bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior tooth alignment – recommendations for stability
Authors: Aulakh Raman , Banerji Subir
Published: August 2017

This article considers the importance of current orthodontic practice in retention and stability when considering anterior tooth alignment.

Clinical Relevance: With the exponential increase of general dentist-based orthodontic systems for anterior tooth alignment, with considerably shorter treatment times, practical recommendations along with a current literature review are required to improve success and outcome of the long-term result.
Shall I go digital?
Authors: Thomas BL , Davies J , Whaites E
Published: August 2017

Dental radiographic imaging is slowly transferring to digital format. The decision to invest in this new technology should be based on a good understanding of the different types of digital imaging available within the dental field. This article outlines its use in general dental practice, highlighting the pros and cons of the various systems both for intra-oral and extra-oral radiography.

Clinical Relevance: An understanding of the mechanisms of digital imaging and their associated potential problems are required by any clinician moving to film-less imaging.
Simplified basic periodontal examination (BPE) in children and adolescents: a guide for general dental practitioners
Authors: Cole Emma , Ray–Chaudhuri Arijit , Vaidyanathan Mina , Johnson Joanna , Sood Sanjeev
Published: August 2017

Dental plaque-induced periodontal diseases are common in children and adults. Guidelines were previously not available for the periodontal screening of under 18s. However, new guidelines have been introduced by the British Society of Periodontology and the British Society of Paediatric Dentistry which set out recommendations for the periodontal screening and management of under 18s in primary dental care. This article provides a practical guide for general dental practitioners on how to use the BPE in children and adolescents, and highlights the importance of early detection and management of periodontal diseases in this age group. A failure to use the modified BPE in a young patient who is later diagnosed with periodontitis may leave a dentist vulnerable to a medico-legal complaint or claim.

Clinical Relevance: New BPE guidelines for children and adolescents have been introduced by the BSPD and BSP; it is important that all dentists are aware of these guidelines and how to implement them in general practice.
The management of risk part 3: recording your way out of trouble
Authors: Collier Andrew
Published: August 2017

Clinical and ethical risk management requires not only the correct treatment being provided, and appropriate consent obtained, but also good records of that treatment. This third article of the series describes the characteristics of good records and their role in helping to prevent the progression of complaints, General Dental Council (GDC) cases and legal claims.

Clinical Relevance: Good records are of fundamental importance in managing risk and preventing and resolving complaints and legal claims.
Bizarre tooth surface loss and the miswak stick
Authors: Karia Roshni , Kelleher Martin G
Published: August 2017

Tooth surface loss can present in a variety of ways, some of which can appear rather strange on first examination. This case report demonstrates an unusual presentation of tooth surface loss (TSL) and its subsequent treatment. This loss of hard dental tissue appeared to be affecting the whole of the patient's remaining dentition, both lingually and buccally. Detailed questioning revealed the origins of this problem which turned out to be due to excessive use of an intra-oral Miswak chewing stick.

Clinical Relevance: This article will enable clinicians to understand the importance of specific, targeted history-taking, involving a rare case of tooth surface loss as well as the use of minimally destructive restoration composites and a fibre-reinforced composite bridge.
‘the last post?’: assessment of the failing post-retained crown
Authors: Beddis Hannah P , Okechukwu Nnaemeka , Nattress Brian R
Published: August 2017

Failure of a post-retained restoration can provide a challenge to the general dental practitioner (GDP) in terms of diagnosis, treatment planning and communication with the patient. The cause of failure must be identified, and a thorough assessment of the restoration, remaining tooth and its functional and aesthetic demands carried out in order to plan treatment to provide the most reliable result.

Clinical Relevance: This article discusses the assessment of failing post-retained crowns, with discussion of reasons for failure, thereby assisting the GDP in decision-making and treatment planning for such teeth.
Evaluation of a novel compule-based gingival retraction system in UK general dental practices
Authors: Burke FJ Trevor , Crisp Russell John
Published: August 2017

Twelve members were selected at random from the PREP panel, a group of UK-based dentists who are prepared to carry out research in their practices. A questionnaire was designed to determine the views of the participants, who were asked to use the retraction paste capsules where clinically indicated. They were asked to return the questionnaire after 8 weeks and the information contained therein was collated and presented mainly on visual analogue scales (VAS). A total of 160 impressions were taken using the Astringent Retraction Paste (3M ESPE, Seefeld, Germany) plus use in the placement of 25 restorations. Of evaluators, 83% (n = 10) agreed that Astringent Retraction Paste was a suitable product for gingival retraction and 75% (n = 9) agreed that it had good haemostatic properties. Overall dispensing and handling of the paste was rated as 4.9 on a VAS scale where 1 = Inconvenient and 5 = Convenient. The viscosity of the paste was rated as 3.6 on a VAS where 1 = too thin and 5 = too thick. Good scores were achieved across all criteria for the product.

Clinical Relevance: Practitioners may wish to be aware of a novel compule-based gingival retraction system.
Denosumab-associated osteonecrosis of the jaw – a case report
Authors: Vyas Sheena , Hameed Sabina , Murugaraj Vaidyanathan
Published: August 2017

Osteonecrosis of the jaw (ONJ) following bisphosphonate use is well documented. However, to our knowledge, there are few cases reported on ONJ related to the use of other pharmaceutical agents, such as denosumab – a monoclonal antibody that is prescribed for the treatment of osteoporosis and is used as an anti-cancer agent. Here we present the first case in the UK of a patient who has developed ONJ following treatment with denosumab. The purpose of this report is to highlight the potential effects of this monoclonal antibody on bone turnover and the subsequent results of osteonecrosis of the jaw. It is hoped that this will allow early recognition by medical and dental practitioners, and appropriate referral and treatment.

Clinical Relevance: Readers should be aware of other causes of osteonecrosis of the jaw.
Restorative aspects of periodontal disease: an update part 1
Authors: Puri Komal , Puri Nikhil , Dodwad Vidya , Masamatti Sujata Surendra
Published: August 2017

Today's dentistry is dominated by restorative procedures which are carried out to meet the demands of not only function but also aesthetics. Prosthetic and restorative therapies generally require a healthy periodontium as a prerequisite for successful treatment outcome. A mouth with a healthy periodontium may be affected by restorations of poor quality, and restorations of the highest quality may fail in a mouth with periodontal disease. This is the first of two articles that attempt to explain the concept of the complex question of biologic width and the problems that occur after improper margin placement in the periodontium. Initially, the dimensions of biologic width are considered and then margin placement and reasons for restorative procedures are discussed. This article also addresses the interactions between periodontal tissues and restorative procedures.

Clinical Relevance: Understanding the impact of restorative procedures on periodontal health in regular dental examination by dentists can help in early diagnosis and treatment of periodontal diseases. This could prevent further progression of disease and reduce the frequency of tooth loss.
Multiple idiopathic external apical root resorption: a literature review
Authors: Dewan Karun , Fairbrother Kevin
Published: August 2017

Multiple idiopathic external root resorption is an unusual condition that may present in a cervical or an apical form. In this paper, we review the published literature relating to root resorption and multiple idiopathic external apical root resorption (MIEARR). The article considers the types, classification and aetiology of root resorption and discusses the restorative options and management. An example of a patient suffering with multiple idiopathic apical external apical root resorption affecting UR2, UR1, UL1, UL2 and hypodontia affecting the maxillary canines is described.

Clinical Relevance: This paper offers clinical advice to practitioners to understand the classification of root resorption and appropriate and timely referral to be made to secondary care for optimum restorative treatment when multiple teeth are involved with no known cause established.
The management of non-vital immature permanent incisors
Authors: Phillips Jillian M , Srinivasan Vidya
Published: August 2017

The management of pulp necrosis in an immature permanent incisor can pose a significant challenge with regards to both operator technique and patient management. The main aim of this paper is to outline techniques described in the endodontic management of the immature incisor: calcium hydroxide apexification; one-visit apexification; and root revascularization.

Clinical Relevance: With 5% of 8-year-olds in the UK reported to have evidence of trauma to the permanent incisors,1an awareness of the challenges posed and techniques available for management is essential for general dental practitioners, should these teeth subsequently become non-vital.
An introduction to health literacy and oral health: the importance of awareness amongst dental care professionals
Authors: Taylor Carly L , Pretty Iain
Published: August 2017

This article introduces the concept of oral health literacy and its potential impact on patient care to the dental team. Factors which influence an individual's level of functional oral health literacy are discussed, along with methods which have been developed to measure it. Finally, public health initiatives to improve oral health literacy are considered, along with measures that individual practitioners can take.

Clinical Relevance: Oral health literacy may potentially play a vital role in the ability of patients to access and understand oral health information and treatment.
Bone defects of the jaws: moving from reconstruction to regeneration
Authors: Kyriakidou Elena , O'Connor Norma , Malden Nicholas J , Lopes Victor R
Published: August 2017

Jaw reconstruction is necessary for a variety of reasons including neoplastic disease, traumatic injuries, infective/inflammatory lesions, and congenital defects. Such defects can be a significant handicap for patients leading to physiological and psychological morbidity. Maxillofacial bone reconstruction remains challenging for the reconstructive surgeon; yet it has evolved significantly over recent years. The current state of the art reconstruction is via the use of vascularized osseous flaps. Modern developments in regenerative medicine propose a future for stem cells in the regeneration of bone for jaw defects.

Clinical Relevance: Knowledge of the current methods of reconstruction and advances in the field of tissue engineering is of interest to dental clinicians.
Localized gingival overgrowths – differential diagnosis for dental practitioners
Authors: Kannan Sathya , Thapasum Arishiya , Suresh Nanditha , Muthusamy Senthilkumar , Chandrasekaran Balamanikandasrinivasan
Published: August 2017

Localized gingival overgrowths (LGOs) encompass a category of oral lesions that are commonly encountered in dental practice. The authors report three cases of gingival epulides and also review the various conditions (both local and systemic) in which LGOs have been reported to occur. A flowchart is also proposed for a systematic approach to aid diagnosis. Although most epulides are hyperplastic lesions, rare conditions clinically identical to inflammatory or reactive LGOs do occur. Their innocuous appearance may frequently deceive the dental practitioner.

Clinical Relevance: Knowledge of various lesions that could present as an LGO is necessary and significant, as prompt diagnosis and specialist referral influences the treatment plan.
Management of patients with non-syndromic clefts of the lip and/or palate part 2: from primary surgery to alveolar bone grafting
Authors: McIntyre Grant T
Published: August 2017

Part 1 of this series of articles addressed the care of the child with a cleft of the lip and/or palate from antenatal diagnosis until primary surgery. The second part of this article discusses their care from primary surgery until alveolar bone grafting.

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.
Precision attachments in partial removable prosthodontics: an update for the practitioner part 2
Authors: Thomas Matthew BM , Williams Gareth , Addy Liam D
Published: August 2017

The aims of this second paper are to address the general principles involved in treatment planning precision attachment-retained dentures, with careful consideration of the whole patient rather than just the intra-oral aspects of planning. These principles are illustrated with four cases. The literature on maintenance and complications is also discussed in this paper.

Clinical Relevance: Precision attachments are an option to increase retention in challenging prosthetic cases.
Patient assessment: preparing for a predictable aesthetic outcome
Authors: Mehta Shamir B , Banerji Subir , Aulakh Raman
Published: August 2017

The flux of patients seeking to make changes to the appearance of their smile zone appears to be on a pathway of continual increase. This is possibly due to an increase in awareness towards oral health, and perhaps social, peer and media pressures, respectively. Cohorts of dental practitioners have thus responded to the latter demands by attending a plethora of educational courses, often focusing on either restorative techniques or other disciplines, notably orthodontics and clear aligners in particular. Consequently, treatment planning and thus treatment provision may carry the risk of being biased or indeed ‘outcome driven’, whereby the skills and knowledge of any clinician towards a particular faculty may significantly influence the ultimate treatment plan, with the unfortunate tendency sometimes to overlook the role of the interdisciplinary approach of concomitant restorative and contemporary techniques. The role of orthodontics to facilitate the provision of such treatment, along with predictable enamel bonding, has the distinct advantage of providing an acceptable aesthetic result with minimal biological intervention. However, to achieve an optimal result in such cases requires meticulous treatment planning and patient selection to avoid pitfalls with regards to long-term stability and function. This article suggests a standardized approach to patient assessment, with an interdisciplinary perspective in mind.

Clinical Relevance: With the growth of patient demand for improving the appearance of the smile, a meticulous assessment protocol is required along with effective interdisciplinary communication. This enables a comprehensive treatment plan to be developed with the correct priorities.
The ethics of interproximal reduction
Authors: Noar Joseph H , Kneafsey Louise C
Published: August 2017

Interproximal reduction (IPR) has become particularly popular with the use of removable aligners. Clinical and ethical factors concerning the use of interproximal reduction to facilitate orthodontic alignment are discussed.

CPD/Clinical Relevance: An understanding of the aetiological factors of a malocclusion is essential to enable full discussion of the risks and benefits, or the alternatives to IPR.
Case report: transpalatal arch resulting in soft tissue damage of the tongue 3 years post-orthodontic treatment
Authors: Noar Joe , Woods Eva , Hodgson Tim
Published: August 2017

Whilst transient effects of orthodontic appliances on the oral mucosa are well recognized, chronic lesions, persisting post therapy are unusual. We describe a persistent lingual mucosal defect related to a transpalatal arch (TPA) in a healthy 19-year-old female. The asymptomatic lesion is presently being monitored, however, surgical revision in the future may be requested by the patient if the area fails to remodel.

Clinical Relevance: Soft tissue trauma to the tongue by anchorage reinforcing appliances may result in long-term effects that could require surgical management.
Is oral health a risk factor for sexual health?
Authors: Eastham Jane , Seymour Robin
Published: August 2017

New evidence suggests that the extent and severity of periodontal disease may be a significant risk factor for erectile dysfunction, sperm motility and time to conception. This paper reviews the evidence and informs members of the dental team when dealing with this sensitive issue. As more research is forthcoming the topic of oral and sexual health is likely to be part of regular routine medical screening. Any issue concerning oral health as a risk factor for sexual health is likely to be a sensitive subject, rarely discussed in the dental setting. However, as new evidence emerges, this topic is likely to get into the public domain. All members of the dental team should be aware of such an association.

Clinical Relevance: Furthermore, the information in this paper may provide further incentive for certain patients to improve their oral health.
A review of communication models and frameworks in a healthcare context
Authors: Cheng Brenda SS , Bridges Susan M , Yiu Cynthia KY , McGrath Colman P
Published: August 2017

This paper reviews six key communication models and frameworks in healthcare contexts. Comparison suggests key inter-relationships between the different stages of the clinical consultations. Implications are identified for future study in healthcare provider-patient communication.

Clinical Relevance: To understand the healthcare provider-patient interaction through communication models.
Complete dentures: designing occlusal registration blocks to save clinical time and improve accuracy
Authors: Bishop Mark , Johnson Tony
Published: August 2017

The techniques described in this article are based on facial measurements and an analysis of the patient's existing dentures to provide measurements that will enable registration blocks to be constructed for individual patients rather than the arbitrarily produced block more commonly seen. Employing the methods shown will lead to a saving in clinical time and contribute to a more accurate registration. It is important to remember that the technician can only provide occlusal registration blocks of the appropriate dimensions if the clinician has assessed the patient and existing dentures and then passed this information to the laboratory.

Clinical Relevance: Being able to assess the clinical suitability of a patient's existing dentures and then take measurements from those dentures will allow occlusal registration blocks to be constructed that have the correct dimensions and anatomical features for a particular patient. This will save time during the registration stage and help to improve accuracy.
The francis report – implications for oral care of the elderly
Authors: Beacher Nicholas , Sweeney M Petrina
Published: August 2017

Oral health is an essential, yet often neglected, aspect of care in the elderly population. A mouth free of pain and disease which is functional, comfortable and aesthetic improves quality of life. Following the shocking reports of patient neglect and abuse published in the Francis Report, the dental profession must acknowledge that there are longstanding deficiencies in the provision of oral healthcare for the elderly, whether residing in care homes, hospitals or at home with support. It must be a universal goal to improve the care provision for this population through developing a greater understanding and overcoming the multi-factorial barriers to care. This article will highlight the key features of the Francis Report and its significance in the context of oral healthcare provision for the elderly.

Clinical Relevance: To provide insight into the oral healthcare needs of the growing elderly population and the necessity of dealing with the current limitations in service provision.
The francis report – dento-legal implications
Authors: Foster Martin
Published: August 2017

This article explores the potential implications of the Francis Report for members of the dental team from a dento-legal perspective. It looks at the broad recommendations in light of the existing ethical environment in which dental registrants work and asks what is new and what the recommendations will actually mean for dental professionals in practical terms.

Clinical Relevance: The fundamental recommendations of the Francis Report, namely, that those who provide care should put patients' interests first and be open about outcomes and performance, are not new concepts. A breach of these ethically based expectations may, however, create grounds for legal proceedings, which is clearly a significant point for all members of the dental team. It is therefore important to be aware of what is expected of those providing clinical care.
Pain paper 2b: classification of orofacial pain and an update on assessment and diagnosis
Authors: Egbuniwe Obi , Renton Tara
Published: August 2017

The classification of chronic orofacial pain remains a contentious area. However, more recently, with the clarification of pain mechanisms and improved understanding of the underlying neurophysiology and modulation factors, there is more clarity of the possible division of pain conditions. Interestingly, the pathophysiology provides a basis for classification that has more clinical relevance. The principles of assessing and managing patients with pain have modified significantly, in line with recent improved understanding of the affective and emotional components in pain behaviour and suffering.

Clinical Relevance: This paper aims to provide the dental and medical teams with a review of the classification of trigeminal pain with an overview of how to assess and diagnose patients with trigeminal pain.
Fibre-reinforced composite (FRC) bridge – a minimally destructive approach
Authors: Van Rensburg J J Jansen
Published: August 2017

Replacing missing teeth is an integral part of the clinical services of the dental practitioner. The fibre-reinforced composite (FRC) bridge is a relatively new method for replacing missing teeth. This article will explain and discuss this alternative treatment option. Practical instructions on how to construct a FRC bridge will be given, by means of a clinical case. Different technique options will be illustrated to provide the reader with a good understanding of the most practical way to use the FRC strips. The fibre-reinforced composite provides a non-destructive, aesthetically pleasing and cost-effective way to restore missing teeth.

Clinical Relevance: Minimally invasive options should always be considered and destruction of healthy enamel and dentine during the preparation phase of a replacement treatment should be avoided as much as possible.
Maintenance periodontal therapy after systemic antibiotic and regenerative therapy of generalized aggressive periodontitis. A case report with 10-year follow-up
Authors: Junior Sergio Siqueira , Ribeiro Fernanda Vieira , Villalpando Karina Teixeira , Cirano Fabiano Ribeiro , Pimentel Suzana Peres
Published: August 2017

Aggressive periodontitis (AgP) is an inflammatory disease characterized by rapid attachment loss and bone destruction. This case report presents the 10-year results in a subject with generalized AgP treated by a regenerative periodontal therapeutic approach and the adjunctive use of antibiotics, following a systematic maintenance periodontal therapy. The use of enamel matrix derivatives (EMD) and adjunctive antibiotic therapy to treat AgP yielded improvements in clinical parameters and radiographic bony fill. This combined therapeutic approach following a systematic supportive periodontal therapy supports the long-term maintenance of teeth with previous advanced periodontal defects, demonstrating successful stability after 10-years follow-up.

Clinical Relevance: The combined treatment protocol using EMD plus adjunctive antibiotic therapy, associated with a systematic supportive periodontal therapy, benefits the long-term maintenance of teeth with previous advanced periodontal defects in subjects presenting AgP, supporting this approach as an alternative in the treatment of AgP.
Rehabilitation of oncology patients with hard palate defects part 3: construction of an acrylic hollow box obturator
Authors: Ali Rahat , Altaie Asmaa , Nattress Brian
Published: August 2017

This article will discuss the clinical stages in the fabrication of a definitive acrylic hollow box obturator to restore a hard palate defect. The first two papers described the restorative/surgical planning phase and the principles of obturator design.

CPD/Clinical Relevance: Each of the clinical stages required to make a hollow box obturator must be performed to the highest possible standard to ensure than an optimal prosthesis is fabricated.
Class II division 1: an evidence-based review of management and treatment timing in the growing patient
Authors: Barber Sophy K , Forde Katherine E , Spencer Richard J
Published: August 2017

Class II division 1 malocclusion is common and various methods have been suggested for successful treatment in the growing patient. A number of recent high-quality studies have been undertaken to assess the efficacy of these treatments. We aim to outline the existing best evidence that supports current practice, with a review of the effect of treatment timing on outcome. This will provide a sound evidence-base for General Dental Practitioners for assessing, advising and referring young patients for treatment.

CPD/Clinical Relevance: General Dental Practitioners should understand the management options and optimal time for treating growing patients with a Class II division 1 malocclusion.
Dental management of a patient with multiple idiopathic cervical root resorption
Authors: Ali Rahat , Fayle Stephen , Langley David , Altaie Asmaa , Nattress Brian
Published: August 2017

Multiple Idiopathic Cervical Root Resorption (MICRR) is a rare condition. It initiates at the cemento-enamel junction of multiple teeth. The lesions continue to grow until they unite, thereby undermining the entire coronal structure of affected teeth. Its distribution can vary from a single region to the entire dentition and the number of teeth affected by resorption tends to increase as the condition is followed over time. The teeth themselves appear clinically normal. The aetiology of MICRR is unknown and it is considered to be a diagnosis of exclusion. The condition tends to be progressive. Consequently, root treatments/surgical curettage and restoration of the lesions have been unsuccessful at arresting the condition. Affected teeth are often extracted in anticipation of catastrophic fracture and have been replaced with partial or complete dentures. In this case report, we describe how a young female patient was dentally managed over 10 years and ultimately rehabilitated with dental implants.

CPD/Clinical Relevance: Patients suspected of having multiple idiopathic cervical root resorption may require specialist, multidisciplinary care and require referral to an appropriate secondary care unit for treatment planning and potential oral rehabilitation.
A PREP panel, practice-based, evaluation of the handling of the kerr demi-ultra light curing unit
Authors: Burke F J Trevor , Crisp Russell J
Published: August 2017

This paper describes the handling evaluation (by a group of practice-based researchers, the PREP Panel) of a recently introduced Light Curing Unit (LCU), the Kerr Demi-Ultra, which possesses a number of novel features such as its ultracapacitor power source, and the Light Emitting Diodes (LEDs) which provide the light output being placed close to the tip of the light guide.

CPD/Clinical Relevance: Testing of new devices and materials with respect to their handling is of importance, given that an easy to handle device should produce better clinical results than one which is difficult to use.
Case report: beware the silver nitrate stick – a risk factor for bisphosphonate-related osteonecrosis of the jaw (BRONJ)
Authors: de Souza Michelle C , Stepavoi Gabriela
Published: August 2017

Topical silver nitrate may be used in oral and maxillofacial clinical settings owing to its astringent, caustic and disinfectant properties. Uses of the toughened silver nitrate pencil stick include haemostasis at bleeding points and for the management of aphthous ulcers, hypergranulation tissue, warts and verrucas. We present an interesting case of apparent silver nitrate-induced, bisphosphonate-related osteonecrosis of the hard palate following mucosal lesion biopsy in a multiple myeloma patient receiving zoledronic acid intravenous infusions. Our review of the literature indicates that this is the first report of such a scenario.

CPD/Clinical Relevance: Clinicians must consider all potential sources of chemical and mechanical trauma to the bone and overlying mucosa when managing patients at risk of developing bisphosphonate-related osteonecrosis of the jaw.
Ectodermal dysplasia: a clinical overview for the dental practitioner
Authors: Halai Tina , Stevens Claire
Published: August 2017

The term ectodermal dysplasia (ED) is used to describe a group of rare congenital disorders characterized by abnormalities of two or more ectodermal structures such as the skin, hair, nails, teeth and sweat glands. This paper will give an overview of the aetiology of ED and describe the manifestations and dental management of this condition. In particular, the important role of the dental practitioner in the identification and management of patients with ED will be highlighted.

CPD/Clinical Relevance: Dental practitioners should be aware of the oral features of ectodermal dysplasia and be able to make timely referrals and provide appropriate continuing care for these patients.
A new generation of antiplatelet and anticoagulant medication and the implications for the dental surgeon
Authors: Johnston Steven
Published: August 2017

The management of dental patients taking either antiplatelet medication, anticoagulant medication or both has been well established in the previous literature. Recently, new generations of drugs have emerged which are becoming increasingly common, including direct thrombin inhibitors, factor X inhibitors and a new class of oral thienopyridines. The implications of these drugs for the dental surgeon are not yet fully known. Awareness remains low and there is very little information available within the literature on safe use during surgery. This review paper aims to provide some guidance for dental practitioners performing invasive procedures.

CPD/Clinical Relevance: A new generation of anticoagulant and antiplatelet drugs have serious implications for patients undergoing surgery and their use is increasing.
Pain part 6: temporomandibular disorders
Authors: Yule Pamela L , Durham Justin , Wassell Robert W
Published: August 2017

TMDs are a complex collection of conditions which can have a significant impact on an individual's quality of life. The aetiology, diagnosis and management of TMDs will be described in this article with the hope of increasing a general dental practitioner's knowledge of these problems, thus helping them to institute simple, initial, conservative therapies for such patients. Diagnosis of TMDs can be simplified by following recent published clinical diagnostic criteria such as those outlined in this article.

CPD/Clinical Relevance: Pain and functional disturbances related to TMDs are common and require simple and pragmatic interventions for most patients. After providing a diagnosis, reassure patients that they do not have a sinister disease, and explain that the condition is usually self-limiting.
Mouth cancer for clinicians part 7: cancer diagnosis and pre-treatment preparation
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 diagnosis, diagnostic and pre-treatment procedures.
British society of prosthodontics debate on the implications of the minamata convention on mercury to dental amalgam – should our patients be worried?
Authors: Austin Rupert , Eliyas Shiyana , Burke FJ Trevor , Taylor Phil , Toner James , Briggs Peter
Published: August 2017

In 2013, the Minamata Convention on Mercury called for a global phase-down of amalgam use, with a view to reduce environmental mercury pollution. This will significantly impact UK dentistry, given the still extensive use of amalgam in UK general dental practice. However, until now there has been little national discussion or debate. In Spring 2015, The British Society of Prosthodontics dedicated a significant part of its Annual Conference to debating the implications of this issue. Clinical case examples were discussed with audience interaction and voting facilitated using innovative Audience Response System Technology. A remarkable range of concerns and opinions were given. The debate elicited specific concerns amongst clinicians regarding the suitability of mercury-free alternatives to amalgam; particularly where cavities are large and extend beneath the gingival anatomy. There are also anecdotal reports of Dental Foundation (DF) dentists not being adequately taught the use of dental amalgam in undergraduate dental schools.

CPD/Clinical Relevance: Many clinicians, especially those treating patients for whom moisture control is challenging, feel that amalgam should remain available for clinicians to choose in certain clinical circumstances for the restoration of posterior teeth, even in the event of a complete phase-down.
Benzodiazepines: sedation and agitation
Authors: Gallagher Catherine
Published: August 2017

Dental anxiety is common and frequently poses a barrier to necessary dental treatment. The increasing availability of conscious sedation in dental practice has made treatment much more accessible for anxious patients. At present, benzodiazepines are the most commonly used drugs in sedation practice and provide a pleasant experience for most, but not all, patients. An understanding of the mechanism of action of benzodiazepines should inform our practice and deepen our understanding of why and how sedation may fail.

CPD/Clinical Relevance: As an increasing number of dentists provide sedation for their patients an update on benzodiazepines is timely.
Dental trauma 2: acute management of fracture injuries
Authors: Djemal Serpil , Singh Parmjit , Polycarpou Nectaria , Tomson Rachel , Kelleher Martin
Published: August 2017

Fortunately, traumatic dental injuries are a relatively uncommon occurrence in general dental practice. However, when they do present, timely diagnosis and treatment of such injuries is essential to maximize the chance of a successful outcome. This is the second part of a two-part series on traumatic dental injuries that are commonly encountered in the clinical setting. Part one covered the management of acute luxation/displacement injuries affecting the supporting structures of the tooth, while part two will cover the management of fracture injuries associated with teeth and the alveolar bone.

CPD/Clinical Relevance: Traumatic dental injuries are uncommon occurrences in everyday general dental practice. This article aims to provide a simple, step-by-step approach in the diagnosis and clinical management of acute fracture injuries.
Case study: management of a loose upper denture opposed by a shortened dental arch
Authors: Powell Laurie
Published: August 2017

For many years, it has been considered necessary to restore posterior support with a bilateral free-end saddle when a full upper denture is opposed by a shortened dental arch. It was thought that this would provide occlusal stability and prevent anterior bite collapse and temporomandibular dysfunction. As free-end saddle partial dentures are often poorly tolerated by patients, this case study tests whether a retentive full-upper denture occluding with a shortened dental arch offers enough to fulfil a patient's needs.

CPD/Clinical Relevance: An increasingly elderly population will present dental practitioners with more partially dentate patients requiring treatment.
Sore or swollen lips part 2: systemic causes
Authors: Malamos Dimitrios , Scully Crispian
Published: August 2017

This series of three papers reviews the causes, diagnosis and differential diagnosis, and outlines the management of sore and/or swollen lips.

CPD/Clinical Relevance: Sore and/or swollen lips are not uncommon, often have a local cause, but may reflect a systemic disease. The previous article reviewed important causes, from actinic to contact cheilitis, while this paper starts with drug-induced cheilitis and completes that alphabetical list.
Modern endodontic principles part 5: obturation
Authors: Darcey James , Roudsari Reza Vahid , Jawad Sarra , Taylor Carly , Hunter Mark
Published: August 2017

Once cleaning and shaping is complete the clinician must obturate the canal. There are many different materials and techniques available each with their own discrete advantages and disadvantages. Whichever technique is used, the goal is to seal the entire prepared length of the root canal. This paper describes how best this may be achieved.

CPD/Clinical Relevance: It is incumbent on the clinician to ensure that once the canal has been prepared it is sealed from bacterial re-entry.
Gingival inflammation and aggressive periodontitis in a child with a specific antibody deficiency
Authors: Liyange Singithi , Edgar David , Shields Michael D , Linden Gerard J
Published: August 2017

Exuberant gingival inflammation accompanied by periodontitis is a rare finding in a very young child and may indicate a defect in the host response. Affected children should be referred to appropriate specialists to establish a definitive diagnosis. A 5-year-old girl presented with persistent gingival inflammation and periodontal destruction. Immunological investigations identified specific polysaccharide antibody deficiency which, when treated, resulted in a significant improvement in the gingival condition. This case illustrates the need for integrated management by a wide range of dental and medical specialists. Antibody deficiency is rare but, if not identified and treated effectively, can be associated with chronic ill health and decreased life expectancy.

CPD/Clinical Relevance: This article describes a rare case of gingival inflammation accompanied by periodontitis in a very young child secondary to an underlying host antibody deficiency and details the investigation, management and clinical outcomes.
Spontaneous alveolar bone growth in ankylosed, infraoccluded teeth in adolescents after elective decoronation – a clinical case series
Authors: Siddiqui Muhammad Musaab , Patel Mital , Shahdad Shakeel
Published: August 2017

This article considers a possible solution to prevent or manage spontaneous alveolar bone growth in ankylosed, infraoccluded teeth in adolescents after elective decoronation, allowing replacement resorption to take place, preserving the surrounding alveolar bone and enabling vertical bone development coronal to the decoronated segment.

CPD/Clinical Relevance: To illustrate the advantages of decoronation allowing subsequent replacement of infraoccluded ankylosed teeth with implant-retained restorations and minimal aesthetic compromise.
Pain part 8: burning mouth syndrome
Authors: Beneng Kiran , Renton Tara
Published: August 2017

Burning mouth syndrome (BMS) is a rare but impactful condition affecting mainly post-menopausal women resulting in constant pain and significant difficulty with eating, drinking and daily function. The aetiology of BMS remains an enigma. Recent evidence suggests it likely to be neuropathic in origin, the cause of which remains unknown. There is no cure for this condition and the unfortunate patients remain managed on a variety of neuropathic pain medication, salivary substitutes and other non-medical interventions that help the patient ‘get through the day’. Some simple strategies can assist both clinician and patient to manage this debilitating condition.

CPD/Clinical Relevance: The dental team will recognize patients presenting with burning mouth syndrome. They are difficult patients to manage and are often referred to secondary care and, ultimately, depend on their general medical practitioners for pain management.
Mouth cancer for clinicians part 9: the patient and care team
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 the multidisciplinary team (MDT; or multi-speciality team) and its roles, and an overview of the implications of therapies that are discussed more fully in future articles in the series.
Mouth cancer for clinicians part 10: cancer treatment (surgery)
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 surgery for the treatment of mouth cancer.
Mouth cancer for clinicians part 11: cancer treatment (radiotherapy)
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 the use of radiotherapy, and its effects on the mouth and other tissues.
The management of the dilacerated impacted maxillary central incisor
Authors: Prado Naomi , Malik Ovais , Waring David
Published: August 2017

The clinical problem of how best to manage a dilacerated, impacted maxillary central incisor will only be encountered rarely. The treatment aim should be to achieve results that are indistinguishable from normal appearance in a way that is appropriate for the patient. This article discusses the incidence of dilacerations in maxillary incisors and describes the treatment approaches available – orthodontic alignment or surgical removal and management of the resulting space, considering orthodontic repositioning, autotransplantation and various prosthetic replacements. Treatment indications, advantages and disadvantages, restorative and surgical implications, as well as the evidence-base relating to the various treatment modalities will be presented, along with clinical case examples.

CPD/Clinical Relevance: This paper discusses a problem that, if not managed appropriately, can lead to poor results for the patient. Even for practitioners who may not undertake the treatment mentioned, it will enable them to have more in-depth discussion with their patients should the situation arise.
Amyloidosis presenting as macroglossia and restricted tongue movement
Authors: Dawoud Basim ES , Taylor Jennifer , Ariyaratnam Senathirajah , Pemberton Michael N
Published: August 2017

Amyloidosis (AL) is a well recognized cause of macroglossia. A case of localized deposition of systemic amyloidosis secondary to multiple myeloma is reported in a 63-year-old female presenting with restricted tongue movement in the dental setting. Amyloidosis secondary to multiple myeloma is well documented in the literature, with amyloid deposits being found at various sites throughout the oral cavity and systemically. This case emphasizes the importance of a full oral soft tissue examination, including the need to examine mobility of the tissues, as it was the restricted movement of the tongue that ultimately alerted the clinician to the diagnosis. This report also highlights other dental implications of managing patients with multiple myeloma and amyloidosis.

CPD/Clinical Relevance: To provide an understanding of what multiple myeloma and amyloidosis are whilst, importantly, relating this to how these conditions can impact on routine dental treatment.
The role of the GDP in assessment and management of the early orthodontic referral
Authors: Flett Andrew MC , Sandler Jonathan
Published: August 2017

Many of the orthodontic patients in the UK are treated in early adolescence. This occurs when most of the permanent dentition has erupted and after the general dental practitioner (GDP) has had the opportunity to assess the patient using the index of orthodontic treatment need (IOTN). There are certain types of malocclusion that present before this age and would undoubtedly benefit from earlier referral.

CPD/Clinical Relevance: To describe the malocclusion and dental anomalies that benefit from ‘early’ orthodontic assessment and active intervention.