bluuebunny/crossref_metadata_2025_split huggingface dataset:
The application of clinical audit to improve pain control following third molar surgery
Authors: Bryant Catherine , Rood J Phil 
Published: August 2017

A telephone survey was used to assess adequacy of pain control after third molar removal in a series of three audits. After each audit, factors contributing to failure to control pain adequately and poor patient compliance with our analgesic regimen were identified. Changes in practice were then introduced to remedy areas of weakness and improve outcome. Despite an apparently sound protocol for the prescription of analgesics for patients having third molar surgery, the first audit revealed that 53% of patients experienced moderate to severe pain. After the introduction of written patient instructions to clarify the use of post-operative analgesics, the second audit demonstrated that 86% had their pain managed successfully. After subsequently increasing the post-operative Ibuprofen doses from 400 mg to 600 mg, the third audit showed that 96% of patients had satisfactory pain control. The use of clinical audit with an evidence-based analgesic regimen and clear, written patient instruction has improved post-operative pain control. Clinical Relevance: This paper demonstrates the usefulness of clinical audit for the monitoring and improvement of pain control and analgesic prescribing regimens following oral surgery, which in turn may improve patient experience and outcome.
The influence of patients' decisions on treatment planning in restorative dentistry
Authors: Kalsi Jagdip S , Hemmings Kenneth W 
Published: August 2017

As part of treatment planning, options are presented to patients by dentists. An informal discussion takes place involving a cost-benefit analysis and a treatment plan is agreed. Evidence-based dentistry takes into account the best available literature, clinical experience and patient factors to guide the dentist. Dentists exert considerable influence on which treatment modality is selected.This paper focuses on the importance of patient factors which lead to less than ideal, clinically acceptable, treatment plans that nevertheless give patient satisfaction over the long term. Though no universally accepted healthcare model exists for restorative dentistry, patients' decisions are most influenced by their relationship with their dentist over factors such as time, access and cost. Letters should be sent to patients clarifying the nature of all proposed options, including advantages and disadvantages, complications, success rates, biological and financial costs and what happens if no treatment is carried out.Clinical Relevance: Many psychological and social determinants influence patients' values and decision-making when planning for restorative dentistry. These lead to a treatment plan agreed between the patient and the dentist. Often an element of compromise is considered acceptable to both parties when the evidence would suggest an alternative treatment to be preferable.
A guide to skin cancer of the face for the dental team
Authors: Main Barry , Felstead Andrew , Hughes Ceri , Thomas Steve 
Published: August 2017

The incidence of skin cancer in the United Kingdom is increasing and is associated with an ageing population and increasing lifetime exposure to sunlight. The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma and malignant melanoma, all three of which may present on the skin of the face. The dental team are, therefore, well-placed to recognize suspicious lesions and arrange for further advice or assessment. This paper outlines the epidemiology, important clinical features and principles of modern management of facial skin cancers to aid dental practitioners in the recognition of suspicious lesions. In addition, some of these treatments have side-effects which have the potential to affect a patient's oral health or its management and these aspects are also discussed. Clinical Relevance: The dental surgeon is ideally placed to recognize malignant or potentially malignant lesions on patients' faces and to advise on seeking further advice or refer for assessment, as appropriate. Dental practitioners will increasingly encounter patients who have undergone surgical or non-surgical management of facial skin cancer and should understand the potential oro-facial side-effects of such treatment.
Quality assurance tests for digital radiography in general dental practice
Authors: Greenall Chris , Drage Nicholas , Ager Matthew 
Published: August 2017

Quality assurance (QA) is essential in dental radiography. Digital radiography is becoming more common in dentistry, so it is important that appropriate QA tests are carried out on the digital equipment, including the viewing monitor. The aim of this article is to outline the tests that can be carried out in dental practice. Clinical Relevance: Quality assurance for digital equipment is important to ensure consistently high quality images are produced.
Implant-supported mandibular denture: planning to delivery – a case report
Authors: Patel Upen S , Walmsley A Damien 
Published: August 2017

Restoring the edentulous mandible with a removable prosthesis can be a challenging prospect for both the dentist and patient during and after treatment. Poor retention and support are the major problems reported with a mandibular complete denture and these can be significantly improved with the use of implants and retentive attachments. Utilizing implants requires careful planning from both the surgical and restorative aspects to ensure that the intended treatment aim and outcome is achieved. Clinical Relevance: This case highlights the importance of both restorative and surgical considerations when planning the rehabilitation of the mandible with dental implants.
How we view complainants; an ethical dilemma?
Authors: Holden Alexander C L 
Published: August 2017

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