bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posts – when it all goes wrong! part 1: case assessment and management options
Authors: Rollings Sam , Stevenson Brian , Ricketts David 
Published: August 2017

Posts have been used for many years to retain restorations or cores for extra-coronal restorations in endodontically treated teeth. This article discusses the variety of post systems that are available and the incidence and reasons for failure of teeth that have been restored with posts. The treatment options available for the management of such failures are considered, in addition to the indications for both non-surgical and surgical management of endodontic failures. The attitudes of dentists and the perceived complications of attempting post removal are reviewed, along with the evidence to support the prevalence of complications. Clinical Relevance: Failure of post-retained restorations is a relatively frequent finding due to failure of the restoration itself or the endodontic treatment. It is therefore important to understand and be aware of the various treatment options available, their indications and associated risks.
Pacifiers: a review of risks vs benefits
Authors: Gederi Arian , Coomaraswamy Kristian , Turner P John 
Published: August 2017

Pacifiers, otherwise known as dummies, have been around for many centuries. They have, however, taken many different forms, shapes and sizes. Their use is increasing and has remained controversial, with both potential risks and benefits identified in the medical and dental literature. The purpose of this article is to review some of the evidence available for and against the use of pacifiers and make recommendations for their application, maintenance and weaning. Clinical Relevance: Dental healthcare professionals need to consider the evidence available for and against pacifiers when making recommendations to patients and their parents.
Techniques for effective management of periodontitis
Authors: Turani Duaa , Bissett Susan M , Preshaw Philip M 
Published: August 2017

The treatment of periodontitis is a complex process that can last for many years. Successful management of this common inflammatory condition necessitates team work by the patient, dental hygienist and dentist. A variety of complex skills are required including, not only the necessary clinical skills, but also excellent communication, education and motivation of patients. Above all, time is required to treat the condition properly, and successful outcomes depend heavily on engaging with and empowering the patient to manage his/her condition. Patients need to be active partners in the management of their periodontitis (supported by the dental team), and this will only happen if the time is spent to educate them on their role. Communication is essential for successful management, and behaviour change is always required of patients. Strategies for working effectively with a dental hygienist, and a suggested treatment protocol are presented to help dentists develop more effective methods of treating periodontitis. Clinical Relevance: This article gives practical guidance on how to manage patients with periodontitis as well as working within the dental team to achieve the best clinical outcomes.
Are dentine pins obsolete?
Authors: Bonsor Stephen J 
Published: August 2017

Dentine pins have been used in operative dentistry for many years to retain a non-adhesive restorative material (such as dental amalgam) in a cavity which has little or no inherent mechanical retention. However, dentine pin placement can be a hazardous procedure and there are a number of problems associated with their use. Alternative techniques have been described which may be utilized and are effective at retaining the restorative material without the shortcomings of dentine pins. There is a strong argument therefore that dentine pins have no place in contemporary dental practice and have consequently become obsolete. Clinical Relevance: Auxiliary retention may be required to retain direct intra-coronal dental restorations in unretentive cavities.
Dental materials – what goes where? class I and II cavities
Authors: Burke FJ Trevor , Mackenzie Louis , Sands Peter 
Published: August 2017

Dental amalgam has helped maintain dental public health in the developed world for over a century. However, its days appear to be numbered. Notwithstanding the environmental consideration, there is an ever increasing demand from dental patients for non-metallic and tooth-coloured restorations in their posterior teeth. This paper gives a brief history of dental amalgam and critically appraises the alternative materials, the principal of these being resin-based composite. Clinical Relevance: The majority of practitioners carry out large numbers of Class I and II restorations, so an appraisal of the pros and cons of the alternatives may assist in decision-making.
Changing concepts in cariology: forty years on
Authors: Kidd Edwina , Fejerskov Ole 
Published: August 2017

The caries lesion is a sign or symptom resulting from numerous pH fluctuations in biofilms on teeth. The lesion may or may not progress and lesion progression can be controlled, slowed down or arrested. Control of the biofilm is the treatment of caries, the most important measure being to disturb the biofilm mechanically using a fluoride-containing toothpaste. The informed patient controls caries and the role of the dental professional is to advise how this should be done. This is the non-operative treatment of caries and it is worthy of payment. It should be mandatory as part of any operative treatment to ensure that the patient understands, and is able to perform, adequate plaque control.Clinical Relevance: It is very unfortunate that the current remuneration scheme (Unit of Dental Activity) in Health Service practice in England and Wales prevents practitioners adopting a modern biological approach to caries control.
Direct anterior composites: a practical guide
Authors: Mackenzie Louis , Parmar Dipesh , Shortall Adrian CC , Burke FJ Trevor 
Published: August 2017

For more than 40 years dentists worldwide have been using directly placed resin-bonded composite to restore damaged anterior teeth. While such techniques are invariably more conservative of tooth tissue than indirect procedures, operative techniques using direct composite can be challenging and are considered technique sensitive. Clinicians require both technical and artistic skill to provide composite restorations that restore function and aesthetics to blend seamlessly with the residual dentition. This paper provides an update on the aesthetic considerations involved in the restoration of anterior teeth with directly placed composite and outlines the contemporary materials, equipment and techniques that are available to optimize every clinical stage. Clinical Relevance: Successful restoration of anterior teeth with direct composite is an integral component of contemporary clinical practice.
Reducing white spot lesion incidence during fixed appliance therapy
Authors: Greene LE , Bearn DR 
Published: August 2017

Fixed orthodontic appliances are commonly used in contemporary orthodontic treatment and can be associated with the development of white spot lesions on the teeth. These lesions can be detrimental to both the aesthetics and health of the teeth so prevention is better than cure and patient selection is critical. This paper discusses predictors of development in addition to methods to help prevent white spot lesions during fixed appliance therapy. Recommendations for oral hygiene regimes during fixed orthodontic appliance treatment are given, the development of white spot lesions (WSLs) described and ways to predict their occurrence identified. Clinical Relevance: Most general dental practitioners will have patients who are considering orthodontic treatment or are wearing fixed orthodontic appliances and so are at increased risk of developing WSLs. It is therefore important they are aware of predictors and ways to prevent WSLs.
Can oil lubricated dental handpieces be sterilized?: part 1. the problem
Authors: Kudhail Ravinder Singh 
Published: August 2017

HTM 01-05 guidelines state that decontamination of handpieces remains a challenge, in particular the lumen, due to oil impeding access for steam sterilization. This paper discusses important aspects of cleaning and sterilization of the handpiece lumen and critically appraises the literature found on this topic. The paper is not intended to cover precleaning methods in detail. Clinical Relevance: The complex structure of handpiece lumens makes them difficult to sterilize. Current knowledge of this subject is necessary for general dental practitioners to decide on investment in new equipment correctly, which has been validated by the manufacturer, in order to comply with HTM 01-05 guidelines.
Preventing dental caries: part 1. the scientific rationale for preventive advice
Authors: Davies Robin M , Blinkhorn Anthony S 
Published: August 2017

This article highlights the fundamental issues which the primary care team should consider when developing preventive dental advice for their patients. Although it is important to have a clear understanding of the carious process, this knowledge must take account of social influences on health when assessing the preventive strategy for individuals. A key factor is that caries is a lifelong process involving fluctuations in demineralization and remineralization. The dental team should ensure that the oral environment favours remineralization and avoids irreversible loss of enamel and dentine. An understanding of this ‘see-saw’ process will influence not only our preventive philosophy but how we, as health professionals, diagnose and treat dental caries. Clinical Relevance: Preventing dental caries is an essential skill for all dental professionals. This article brings together the scientific basis of the appropriate advice.
The risk of bisphosphonate-related osteonecrosis of the jaw in children. a case report and literature review
Authors: Ngan Kwok-Kit , Bowe John , Goodger Nicolas 
Published: August 2017

Bisphosphonate use has been described in children diagnosed with osteogenesis imperfecta (OI), fibrous dysplasia, neuromuscular disorders, bone dysplasia, idiopathic juvenile osteoporosis, rheumatologic disorder and even Crohn's disease. In OI patients, bisphosphonates have become an important symptomatic therapy for moderate and severe forms of the disease, because their inhibitory effect on osteoclasts increases bone mineralization and density, thereby reducing the risk of bone fractures. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) has become an increasingly common complication as the use of these drugs is becoming more widespread in adults. However, the evidence for BRONJ in paediatric patients is scarce. We present a case of a patient with OI on IV bisphosphonate therapy who required dental extractions and review the literature of the risk of BRONJ in this group of patients. Clinical Relevance: Dental clinicians need to be aware of the potential risk of BRONJ in paediatric patients who have had intravenous bisphosphonate therapy. It is important that these patients are identified and managed appropriately.
Guidelines for the assessment of the impacted maxillary canine
Authors: Counihan Kate , Al-Awadhi EA , Butler Jonathan 
Published: August 2017

Canine impactions are frequently encountered, occurring in 1.7% of the population. The aim of this paper is to provide guidance on the assessment and management of cases which present in general dental practice. Canine position is considered in four categories; canine overlap with adjacent incisor, vertical canine height, angulation to midline and position of canine root apex. Good, average and poor prognostic outcomes are considered for each category and a brief outline of their management is included. Clinical Relevance: Canine impactions frequently present during routine examination. Appropriate recognition, investigation and referral, if necessary, are paramount to successful treatment.
The importance of early intervention in the treatment of dental infection
Authors: Paterson Paul , Nichols Elizabeth Hannah , Watson Katie , Boyd Deborah 
Published: August 2017

With recent reports of increasing hospital admissions relating to dental infection, the authors believe it is time to re-visit the importance of its effective early treatment. A series of three cases is used to illustrate the potentially life-threatening progression of what, in the early stages, is an easily treatable condition. Clinical Relevance: The principles of effective management of dental infection are highlighted in the first instance and then indications for specialist maxillofacial referral are discussed.
The state-of-the-art of ART sealants
Authors: Frencken Jo E 
Published: August 2017

Sealing caries-prone pits and fissure systems is an effective caries-preventive measure. There are basically two types of sealant materials: glass-ionomer and resin-based materials. Low-and medium-viscosity glass-ionomers were initially used and showed a low level of retention. With the advent of the ART approach in the mid-nineties, high-viscosity glass-ionomers were introduced as sealant material and the retention rate of ART sealants increased substantially. As the effectiveness of a sealant is measured by its capacity to prevent (dentine) carious lesion development, sealant retention is considered a surrogate endpoint. The ART sealant protocol is described. Systematic reviews and meta-analysis covering low-medium-and high-viscosity glass-ionomer (ART) sealants have concluded that there is no evidence that either glass-ionomer or resin-based sealants prevent dentine carious lesions better. The annual dentine carious lesion development in teeth with high-viscosity glass-ionomer ART sealants over the first three years is 1%. These ART sealants have a high capacity of preventing carious lesion development. Because no electricity and running water is required, ART sealants can be placed both inside and outside the dental surgery. Clinical Relevance: High-viscosity glass-ionomer ART sealants can be used alongside resin-based sealants.
Aspects of dento/medico-legal report writing
Authors: Wood Geoff D 
Published: August 2017

This paper offers some guidance on aspects of dento/medico-legal report writing, citing anonymized examples from the author's caseload for clarification of the points made, and also serves to illustrate that sometimes not everything is as straightforward as it may initially appear. It provides reference to the current Civil Procedure Rules in England and Wales and its relevance in report writing. Clinical Relevance: To provide guidance on aspects of dento/medico-legal report writing.
Metastatic involvement of the maxillary antrum from an uncommon source
Authors: Elledge Rokhsareh , Elledge Ross OC , Raskauskiene Diana 
Published: August 2017

Metastatic involvement of the jawbones is uncommon, particularly in the maxilla. Case reports of such metastases from renal cell primaries are few, making a consensus on treatment difficult to establish. We present a case of metastatic involvement of the maxilla two years following a nephrectomy for renal cell carcinoma. The case exemplifies the broad range of symptoms attributable to metastases in the maxilla and the management dilemmas. Clinical Relevance: The case highlights the role of practitioners in primary dental care in identifying the potential for such pathology based on clinical and radiographic features.
TADs: an evolutionary road to success
Authors: Pace Audrey , Sandler Jonathan 
Published: August 2017

This is a literature search about the clinical use of temporary anchorage devices (TADs) as a means of providing effective orthodontic anchorage. It takes the reader through a journey from the initial description of the technique to the enormous popularity TADs are currently experiencing in clinical practice. This paper aims to present good quality clinical information to allow the clinician and the patient to make an informed decision. Clinical Relevance: The purpose of this literature review is to provide readers with an overview of the current available literature on this subject and encourage general dental practitioners to adopt a more evidence-based approach to this aspect of orthodontic care.
Does stress predispose to periodontal disease?
Authors: Parwani Rajkumar N , Parwani Simran R 
Published: August 2017

The relationship of a sound mind to the maintenance of a healthy body has been recognized throughout most of recorded history. The term ‘stress’ is used to describe adverse emotions or reactions to unpleasant experiences. Individuals with high levels of stress and poor coping skills experience twice as much periodontal disease as compared to those with minimal stress and good coping skills. Although stress may predispose an individual to more destruction from periodontitis, the presence of periodontal pathogens remains the essential aetiologic factor. This review presents a summary of stress, discussing how it can predispose an individual to periodontal disease. Clinical Relevance: Stress, which is a universal phenomenon, is implicated to have various systemic effects besides being a risk factor for periodontal disease. This article elucidates the relationship between psycho-social stress and destructive periodontal disease.
Haemostasis part 1: the management of post-extraction haemorrhage
Authors: McCormick Neal J , Moore Undrell J , Meechan John G 
Published: August 2017

The management of bleeding complications following a dental extraction is an essential skill for the dental practitioner. Extractions are often carried out on patients with complex medical histories and a long list of medications. This paper aims to help the clinician manage post-extraction haemorrhage. A review of the management of patients on anti-thrombotic medications will be covered in a subsequent paper. Clinical Relevance: This article reviews the management of haemorrhage following tooth extraction; from the risk assessment of any underlying medical conditions and medications, to the clinical techniques used to control bleeding following an extraction.
Bilateral balanced articulation: science or dogma?
Authors: Farias-Neto Arcelino , Carreiro Adriana da Fonte Porto 
Published: August 2017

For more than a hundred years, it has been supposed that canine guidance should be avoided in conventional complete dentures, since it would result in denture instability. Thus, bilateral balanced articulation has been held by many authors as fundamental for treatment success. However, randomized clinical trials have shown that balanced articulation is not as important as previously thought. The issue about which occlusal concept is the most appropriate for individual needs is clinically and economically relevant for both the dentist and dental technician. Therefore, the purpose of this study is to provide an evidence-based update on complete denture occlusion. Clinical Relevance: The issue about which occlusal concept is the most appropriate for individual needs is clinically and economically relevant.
Electronic cigarettes: harm reduction or another addiction?; the dental perspective
Authors: Holliday Richard , Horridge Catherine , Corson Margaret 
Published: August 2017

The use of electronic cigarettes (e-cigarettes) has grown rapidly over recent years with an estimated 2.1 million people ‘vaping’ in the UK. E-cigarettes are battery-powered devices which simulate smoking. A heated element vaporizes chemicals, usually nicotine plus diluents like propylene glycol and glycerine as well as flavourings, which are then inhaled. Only limited research exists on the safety and efficacy of e-cigarettes and opinions are divided in the health profession as to whether they should be endorsed or not. Similarly, at a regulatory level and among the general public, an intense debate is taking place as to how they should be considered. In this paper we will review the available research with regards to e-cigarette contents, safety and health effects. As the mouth will take the initial insult from the vapour, we consider the potential effects on oral health as well as discussing the current regulatory and political position, so that we can be in a more informed position to advise our patients. Clinical Relevance: As dental health professionals it is already our duty of care to educate patients about the impact of smoking on their oral health. So if patients look to alternatives in the form of e-cigarettes, it is important that we are informed about this new technology and its potential effects on oral health to be able to advise in discussions on the subject.
Management of patients with non-syndromic clefts of the lip and/or palate part 1: from antenatal diagnosis to primary surgery
Authors: McIntyre Grant T 
Published: August 2017

Patients with clefts of the lip and/or palate require input from a diverse group of medical, surgical, dental and parasurgical specialties working as part of a multidisciplinary team in the UK. Co-ordinated care ensures that the patient receives optimal treatment whilst minimizing the burden of care for the NHS and family. The primary care dentist has an important role in the overall management of patients with clefts. Because the dentist-patient/parent relationship is of a long-term nature, the primary care dentist can also provide useful support and advice for families as they progress through the care pathway. This three-part article will illustrate the integration of dentistry with the other aspects of care. Clinical Relevance: Dentists should be aware of the different types of cleft lip and/or palate that occur and the role of the dentist in the overall management of patients who have clefts.
The dos and don'ts of social networking in dentistry
Authors: Khatoon Binish , Hill Kirsty B , Walmsley A Damien 
Published: August 2017

Online social networking sites are a popular way to share interests, build and maintain relationships and stay more connected to the world. Tools that were not available a few years ago are now used on a daily basis. Social networking has been likened to a digital tattoo. Both Universities and Healthcare Institutions have concerns about the potential implications that students, educators and practitioners may face when using the media. The main concerns are related to patient protection by both qualified and student healthcare workers. This article outlines the guidelines put in place to avoid any mistakes made on SNS and how to maintain an e-professional aura whilst using SNS. Examples of good and bad social networking by students and practitioners are given. How the implementation of recently introduced guidelines impacts on the use of SNS in dentistry requires further research. Clinical Relevance: Social networking has become part of everyday life and yet it can create problems for dental healthcare professionals as they attempt to accommodate both personal and professional ‘aura’ in the medium.
Local drug delivery in the management of periodontal diseases part 1: general principles
Authors: Eastham Jane E , Seymour Robin A 
Published: August 2017

Periodontal pockets provide an ideal environment for the application of local drug delivery for the management of periodontitis. In this first article, consideration is given to the principles that underlie local drug delivery and the pharmacological challenges. It is essential that such systems are compatible with the periodontal tissues. Potential unwanted effects that can arise from both drug and delivery vehicle are also appraised. Clinical Relevance: Local drug delivery systems still have a place in the management of periodontal diseases. This first article considers the pharmacological principles and unwanted effects that can arise from the use of such systems.