bluuebunny/crossref_metadata_2025_split huggingface dataset:
Importance of quality in referral letters sent for potentially malignant oral, head and neck lesions
Authors: Patel Mital , Khan Adeel Qutub , Thiruchelvam Janavikulam 
Published: August 2017

Early diagnosis of oral, head and neck cancer is very important. Delay in diagnosis and referral to a specialist unit can result in an enlarged tumour with an increased chance of metastatic spread which will result in upstaging of the tumour, thus worsening the five year survival rate. There is a great need for early identification and referral of potentially malignant lesions by general dental and medical practitioners. Referral letters are the standard and, typically, the sole method of communicating confidential information between two professionals. It is vital that the referral letters sent for potential malignant lesions are of good quality, clearly marked as urgent and contain adequate administrative and clinical data. An audit was undertaken at the Oral and Maxillofacial Department at Barnet and Chase Farm NHS Trust, to examine the quality of referral letters sent for potentially malignant oral, head and neck lesions. The outcome is discussed and a standard referral letter is also proposed if not referring using the standard local cancer network referral proforma. Clinical Relevance: A good quality referral letter should minimize delay in diagnoses and management of a patient with an oral, head and neck lesion.
Practical considerations for treatment of patients taking bisphosphonate medications: an update
Authors: Brock Gareth , Barker Kate , Butterworth Christopher J , Rogers Simon 
Published: August 2017

Osteonecrosis of the jaw – bisphosphonate-related (ONJ-BR) is an established clinical entity associated with both oral and intravenous (IV) bisphosphonate therapy. An update for the general practitioner on the indications for bisphosphonate therapy and both risk assessment and prevalence of ONJ-BR is provided. Management philosophy within a local unit is illustrated through four brief case studies. It is not uncommon to encounter patients on bisphosphonate therapy in the dental practice environment; the vast majority of these will be on oral bisphosphonates as part of their management for osteoporosis. The risk of developing ONJ-BR is rare in these patients compared with those receiving treatment for skeletal complications associated with cancer, many of whom will be managed with IV bisphosphonates. Although rare, it is important to recognize the potential risk of ONJ-BR. Whilst most patients on oral bisphosphonates can be managed no differently from other patients, it should be appreciated that the relative risk of long-term cumulative exposure, comorbidity and other factors are still to be determined. Surgical intervention and extractions can place the patient at risk of ONJ-BR and vigilance is necessary to ensure that healing progresses satisfactorily. Early referral to the local hospital should be sought if there is cause for concern. Clinical Relevance: Although the risk of ONJ-BR is low in non-oncological indications, it is important to be aware that it exists and to know how the risk may be minimized.
Recurrent intra-oral herpes simplex 1 infection
Authors: Westley Suzanne , Seymour R A , Staines Konrad 
Published: August 2017

Human herpes simplex 1 virus (HSV-1) is a DNA virus that has the ability to lie latent and be subsequently re-activated at any point during a patient's life. In the immunocompetent patient, resolution of clinical signs and symptoms usually occurs spontaneously after 14 days. In the immunocompromised patient, healing is often delayed and the effects are much more debilitating. Indications for therapeutic regimes of systemic antiviral treatment are discussed. Clinical Relevance: Recurrent oral ulceration caused by HSV-1 may be seen by the general dental practitioner and can cause significant morbidity.
Fabrication of an auricular prosthesis: a case report
Authors: Prabhu Nayana , Kumar Sandeep , Gupta Seema 
Published: August 2017

The fabrication of ear prosthesis is considered by many prosthetists to be one of the more difficult replacements in maxillofacial reconstruction. The severe undercuts and pronounced convolutions of the ear's surface present a challenge in simulating a natural proportioned prosthesis. The mould for the ear is generally made by creating a three surface die to reproduce the unique configuration adequately and to allow retrieval of the finished prosthesis without damage. This article presents an outlined procedure in the basic fabrication of a prosthetic ear by a conventional technique where the wax pattern is fabricated from the impression of an individual with a similarly proportioned ear. Clinical Relevance: Fabricating an auricular prosthesis may be part of the work of a maxillofacial department.
Contemporary adhesive bonding: bridging the gap between research and clinical practice
Authors: Green DJB , Banerjee A 
Published: August 2017

The dawn of minimally invasive dentistry has led to the development of materials which rely on the use of effective adhesion to bond to remaining tooth tissue. Successful adhesive bonding is dependent upon appreciating the quality of the dental substrate, appropriate clinical handling of the material and patient, together with an appreciation of the chemistry of the adhesive. This paper outlines the current status of contemporary bonding, with particular emphasis on translating laboratory-based evidence into clinical practice. Using laboratory-based evidence, the ability of a bond to achieve a seal to enamel appears to be the best predictor of clinical performance. Clinical Relevance: This article discusses the issues raised when translating research data about adhesive bonding from the laboratory to clinical dental practice.
Anterior open bite: aetiology and management
Authors: Sandler Paul Jonathan , Madahar Arun K , Murra Alison 
Published: August 2017

Anterior open bite has a multi-factorial aetiology comprising: genetically inherited skeletal pattern, soft tissue effect and digit-sucking habits. To formulate an appropriate treatment plan, accurate diagnosis is essential. Simple open bites may sometimes resolve completely during the transition from mixed to permanent dentition, if the digit-sucking habit is broken. More significant open bites, however, sometimes extending right back to the terminal molars, rarely resolve spontaneously and will often require complex orthodontic treatment, involving active molar intrusion or even major orthognathic surgery. Unfortunately, surgery has associated risks attached, including pain, swelling, bruising, altered nerve sensation and, occasionally, permanent anaesthesia, as well as involving significant costs, as with any major surgical procedure under general anaesthesia. The introduction of Temporary Anchorage Devices (TADs) has expanded the possibilities of orthodontic treatment, beyond traditional limitations of tooth movement. Molar intrusion can be successfully carried out without the need for major surgical intervention, thus avoiding all the attendant risks and disadvantages. This paper provides an overview of anterior open bite and uses an illustrative case where open bite was successfully treated with a combination of fixed appliance therapy and TADs. Clinical Relevance: Anterior open bite is commonly seen in general practice. A knowledge of the possible aetiological factors and their potential management should be understood by general dental practitioners. The increased popularity of TADS allows a new and less invasive approach to management of these cases.
A review of root fractures: diagnosis, treatment and prognosis
Authors: Malhotra Neeraj , Kundabala M , Acharaya ShashiRashmi 
Published: August 2017

Tooth fractures (crown or root fractures) are commonly encountered emergencies in a dental clinic. Root fractures are defined as fractures involving the dentine, cementum and pulp. They are broadly classified as horizontal and vertical root fractures. They may be clinically challenging cases to treat as, usually, treatment of such cases requires an interdisciplinary/multidisciplinary approach for complete rehabilitation of teeth. For a successful outcome, it is imperative to arrive at an appropriate diagnosis and design a treatment plan accordingly as soon as possible. This review article discusses the various types of root fractures, their diagnosis and treatment, along with the factors affecting their healing and prognosis. Clinical Relevance: Treatment of root fractures depends on a number of factors such as, position of fracture line, mobility of tooth and pulpal status. Thus clinicians must have thorough knowledge and adequate clinical experience to treat them properly.
Dislodged lower right third molar tooth into the parapharyngeal space
Authors: Ogadako Rhiyoma Monique , Woods Martin , Shah Neil 
Published: August 2017

Lower third molar teeth can be dislodged into fascial tissue spaces when they are extracted or elevated out of their sockets. Thankfully, this rarely occurs. We present a case report on a lower right wisdom tooth dislodged into the right parapharyngeal space on its removal from the socket and the subsequent management of this rare complication. Clinical Relevance: Though a rare complication, clinicians have to be aware that lower third molars can be dislodged into tissue spaces and the importance of prompt appropriate management.
Sedation for patients with movement disorders
Authors: Curl Charlotte , Boyle Carole 
Published: August 2017

The general features of the movement disorders are outlined and the effects of inhalational sedation with nitrous oxide and oxygen and intravenous sedation, using midazolam, are described. Two case reports of patients with cerebral palsy treated in a community care setting are presented, and the advantages of intravenous and inhalational sedation are explained. Clinical Relevance: Inhalational sedation (IS) with nitrous oxide and intravenous sedation (IVS) with midazolam can be useful aids to reduce unwanted movements in patients with movement disorders during dental treatment.
The role of the general dental practitioner in managing the oral care of head and neck oncology patients
Authors: Moore Suzanne , Burke Mary C , Fenlon Michael R , Banerjee Avijit 
Published: August 2017

The general dental practitioner (GDP) plays a critical role in managing head and neck cancer patients. The first and most important role is to offer preventive services, particularly to smokers and to patients who drink alcohol to excess. It is of critical importance that every patient has a systematic examination of oral soft tissues when seen by a GDP. All patients with suspicious lesions should be referred for urgent attention to a specialist centre. Once oral cancer has been diagnosed, GDPs may be presented with patients requiring urgent dentistry, including extractions before commencement of treatment, requiring palliation of symptoms during treatment, or requiring general dentistry after treatment. Radiotherapy provides increased survival but has serious adverse consequences, which may be lifelong, including dry mouth, radiation caries, limitation of mouth opening and high risk of osteonecrosis after extractions. Extraction of teeth in irradiated bone should be referred to specialist centres. Improving survival rates and an ageing population mean that GDPs will see many more survivors of head and neck cancer in the future, with an increased burden of dental care in the longer term and an increased need for monitoring and secondary prevention. Clinical Relevance: The management of patients with head and neck cancer is complex and involves a multi-disciplinary team, both in the primary treatment but also in the long-term care. This paper reviews the consequences of treatment for head and neck cancer and gives practical advice for GDPs and their team in the long-term care of these patients.
Should deciduous teeth be restored? reflections of a cariologist
Authors: Kidd Edwina 
Published: August 2017

Whether deciduous teeth should be restored has caused controversy for at least 150 years and the argument rages on. Dental caries is a controllable process. The role of operative dentistry and restorations, as far as caries control is concerned, is to make cavitated, uncleansible lesions accessible to plaque control. However, deciduous teeth are exfoliated and perhaps non-operative treatments (plaque control, fluoride, diet) are all that are required to take cavitated teeth pain-free to exfoliation. Are such techniques child-friendly, obviating the need for anaesthesia or the use of handpieces? Alternatively, are they wanton neglect? This paper is written by a cariologist who never treated children, to present alternative managements and rehearse these arguments from a cariological perspective.Clinical Relevance: This paper might serve as a discussion document for a group of dentists deciding practice policy with regard to the management of caries in deciduous teeth.
Aphasia – the hidden disability
Authors: Orchardson Robert 
Published: August 2017

Aphasia is an acquired language disorder due to brain damage and which may include difficulty in producing or comprehending spoken or written language. Stroke is the commonest cause and each year 50,000 new patients develop aphasia. People with aphasia differ in their speech output and in their fluency. Some people communicate reasonably well, while others have very limited powers of expression. This review will describe the neurology of speech and aphasia, and will focus on the role of the speech and language therapist in dealing with people with aphasia. Clinical Relevance: Dentists and their staff should be aware that after a stroke some people are unable to talk or have limited powers of expression. Comprehension might be impaired and people with aphasia may be unable to grasp some common language, such as appointment letters and patient information.
The ovate pontic for fixed bridgework
Authors: Gahan Matthew J , Nixon Peter J , Robinson Stephen , W-Y Chan Martin F 
Published: August 2017

The provision of fixed prosthodontic restorations that meets the patient's functional and aesthetic demands can be challenging, especially in the anterior maxilla. It requires close communication with the technician and knowledge of the available options. This article will outline the options for pontic design and focus on the ovate pontic, which has the potential to provide the most aesthetic outcome. This should equip the practitioner with the knowledge as to which pontic to prescribe if such a challenge arises. Clinical Relevance: Fixed bridgework is a commonly prescribed prosthesis for the replacement of missing teeth. In order for this to be provided successfully, the practitioner should have a working knowledge of the available options for pontic design. This is especially important in cases where aesthetic demands are high.
Reducing the risk of failure in complete denture patients
Authors: Critchlow SB , Ellis JS , Field JC 
Published: August 2017

This paper aims to review the factors associated with an increased risk of failure in complete denture patients, based on the strength of the available evidence base. These include accuracy of jaw relations, a poorly formed mandibular ridge, poor quality dentures and patient neuroticism. Clinical strategies for overcoming these issues are described with particular reference to impression-taking and jaw relations. Clinical Relevance: Identifying potential problems will help to improve outcomes for edentulous patients treated with conventional complete dentures.
The role of the general dental practitioner (GDP) in the management of abuse of vulnerable adults
Authors: Moore R , Newton J T 
Published: August 2017

Abuse of vulnerable adults is largely under reported. The most common forms of abuse amongst this group are neglect and financial abuse, although an individual may be at risk of any or all forms of abuse. Certain individuals are at an increased risk of abuse due to their domestic environment and any physical or mental disability they may have. Clinical Relevance: Vulnerable adults constitute a significant proportion of the population. GDPs should be aware of the signs of abuse, to be able to identify those individuals at risk, and how and when to raise concerns of abuse to social services.
The potential for resin infiltration technique in dental practice
Authors: Paris Sebastian , Meyer-Lueckel Hendrik 
Published: August 2017

Caries infiltration is a micro-invasive treatment to arrest non-cavitated caries lesions. The method is based on the penetration of low-viscosity light-curing resins, so called infiltrants, into the pores within the enamel lesion. That way, diffusion pathways for cariogenic acids are occluded, resulting in a reduction or even arrest of lesion progression. A positive side-effect of caries infiltration is that lesions change their optical properties and appear similar to sound enamel. Therefore, caries infiltration can also be used to camouflage aesthetically disfiguring white spot lesions on buccal surfaces. Clinical Relevance: Resin infiltration is a micro-invasive treatment to arrest and to camouflage non-cavitated proximal caries lesions that virtually bridges non-invasive and restorative treatment options.
An ectopic tooth concealing an odontogenic myxoma
Authors: Singh Parmjit , Davies Huw Teifion 
Published: August 2017

This case report presents a 13-year-old girl who attended an orthodontic clinic for an ectopic UR5. After investigation, a diagnosis of an odontogenic myxoma was made and the tumour was excised. A panoramic radiograph taken almost two years earlier for another dental problem was found to show an ectopic UR5 associated with a subtle radiolucency. Odontogenic myxomas may be of higher frequency than once thought in the paediatric population and therefore should always be considered in the differential diagnosis of any intraosseous radiolucency. Any radiolucent area associated with an unerupted tooth should be investigated further or closely followed up. Clinical Relevance: The odontogenic myxoma is a rare but potentially serious benign tumour of the jaws.
The long and winding road – the journey of a cleft lip and palate patient part 1
Authors: Madahar Arun K , Murray Alison , Orr Robert , Sandler Paul Jonathan 
Published: August 2017

Patients with a cleft lip and palate (CLP) deformity require the highest standard of care that can be provided and this requires multidisciplinary care from teams located in regional cleft centres. Care of these cases is from birth to adulthood and requires several phases of intervention, corresponding to the stages of facial and dental development. Management ideally starts pre-natally, following the initial diagnosis, and occasionally pre-surgical appliances are prescribed. The lip is ideally repaired within three months, followed by palate closure between 12 and 18 months. Careful monitoring is required in the first few years and ENT referral, where necessary, will diagnose middle ear infection, which commonly affects CLP patients. Speech therapy is an integral part of the ongoing care. Excellent oral hygiene is essential and preventive dietary advice must be given and regularly reinforced. Orthodontic expansion is often needed at 9 years of age in preparation for a bone graft and, once the permanent dentition erupts, definitive orthodontic treatment will be required. Maxillary forward growth may have been constrained by scarring from previous surgery, so orthognathic correction may be required on growth completion. Final orthodontic alignment and high quality restorative care will allow the patients to have a pleasing aesthetic result. CLP patients and their families will need continuing support from medical and dental consultants, specialist nurses, health visitors, speech and language specialists and, perhaps, psychologists. These two articles outline the principles of care for the CLP patient and, secondly, illustrate this with a case report, documenting one patient's journey from birth to 21 years of age. Clinical Relevance: A successful outcome for CLP patients requires a sound dentition. The general dental practitioner role is vital to establish and maintain excellent oral hygiene, a healthy diet and good routine preventive and restorative care. Understanding the total needs of CLP patients can help the dentist to provide high quality care as part of the multidisciplinary management.
Overview of paediatric dental sedation: 2. nitrous oxide/oxygen inhalation sedation
Authors: Wilson Katherine E 
Published: August 2017

The use of conscious sedation for the management of anxious paediatric dental patients is extremely beneficial. Inhalation sedation with nitrous oxide and oxygen remains the mainstay for paediatric sedation in the UK. Clinical Relevance: Dentists carrying out inhalation sedation for dental treatment must be fully conversant with the technique and the principles of patient management.
Dental fluorosis in the paediatric patient
Authors: Atia Gahder-Sara , May Joanna 
Published: August 2017

Exposure to excessive fluoride intake during the early childhood years can disrupt the normal development of enamel, resulting in dental fluorosis. This varies in severity, ranging from white opacities in mild cases to more severe black and brown discoloration or enamel pitting. This article aims to give the reader a better understanding of the aetiology, diagnosis and subsequent treatment of dental fluorosis in the paediatric patient. Clinical Relevance: Fluorosis can have a marked effect on dental aesthetics. The prevalence of fluorosis in the United Kingdom may increase following the publication of Delivering Better Oral Health, published by the Department of Health in 2007, 1 which suggested changes to fluoride levels in children's toothpastes. This article highlights the importance of accurate diagnosis of fluorosis and also explains the treatment options available to paediatric patients.
Dental materials – what goes where? the current status of glass ionomer as a material for loadbearing restorations in posterior teeth
Authors: Burke FJT 
Published: August 2017

Glass ionomer materials have been available for 40 years, but have not been indicated for loadbearing restorations, other than when used in the ART concept. However, there is anecdotal evidence that dentists are using the reinforced versions of this material in posterior teeth, possibly as a result of demands from patients to provide them with tooth-coloured restorations in posterior teeth at a lower cost than resin composite. This paper reviews the existing literature on reinforced glass ionomer restorations in posterior teeth, concluding that, under certain circumstances (which are not fully elucidated) these materials may provide reasonable service. However, the patient receiving such restorations should be made aware of the minimal amount of evidence for the success of these restorations and the potential need for the restorations to be re-surfaced in due course. Clinical Relevance: Reinforced glass ionomer restorations may provide patients with tooth-coloured restorations in posterior teeth, but their survival may not equate to restorations in resin composite in loadbearing situations.