bluuebunny/crossref_metadata_2025_split huggingface dataset:
An overview of preformed metal crowns part 2: the hall technique
Authors: Hyde Amy C , Rogers Helen J , Batley Haris A , Morgan Annie G , Deery Chris 
Published: August 2017

Part 2 of this series of two articles addresses the Hall Technique for preformed metal crowns. It will discuss the need for an effective child and dentist friendly method to restore carious primary molars. The technique is described in detail and the evidence for its effectiveness and acceptance by children, parents, dentists and dental educators is presented. CPD/Clinical Relevance: Dentists and dental care professionals should be aware of the evidence to support the adoption of the Hall Technique.
The francis report – implications for the education and training of dental professionals
Authors: Bissell Vince , Felix David H 
Published: August 2017

This paper explores the implications of the Francis Report for education of the dental team. It considers selection of candidates for training, issues relating to the curriculum itself, including assessment and the importance of listening to trainees. The overriding importance of the ‘informal’ or ‘hidden’ curriculum, through which students and trainees observe their teachers and develop a sense of the professional and ethical culture within an educational institution, is stressed. Clinical Relevance: Sound education, rooted in the recognized ethical principles highlighted in the Francis Report, is essential to the delivery of a dental work force that will deliver care according to the fundamental standards laid down by the GDC.
An update on crown lengthening part 2: increasing clinical crown height to facilitate predictable restorations
Authors: Kalsi Harpoonam Jeet , Bomfim Deborah Iola , Darbar Ulpee 
Published: August 2017

This is the second paper in this two-part series. Paper one provided an overview of managing gingival tissue excess and paper two will focus on increasing clinical crown height to facilitate restorative treatment. Crown lengthening is a surgical procedure aimed at the removal of gingival tissue with or without adjunctive bone removal. The different types of procedure undertaken will be discussed over the two papers. In order to provide predictable restorations, care must be taken to ensure the integrity of the margins. If this is not taken into account it can lead to an impingement on the biologic width, which may in turn lead to chronic inflammation resulting in recession or the development of periodontal problems which can be hard to manage. Clinical Relevance: This paper aims to reinforce the need for thorough diagnosis and treatment planning and provides an overview of the various procedures that can be undertaken.
Pain part 2a: trigeminal anatomy related to pain
Authors: Renton Tara , Egbuniwe Obi 
Published: August 2017

In order to understand the underlying principles of orofacial pain it is important to understand the corresponding anatomy and mechanisms. Paper 1 of this series explains the central nervous and peripheral nervous systems relating to pain. The trigeminal nerve is the ‘great protector’ of the most important region of our body. It is the largest sensory nerve of the body and over half of the sensory cortex is responsive to any stimulation within this system. This nerve is the main sensory system of the branchial arches and underpins the protection of the brain, sight, smell, airway, hearing and taste, underpinning our very existence. The brain reaction to pain within the trigeminal system has a significant and larger reaction to the threat of, and actual, pain compared with other sensory nerves. We are physiologically wired to run when threatened with pain in the trigeminal region and it is a ‘miracle’ that patients volunteer to sit in a dental chair and undergo dental treatment. Clinical Relevance: This paper aims to provide the dental and medical teams with a review of the trigeminal anatomy of pain and the principles of pain assessment.
Mouth cancer for clinicians part 1: cancer
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 a simplified overview of carcinogenesis, and a review of cancers that affect the oral region.
Osteochondroma of the mandibular condyle: an unusual case of dentofacial asymmetry
Authors: Power Andrew , Carter Lachlan 
Published: August 2017

An osteochondroma of the mandibular condyle is a rare tumour of the maxillofacial region that could first present to the general dental practitioner. This case report describes an osteochondroma of the posterio-medial mandibular condyle presenting with marked facial asymmetry and trismus over a six-month period. Appropriate referral and investigation enabled successful removal of the tumour, recontouring of the condyle and an uncomplicated, positive outcome for our patient. Clinical Relevance: Temporomandibular joint disorders can be a cause of dento-facial asymmetry. Pathology of the temporomandibular joint should be considered in the differential diagnosis when such a patient presents.
Denosumab, an alternative to bisphosphonates but also associated with osteonecrosis of the jaw – what is the risk?
Authors: Sidhu Harlene Kaur 
Published: August 2017

Most dental professionals will have, or will soon, encounter patients prescribed this novel alternative antiresorptive drug to bisphosphonates, denosumab (Prolia®, Xgeva®). Denosumab is licensed in the UK for the prevention of osteoporotic fractures in postmenopausal women and the prevention of skeletal-related events (SRE) in adults with bone metastases. The presence of osteonecrosis of the jaw in patients receiving non-bisphosphonate antiresorptives has led to the introduction of the term antiresorptive-related osteonecrosis of the jaw or ARONJ. This paper discusses the basic physiology of bone remodelling, the pharmacology of bisphosphonates and denosumab, and the risk of ARONJ. CPD/Clinical Relevance: What is the potential risk of ARONJ arising from dental treatment that we should be advising for our patients?
An unusual extranodal presentation of mycobacterium tuberculosis in the upper lip
Authors: Taute Rachel B , Wylie Jennifer , Carter Lachlan 
Published: August 2017

Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide, with a peak incidence in South-East Asia and Sub-Saharan Africa. A significant number of patients in the UK are affected. Extra-pulmonary TB presentation varies, and includes head and neck manifestations that can present on routine examination in the dental practice setting. We report an unusual case of extra-nodal TB in the upper lip, and provide some guidance to general dental practitioners on the presenting features of such lesions, and what to refer for further investigation where TB is included in the differential diagnosis. CPD/Clinical Relevance: This case report highlights important factors in TB diagnosis, with particular emphasis on presenting features relevant to general dental practitioners, and informs on the accepted and current treatment regimen.
Mouth cancer for clinicians part 3: risk factors (traditional: tobacco)
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. CPD/Clinical Relevance: This article offers the dental team an overview of the main cancer risk factors, tobacco and alcohol, betel and other chewing habits, and environmental factors.
Decision-making for residual periodontal pockets after aetiological treatment
Authors: Bouziane Amal , Benrachadi Latifa , Ennibi Oumkeltoum 
Published: August 2017

The practitioner may have difficulties making decisions regarding the most appropriate therapeutic approach in the case of the persistence of periodontal pockets after initial periodontal treatment. Several options may be considered: aetiologic retreatment, maintenance, surgery of the pocket or extraction of the tooth for strategic reasons or when the conservation of the tooth is impossible. There are no clear guidelines for the treatment decision. The aim of this article is to present the main factors involved in making a treatment decision. An algorithm and its background rationale are presented to help the practitioner make a decision about residual periodontal pockets after aetiological treatment. CPD/Clinical Relevance: Many factors need to be considered in making a treatment decision for residual periodontal pockets: depth of the pocket, presence of signs of infection, difficulty of access to deposits and the type of periodontal lesion.
Oral ulceration in newly diagnosed leukaemic patient with undiagnosed sweet's syndrome
Authors: Brierley Daniel , Slater David N , Snowden John , Holt Debbie , Hegarty Anne 
Published: August 2017

Sweet's syndrome is a relatively rare but important skin condition which can affect the oral cavity. Awareness of this reactive condition is important for dentists who work in hospitals, where it is most likely to present. This report summarizes one such case and aims to introduce the reader to Sweet's syndrome. CPD/Clinical Relevance: Oral ulceration is a common condition occurring in medical inpatients for which oral and maxillofacial surgery and medicine senior house officers and specialists are often asked to review on the ward. An awareness of Sweet's syndrome is important as it is most likely to occur in this setting and may present with oral ulceration.
Modern endodontic planning part 1: assessing complexity and predicting success
Authors: Jawad Sarra , Taylor Carly , Roudsari Reza Vahid , Darcey James , Qualtrough Alison 
Published: August 2017

Following a diagnosis of irreversible pulpal disease, periapical disease or failed endodontic therapy, the options for the tooth are extraction or root canal treatment. There is increasing evidence that certain factors may allow the clinician to predict the likely outcome of root canal therapy (RCT) and thus better inform the patient of the possible success rates. Should the patient choose root canal treatment, the clinician must also be able to gauge the potential difficulties that may be encountered and consequently determine whether it is within their competency. CPD/Clinical Relevance: Assessing outcomes and complexity of care is an essential part of informed consent. Knowing when to refer is an essential component of best clinical practice.
Dental abrasion of incisor caused by a babies' dummy clip: a case report
Authors: Doğramacı Esma J , Rossi-Fedele Giampiero 
Published: August 2017

Tooth surface loss (TSL), the non-carious loss of tooth tissue, is considered pathological if the teeth involved experience sensitivity and pain, are functionally compromised or they detract from the patient's appearance. TSL is a common clinical finding in many patient groups, although differences between the primary and permanent dentition contribute to TSL occurring at a faster rate and with worse outcomes in the primary dentition. This case report presents localized abrasion and associated apical periodontitis affecting a single primary tooth in a 2-year-old infant following the misuse of a babies' dummy clip whilst teething. Abrasion is rare in the primary dentition. CPD/Clinical Relevance: This article highlights an unusual presentation of dental abrasion affecting the primary dentition caused by a previously unreported foreign object; abrasion in this case was a side-effect of soothing the discomfort of teething.
Mouth cancer for clinicians part 6: potentially malignant disorders
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 oral potentially malignant disorders.
Periodontal disease, dental implants, extractions and medications related to osteonecrosis of the jaws
Authors: Shah Neha P , Katsarelis Helen , Pazianas Michael , Dhariwal Daljit K 
Published: August 2017

Patients taking bisphosphonates and other anti-resorptive drugs are likely to attend general dental practice. The term ‘bisphosphonate’ is often immediately associated with osteonecrosis of the jaws (ONJ). Risk assessment and subsequent management of these patients should be carried out taking into account all the risk factors associated with ONJ. The introduction of newer drugs, also shown to be associated with ONJ, demands increased awareness of general dental practitioners about these medications. CPD/Clinical Relevance: This paper provides an update on medication-related ONJ and considers the effects of anti-resorptive drugs on the management of patients needing exodontia, treatment for periodontal disease and dental implant placement.
A case of undiagnosed harlequin syndrome presenting in general dental practice
Authors: Edwards Kathryn , Schaefer Andrew , Greenwood Mark , Staines Konrad 
Published: August 2017

Harlequin syndrome is a rare, clinically striking syndrome characterized by distinctly demarcated asymmetric facial flushing and sweating. It may be of idiopathic aetiology or caused by demonstrable ipsilateral damage to the sympathetic nervous system. 1 A case is described where a patient presented to her general dental practitioner complaining of distinctly demarcated unilateral facial flushing and sweating. Onward referral resulted in a diagnosis of Harlequin syndrome. CPD/Clinical Relevance: This article highlights the neurological signs and symptoms of Harlequin syndrome, making it easier to recognize if it presents in general dental practice.
A review of the available guidance regarding management of medical emergencies in primary dental care
Authors: Lello Suzanne , Burke Julie , Taylor Kathryn 
Published: August 2017

This article provides an overview of the recent changes in guidance relating to the management of medical emergencies in primary dental care in the UK. The guidance relating to automated external defibrillators is also presented. The expectations of our regulatory bodies are discussed, as are the requirements for continued professional development. The potential shortcomings of the changes to the guidance are also discussed, as well as proposed solutions, such as the development of algorithms to use in a dental practice setting. CPD/Clinical Relevance: All dental practitioners should be able to deal with medical emergencies in their practice.
An interesting case of oral inverted ductal papilloma
Authors: Berridge Natasha , Kumar Mahesh 
Published: August 2017

Ductal papillomas are rare benign papillary tumours of the minor salivary glands. Previously they have been classified into three subtypes: inverted ductal papilloma (IDP), sialadenoma papilliferum and intraductal papilloma. The oral inverted ductal papilloma is the least common of these lesions, with 48 cases reported to date in a search of the English-language literature. We describe an interesting case of oral IDP and highlight the pertinent clinical and histopathological features. Importantly, unlike the histologically similar inverted papilloma (IP) of the nose and paranasal sinuses, oral IDP is a completely benign lesion and is not associated with malignant change. CPD/Clinical Relevance: This case report aims to raise awareness of the lesion, oral inverted ductal papilloma (IDP). We outline the clinical features and unique histopathology of oral IDP so that clinicians may correctly diagnose such a lesion and implement appropriate treatment.
A festive case series of emergencies, admissions and friendship at a busy oral and maxillofacial unit
Authors: Keat Ross , Leavy Paul , Thomas Mathew 
Published: August 2017

The festive season presents oral and maxillofacial surgery (OMFS) dental core trainees (DCTs) with the challenges of managing an eclectic mix of emergencies. We present three such patients in this case series. First, Patient A, a 39-year-old homeless male who presented with a maxillary extra-oral draining sinus. Secondly, Patient B, a 38-year-old intra-venous (IV) drug user who suffered pan-facial fractures following an alcohol-fuelled assault. Finally, Patient C, a 38-year-old male who sustained a left zygomatic complex fracture a week previously, in attendance for corrective surgery. Despite the hardship, there was still festive cheer to be had by these individuals. CPD/Clinical Relevance: Primary and secondary care practitioners should be aware of the advanced clinical presentation of dental and maxillofacial emergencies that occur over holiday periods.
A guided, conservative approach for the management of localized mandibular anterior tooth wear
Authors: Mehta Shamir B , Francis Selar , Banerji Subir 
Published: August 2017

The successful management of the worn mandibular anterior dentition may present an awkward challenge to the dental operator. The purpose of this article is to describe a case report illustrating the use of a guided, three-dimensional protocol for the ultra-conservative and predictable restoration of the worn lower anterior dentition using direct resin composite. This technique utilizes information based on established biomechanical and occlusal principles to fabricate a diagnostic wax-up, which is duplicated in dental stone. This is used to prepare a vacuum-formed modified stent, assisting the clinician to place directly bonded resin composite restorations to restore the worn lower anterior dentition. The technique, described in 2012 and referred to as ‘injection moulding’ has the potential to offer optimal form, function and an aesthetic outcome in an efficient manner. CPD/Clinical Relevance: This article aims to describe an alternative technique to simplify the processes involved with restoration of worn lower anterior teeth.
Indications for cuspal coverage
Authors: MacInnes Andrew , Hall Andrew F 
Published: August 2017

Cuspal-coverage restorations are important to preserve the integrity of a weakened tooth against the forces of occlusion. This article discusses the clinical indications for both direct and indirect cuspal-coverage restorations and the evidence supporting their use. Factors that modify a tooth's ability to dissipate normal occlusal forces and the effect cuspal-coverage restorations have on force distribution are examined. Clinical criteria, choice of restorative material and methods for tooth preparation are also discussed.CPD/Clinical Relevance: Re-enforcement of weakened teeth with cuspal-coverage restorations provides a minimally invasive alternative to conventional crowns.
Modern endodontic principles part 6: managing complex situations
Authors: Taylor Carly , Roudsari Reza Vahid , Jawad Sarra , Darcey James , Qualtrough Alison 
Published: August 2017

Clinicians are often faced with endodontic cases that are significantly more challenging than the primary root canal treatment of mature adult teeth. This paper outlines some of the common treatment modalities which can be employed in situations in which either primary treatment has failed, or there is iatrogenic damage or unusual anatomy. CPD/Clinical Relevance: This paper will provide the reader with advice and techniques for undertaking orthograde endodontic retreatment, hemisection, endodontic surgery and management of teeth with incompletely formed roots.
Resin-bonded bridges – can we cement them 'high'?
Authors: Dayanik Sinem 
Published: August 2017

Controversy exists surrounding resin-bonded bridges (RBBs), particularly with regards to abutment preparation. Should the abutments be prepared? If the abutments are prepared what design should be adopted? If there is to be no preparation, will there be space for the restoration? Many factors need consideration when planning for this treatment. This article aims to explore the effect of abutment preparation. In this regard, a literature review was conducted to present the latest available evidence. CPD/Clinical Relevance: Minimal intervention is key in modern dentistry, so clinicians must be able to make confident decisions in the provision of minimally invasive treatments like the RBB and be aware of the latest evidence.
Return of the great pox
Authors: Scully Crispian , Setterfield Jane F 
Published: August 2017

Syphilis is on the increase globally. While recognized more frequently in patients with, HIV/AIDS, it is not unusual among immune competent individuals sometimes presenting with unusual manifestations and/or behaviour. This paper reviews the history and clinical features of syphilis and draws attention to the oral manifestations. CPD/Clinical Relevance: Syphilis should be in the differential diagnosis of oral ulcers or unusual oral lesions.
Allergy to chlorhexidine
Authors: Pemberton Michael N 
Published: August 2017

Chlorhexidine is an effective antiseptic which is widely used in dentistry. Over recent years, it has also been used in other healthcare products as well as in cosmetics. Anaphylaxis to chlorhexidine has been increasingly reported throughout the world, including two incidents in the UK where chlorhexidine-containing mouthwash had been used to wash tooth sockets following recent tooth extraction. Chlorhexidine is under-recognized as a cause of anaphylaxis and dentists should be aware of its potential for serious adverse effects. Dentists need to consider whether the washing out of a tooth socket with chlorhexidine solution should be avoided in the treatment of established dry socket. On current evidence the potential risks of using chlorhexidine as irrigation solution for treating an established dry socket appears to outweigh any known benefit. CPD/Clinical Relevance: Chlorhexidine has the potential to cause anaphylaxis in the dental surgery.
Counterfeit and non-compliant dental devices: the dangers and how to mitigate them
Authors: Proffitt Edmund 
Published: August 2017

The Medicines and Healthcare products Regulatory Agency (MHRA) is dealing with a growing number of counterfeit and non-compliant dental devices and instruments for sale to dental practices in the UK. This paper examines the extent of the issue, the dangers posed by the use of counterfeit and non-compliant products, discusses initiatives to address the problem and how the dental team can identify these products and mitigate the associated risks. CPD/Clinical Relevance: To ensure that all members of the dental team are aware of the dangers posed by counterfeit and non-compliant dental devices and instruments and how to mitigate such risks.