This article discusses a number of the more common techniques, systems and their indications.

Clinical Relevance: Dentists should be aware of the techniques available for the removal of posts and understand which techniques are appropriate for individual cases.
To retrieve or not to retrieve the coronectomy root – the clinical dilemma
Authors: Patel Vinod , Kwok Jerry , Sproat Chris , McGurk Mark
Published: August 2017

Abstract: Coronectomy of mandibular third molars is a well established technique that is going through a resurgence as it seems to reduce the risk of inferior dental nerve (IDN) injury. The reservation with the technique arises because of fear that the retained root will become infected and symptomatic over time. General dental practitioners will be responsible for the long-term review and care of these patients and, consequently, it is important that they are aware of the technique and its sequelae.

Clinical Relevance: Coronectomy of mandibular third molars to avoid nerve injury is becoming increasingly popular. It is important that general dental practitioners (GDPs) are aware of the immediate and later sequelae of treatment and the implication of the retained root.
The coping-retained bridge: a modified approach to conventional bridge design – review and case report
Authors: Campbell Stuart C , Harper Amy L , Scott Kenneth H
Published: August 2017

Missing teeth may be restored with conventional bridgework. A modified approach to traditional bridge design may be necessary to restore edentulous spaces in the presence of poorly aligned abutment teeth and abutment teeth of guarded prognosis. The coping bridge is a useful technique in the dentist's armamentarium for patients in whom implant-supported or removable prostheses are inappropriate. This paper examines the use of coping-retained bridges as a modification on traditional design and discusses how these appliances may be applied in general practice. A case report is presented describing the application of this design in general practice.

Clinical Relevance: Applying a modified approach to bridge design may allow complicated edentulous spaces to be restored successfully in general practice.
Special care dentistry: part 2. dental management of patients with drug-related acquired bleeding disorders
Authors: Nizarali Najla , Rafique Sobia
Published: August 2017

The first of this series of three articles discussed the dental management of patients with inherited bleeding disorders. This paper will discuss and outline the dental management of patients with acquired bleeding disorders that can result from drug therapy. These may be associated with vascular defects, platelet defects or coagulation defects.

In an age when people are living longer, and medical interventions are continually becoming more advanced, clinicians will need to be aware of systemic disorders and treatments that may cause complications in the dental setting. According to National Statistics, 1 the UK population is projected to increase by 0.7% by 2016. This trend is shared with other European countries which also have ageing populations. The proportion of people aged over 65 is predicted to increase from 16% in 2006 to 22% in 2031.

Clinical Relevance: Being able to recognize which drugs may cause bleeding problems at an early stage will lead to good patient management, particularly in planning and delivering treatment following invasive procedures such as dental extractions. Whilst most patients can be successfully treated in general dental practice, the clinician may need to make a decision on whether or not to refer a patient to specialist services for all dental treatment, or to share care between primary care and specialist services for selected procedures.
Overview of paediatric dental sedation: 1. current UK guidelines
Authors: Wilson Katherine E
Published: August 2017

The use of conscious sedation in paediatric dentistry is very beneficial for the management of anxious children. It is essential that it is provided according to national guidelines in a safe and effective manner.

Clinical Relevance: Dentists carrying out conscious sedation in children must be aware of current national guidance and the most appropriate techniques to use.
The long and winding road part 2. the CLP patient's journey, 0–21 years
Authors: Sandler Paul Jonathan , Murray Alison , Orr Robert , Madahar Arun K
Published: August 2017

Patients with a cleft lip and palate (CLP) deformity require the highest standard of care that the NHS can provide 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. The first article in this series of two outlined the principles of care for the CLP patient and this second part illustrates 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.
Information for patients undergoing treatment for toothwear with resin composite restorations placed at an increased occlusal vertical dimension
Authors: Burke FJ Trevor
Published: August 2017

Toothwear is affecting increasing numbers of the population. In the past, treatment of patients whose teeth were affected by toothwear often involved the reduction of these teeth for crowns; a severe form of toothwear. Contemporary management of such cases is by the bonding of resin composite restorations to the worn and wearing surfaces, with these restorations being placed at an increased occlusal vertical dimension. The advantage of the technique is its minimal-or non-intervention nature and its high reported degree of patient satisfaction. There are, however, short-term disadvantages to the technique, such as the potential for lisping, pain from the teeth which will be subject to axial orthodontic tooth movement, and difficulty in chewing on the posterior teeth if these are discluded. It is therefore important, as with any treatment, that the advantages and disadvantages are fully explained to the patient. This paper therefore describes the clinical technique and presents a Patient Information Leaflet that the author has used for over five years.

Clinical Relevance: Patients should be advised regarding the disadvantages and advantages of any technique.
International rescue? managing the dental tourist
Authors: Iqbal Junaid , Shah Shilpa , Ashley Martin
Published: August 2017

The concept of dental tourism can be considered two-fold. On one side it is a term used to describe non-UK residing patients who visit, requesting NHS dental care whilst here in the UK. Alternatively, it also encompasses patients who travel to destinations outside their residing countries to receive care. The latter has become an ever-growing issue in the UK; one that warrants appropriate management and knowledge of current legislation amongst dental professionals.

Clinical Relevance: Clarity and guidance on who is eligible for care under the NHS when visiting the UK and who, if anyone, is ultimately responsible when treatment abroad fails.
How many of our patients can really give consent? – a perspective on the relevance of the mental capacity act to dentistry
Authors: Holden Alexander C L , Holden Neil L
Published: August 2017

The different ways that clinicians perceive adult patients with dental phobia is varied and diverse. From treating the dental phobia as a separate illness to dismissing it as a neurosis, sometimes little consequence is attached to its existence. True dental phobia is classed as a psychological illness and therefore comes under the remit and guidance of the Mental Capacity Act 2005. Failure to assess the impact of dental phobia upon an individual's capacity to consent could lead to allegations of negligence or even assault.

Clinical Relevance: This paper highlights the importance of considering the capacity to consent of some of the most vulnerable dental patients and how we can better protect both their rights in the law and their dignity.
Thank you to our reviewers
Authors: Burke FJ Trevor
Published: August 2017

Every paper in Dental Update is considered by two reviewers. I would like to thank all those on the list below for giving their time and expertise in checking the validity of the papers published in Dental Update in 2013 and making suggestions on how papers might be improved.
NHS pilots in primary care – an insight into the future?
Authors: Sihra Tajinder , D'Cruz Len
Published: August 2017

This article looks at the background to the current changes in primary care dentistry being piloted in England. It looks at the structure of the different elements being piloted, such as the oral health assessment, interim care appointments and care pathways. It also examines advanced care pathways and how complex care will be provided when clinically feasible and beneficial to the patient.

The authors have worked in a Type 1 pilot practice since September 2010.

Clinical Relevance: The NHS contract currently being piloted in England delivers care through care pathways and clinical risk assessments with prevention as an important building block for the delivery of services. There are new measures planned for measuring quality outcomes in primary care. This has implications for how services are delivered, who delivers them and how dentists will be remunerated in the future.
Fact or fiction: does a relationship exist between free sugars, dental caries and body weight?
Authors: Carson Susan , Freeman Ruth
Published: August 2017

This article is about dental caries and body weight. It will provide the reader with an overview of the complexity in the relationship between these and suggest the implications of taking a public health approach when addressing them within a primary dental care setting.

Clinical Relevance: To provide dental care professionals with an update on the available evidence surrounding the relationship between free sugar, dental caries and body weight.
Swallowed and inhaled dentures – what's the problem?
Authors: King Elizabeth , Jagger Robert
Published: August 2017

Loose or fractured dentures may be displaced towards the back of the mouth into the pharynx and become ingested or inhaled. The consequences of denture impaction on a patient's health can be severe, both short-term and long-term. Diagnosis and treatment can be challenging, therefore an understanding of the incidence, risk factors, symptoms and management of risk factors is important to reduce the occurrence of denture impaction in the aero-digestive system. This article includes an overview of the related literature and highlights the importance of managing risks and the importance of good denture design and appropriate maintenance.

Clinical Relevance: Dentists need to be aware of risk factors and harmful effects associated with inhaled and swallowed dentures to help minimize the incidence.
The use of the operating microscope in general dental practice part 1: magnification in general
Authors: Bonsor Stephen J
Published: August 2017

An increasing number of clinicians are using magnification to facilitate their vision when carrying out dental examinations and treatments. The use of an operating microscope in some dental specialties (such as endodontics) is now commonplace and there is also a role for this equipment in branches of general dentistry. This paper, the first of two, reviews the many advantages of using an operating microscope and offers practical advice on how the interested clinician may embark on using such an instrument by discussing the equipment required. The second paper will focus on the potential uses for the operating microscope in general dental as well as specialist practice.

Clinical Relevance: The operating microscope enhances the dental surgeon's vision, potentially improving treatment outcomes not only in specialist fields, such as endodontics, but also in many of the disciplines that general dental practice encompasses.
Diabetes mellitus: considerations for the dental practitioner
Authors: Mohamed Kareem , Yates Julian , Roberts Anthony
Published: August 2017

The prevalence of diabetes is increasing significantly and, therefore, dental practitioners are having to manage diabetic patients on a more regular basis. Alongside the systemic effects on the various tissues and organs of the body, diabetes can adversely affect oral health and all clinicians should be aware of the issues that may arise.

Clinical Relevance: Dental practitioners are almost guaranteed to encounter both diagnosed and undiagnosed diabetic patients. It is therefore important that they are aware of the oral signs and symptoms of disease and the reciprocal relationship between oral health and glycaemic control, so that diabetic patients are managed accordingly.
Management of the single discoloured tooth part 1: aetiology, prevention and minimally invasive restorative options
Authors: Barber Andrew J , King Paul A
Published: August 2017

The single discoloured tooth is commonly encountered in general practice. This is the first of two articles covering the broad range of management options for the single discoloured tooth. This first part outlines the common causes of discoloration and possible methods of prevention. Minimally invasive techniques are covered. Clinical procedures are outlined and clinical cases used to demonstrate outcomes that can be achieved.

Clinical Relevance: The single discoloured tooth is a commonly encountered clinical problem in general dental practice. A wide variety of management options exist and any one in particular may be most appropriate given the clinical scenario. It is therefore essential that general dental practitioners are familiar with the range of options that exist, as well as their indications, and consider adopting minimally invasive techniques in the first instance before moving to more invasive therapies.
Management of the single discoloured tooth part 2: restorative options
Authors: Barber Andrew J , King Paul A
Published: August 2017

This is the second article of a two part series covering the aetiology, prevention and broad range of management options for the single discoloured tooth. The article covers situations where masking and simulation techniques with direct composite are required. Direct composite, indirect composite and ceramic veneers are then considered, as well as full coverage crowns. The option of extraction of the affected tooth and its prosthodontic replacement will also be considered. Clinical cases are used to illustrate various scenarios.

Clinical Relevance: The single discoloured tooth is a commonly encountered clinical problem in general dental practice. A wide variety of management options exist and it is recommended that general dental practitioners consider adopting minimally invasive techniques in the first instance before moving on to more invasive therapies.
Interactive treatment planning in toothwear: are we doing it right?
Authors: Eliyas Shiyana , Shah Kewal , Briggs Peter FA
Published: August 2017

Toothwear is now common, especially in younger patients, with high demand for the restoration of the damaged teeth which is likely to increase further over time. Fixed prosthodontic options range from direct composite resin to conventional tooth preparation and cemented indirect restorations. This paper summarizes the views of a variety of clinicians on a plan delivered to a patient with toothwear in secondary care and explores the possible reasons for the variation in decision-making in the treatment of toothwear.

Clinical Relevance: With levels of toothwear increasing, the clinician needs to be aware of the different treatment modalities which are appropriate.
What steroid supplementation is required for a patient with primary adrenal insufficiency undergoing a dental procedure?
Authors: Henderson Simone
Published: August 2017

Patients with primary adrenal insufficiency (Addison's disease) lack the endogenous steroid hormones cortisol and aldosterone and require daily steroid therapy (usually hydrocortisone and fludrocortisone) to replace them. These patients are unable to adapt physiologically to stress and may need supplemental steroid therapy when having dental procedures, to prevent adrenal crisis. This paper provides guidance on dental procedures for which steroid supplementation may be required in patients with primary adrenal insufficiency and gives advice on doses and timing of supplementation. It does not address the management of patients with secondary adrenal insufficiency caused by long-term use of high doses of steroids. This document is for guidance only. Patients with primary adrenal insufficiency should be assessed individually as steroid requirements will vary.

Clinical Relevance: Although patients with primary adrenal insufficiency (Addison's disease) are invariably very well informed about their steroid requirements prior to a dental procedure, dental staff should have an understanding of the steroid supplementation that may be required.
Haemostasis part 2: medications that affect haemostasis
Authors: McCormick Neal J , Moore Undrell J , Meechan John G , Norouzi Mohsen
Published: August 2017

Post-operative haemorrhage is a recognized complication in dental practice. This may be more prevalent in patients taking anti-thrombotic medications. It is important that the dentist understands the mechanism of action of these drugs and how they may affect management of dental patients.

Clinical Relevance: Dental professionals must be aware of those medications affecting haemostasis and how they may impact on management. The emergence of different therapeutic regimens has increased the number of such drugs.
Dysphagia and dentistry
Authors: Curl Charlotte , Boyle Carole
Published: August 2017

Dysphagia is defined as a ‘difficulty in swallowing’ and is commonly found in the general population, particularly in the elderly. This article gives an overview of the more frequently encountered swallowing disorders and provides advice on how to manage the dysphagic patient in the dental surgery.

Clinical Relevance: By identifying patients with dysphagia and being aware of the potential problems that the clinician may experience when treating them, the risk of aspiration, choking and healthcare-acquired upper respiratory tract infections may be reduced.
Minimal intervention dentistry and older patients part 2: minimally invasive operative interventions
Authors: Hayes Martina , Allen Edith , da Mata Cristiane , McKenna Gerald , Burke Francis
Published: August 2017

As described in the first paper of this two part series, the expansion of our older population and the concomitant reduction in levels of edentulism will result in an increase in the number of patients presenting in general practice with complex restorative challenges. The application of the concepts of minimal intervention dentistry and minimally invasive operative techniques may offer a powerful armamentarium to the general dentist to provide ethical and conservative treatment to older patients.

Clinical Relevance: When it is unavoidable, operative intervention should be as minimally invasive as practicable in older patients to preserve the longevity of their natural dentition.
Oral health and the provision of care to panjabi patients in the UK
Authors: Farrukh Affifa , Sayeed Saad , Mayberry John
Published: August 2017

There is a substantial Panjabi community in the UK and its language is the second most common to be used in the country. As a result, it is critical that all practitioners concerned with oral health are aware of the dental practices of this community and of the increased risk of conditions such as head and neck cancer. This review assesses work published in the UK as well as in India and Pakistan. It emphasizes the need for a better understanding of cultural aspects of our care. Of course many aspects are not unique to this community but a better understanding will help with approaches to other communities. Social practices, such as paan use, can occur with greater frequencies amongst others, such as the Bangladeshi community. However, the purpose of this review is to concentrate attention on the largest minority community in the UK and, through this mechanism, to encourage interest in other groups. This interest should lead to practical approaches, such as: the development of relevant focus groups to improve clinical care; to develop outreach programmes to schools and community associations, including temples, gurdwaras and mosques; the production of appropriate literature and other media.

Clinical Relevance: This review should ensure that the reader is aware of attitudes towards dental care in the Panjabi community and of the increased frequency of a range of clinical conditions.
Precision attachments in partial removable prosthodontics: an update for the practitioner part 1
Authors: Williams Gareth , Thomas Matthew BM , Addy Liam D
Published: August 2017

Precision attachments can be used in removable prosthodontics to improve the retention, stability and aesthetics of a prosthesis. Their use is not commonplace. However, when used appropriately, it is possible to construct a more satisfactory prosthesis where conventional partial dentures have previously been unsuccessful. The first of two articles will describe the different types of precision attachments, including intracoronal, extracoronal and radicular. Their relative indications, advantages and disadvantages will also be discussed.

Clinical Relevance: Precision attachments are an option to increase retention in challenging prosthetic cases.
An overview of preformed metal crowns part 1: conventional technique
Authors: Rogers Helen J , Batley Haris A , Deery Chris
Published: August 2017

This article details the clinical techniques for conventional preformed metal crown placement. It aims to increase the readers' awareness of the clinical advantages of preformed metal crowns and the indications for their use. The second part will discuss the Hall Technique.

CPD/Clinical Relevance: This two-part article aims to guide the reader through the conventional and alternative techniques available for placement of a preformed metal crown whilst providing an update of the evidence for each.