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, Pat...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. 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.
This series of three papers reviews the causes, diagnosis and differential diagnosis, and outlines the management of sore and/or swollen lips. Clinical relevance: Sore and/or swollen lips are not uncommon, often have a l...This series of three papers reviews the causes, diagnosis and differential diagnosis, and outlines the management of sore and/or swollen lips. Clinical relevance: Sore and/or swollen lips are not uncommon, often have a local cause, but may reflect a systemic disease. The previous article reviewed important causes, from actinic to contact cheilitis, while this paper starts with drug-induced cheilitis and completes that alphabetical list.
Root resorption is the loss of hard dental tissue as a result of odontoclastic action involving vital and pulpless teeth. Cervical root resorption (CRR) is a type of external resorption which usually occurs immediately b...Root resorption is the loss of hard dental tissue as a result of odontoclastic action involving vital and pulpless teeth. Cervical root resorption (CRR) is a type of external resorption which usually occurs immediately below the epithelial attachment of the tooth in the cervical region. The idiopathic cervical resorption (ICR) refers to a clinical situation in which all other causes, whether local or systemic, have been ruled out as the origin of the disease. The early stage is asymptomatic and might be diagnosed by a routine radiograph or a clinical examination. In this study, the aetiological, histological, clinical and radiological analysis is undertaken; a review is made concerning the pathologies to which the differential diagnosis should be applied; and the different therapeutical options are discussed. This lesion sometimes demands the management of a broad field of multidisciplinary techniques such as restorative dentistry, endodontics, surgery, implants and prosthesis. Clinical relevance: Cone-beam computed tomography (CBCT) may be a useful tool to determine the true extent of external cervical resorption lesions.
For many years, it has been considered necessary to restore posterior support with a bilateral free-end saddle when a full upper denture is opposed by a shortened dental arch. It was thought that this would provide occlu...For many years, it has been considered necessary to restore posterior support with a bilateral free-end saddle when a full upper denture is opposed by a shortened dental arch. It was thought that this would provide occlusal stability and prevent anterior bite collapse and temporomandibular dysfunction. As free-end saddle partial dentures are often poorly tolerated by patients, this case study tests whether a retentive full-upper denture occluding with a shortened dental arch offers enough to fulfil a patient’s needs. Clinical relevance: An increasingly elderly population will present dental practitioners with more partially dentate patients requiring treatment.
The purpose of this paper is to review the principles of antibiotic prescribing in light of the increasing worldwide problem of antimicrobial resistance and the evidence of inappropriate use of antibiotics in dentistry....The purpose of this paper is to review the principles of antibiotic prescribing in light of the increasing worldwide problem of antimicrobial resistance and the evidence of inappropriate use of antibiotics in dentistry. Guidance on the management of dental infections and antibiotic prophylaxis based on a review of the scientific evidence will be given to ensure good patient care. Clinical relevance: To discuss the relevance of legislation around antimicrobial prescribing and antimicrobial stewardship for dentists.
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 papill...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. 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.
This article informs readers of a method of implementing evidence-based dentistry in practice. Following these steps, practitioners should be able to use this skill in an efficient manner. The importance of evidence-base...This article informs readers of a method of implementing evidence-based dentistry in practice. Following these steps, practitioners should be able to use this skill in an efficient manner. The importance of evidence-based dentistry and its relevance to situations encountered in everyday practice is also highlighted. Clinical relevance: This article highlights a series of steps to be followed by practitioners to ensure that treatment provided is supported by the most recent, good quality evidence.
Osteonecrosis of the jaw associated with bisphosphonates and other medications is a growing problem facing dentists. It can have a significant and debilitating impact upon patients. Various treatment options ranging from...Osteonecrosis of the jaw associated with bisphosphonates and other medications is a growing problem facing dentists. It can have a significant and debilitating impact upon patients. Various treatment options ranging from surgical intervention to management with antibiotics and analgesics have been proposed. This article presents one method of conservative treatment and prosthetic rehabilitation in a patient with ongoing BRONJ of the maxilla unsuitable for surgical management. Clinical relevance: Dentists need to be able to identify patients who are at risk of developing BRONJ and have an awareness of the appropriate management as well as potential oral rehabilitation options for these patients.
Successful root canal treatment requires management of the bacterial infection within the root canal space and protection of residual tooth structure with direct/indirect restorations. Long-term success depends upon prev...Successful root canal treatment requires management of the bacterial infection within the root canal space and protection of residual tooth structure with direct/indirect restorations. Long-term success depends upon prevention of re-infection of the root canal space as well as ensuring favourable distribution of the occlusal forces throughout the residual tooth structure. Appropriate planning and design of the final restoration prior to initiating root canal treatment is paramount in achieving this objective. This article describes simultaneous restorability assessment and access cavity preparation to optimize outcome of both endodontic and prosthodontic treatment of the endodontically involved tooth. Clinical relevance: This paper proposes a method to improve visibility and reduce iatrogenic errors whilst simultaneously facilitating effective design of the definitive restoration based on the quantity and distribution of residual tooth structure.
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 p...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. Clinical relevance: All dental practitioners should be able to deal with medical emergencies in their practice.
Fortunately, traumatic dental injuries are a relatively uncommon occurrence in general dental practice. However, when they do present, timely diagnosis and treatment of such injuries is essential to maximize the chance o...Fortunately, traumatic dental injuries are a relatively uncommon occurrence in general dental practice. However, when they do present, timely diagnosis and treatment of such injuries is essential to maximize the chance of a successful outcome. This is the second part of a two-part series on traumatic dental injuries that are commonly encountered in the clinical setting. Part one covered the management of acute luxation/displacement injuries affecting the supporting structures of the tooth, while part two will cover the management of fracture injuries associated with teeth and the alveolar bone. Clinical relevance: Traumatic dental injuries are uncommon occurrences in everyday general dental practice. This article aims to provide a simple, step-by-step approach in the diagnosis and clinical management of acute fracture injuries.
Provisional restorations play an important role when providing indirect restorations. There are a number of materials and techniques available for their construction. Careful planning and construction can protect the pre...Provisional restorations play an important role when providing indirect restorations. There are a number of materials and techniques available for their construction. Careful planning and construction can protect the prepared tooth surface, improve the periodontal condition and help plan for the definitive restoration. A good provisional restoration can save time, money and effort. Clinical relevance: Provisional restoration construction is an integral part of the indirect restorative process for inlays, onlays, crowns and bridges.