Sleep bruxism: an overview for clinicians.

Bruxism is characterised by clenching or grinding of the teeth due to contraction of the masseter, temporalis and other jaw muscles. Bruxism may lead to masticatory muscle hypertrophy, tooth surface loss, fracture of restorations or teeth, hypersensitive or painful teeth and loss of periodontal support. Sleep bruxism has previously been viewed as a dysfunctional movement or pathological condition, whereas it is now accepted as a centrally controlled condition with various systemic risk factors. It has been postulated that sleep bruxism may have a protective role during sleep, for example in relation to airway maintenance or in stimulating saliva flow. A diagnosis of sleep bruxism may be made via patient report and clinical interview, clinical examination, intraoral appliances or recording of muscle activity. Bruxism in itself does not require treatment: management is only indicated where problems arise as a result of bruxism. Oral appliances primarily aim to protect the dentition from damage caused by clenching/grinding, although they may reduce muscle activity. Irreversible occlusal adjustments have no basis in evidence in the management of bruxism. Behavioural strategies include biofeedback, relaxation and improvement of sleep hygiene. Administration of botulinum toxin (Botox) to the masticatory muscles appears to reduce the frequency of bruxism, but concerns have been raised regarding possible adverse effects. Dentists should be aware of the potential aetiology, pathophysiology and management strategies of sleep bruxism.

Survey of consultants in restorative dentistry in the UK regarding ongoing care of patients provided with dental implants.

Background Funding for implant-based treatment within secondary care is limited, and acceptance criteria are determined locally according to funding agreements with NHS England. Indefinite review of all patients in secondary care is unlikely to be feasible due to limitations on departmental capacity. The increasing number of patients provided with implant-based treatment in secondary care has resulted in a growing maintenance burden, raising the question of who should provide this care. Management of some complications within primary care would facilitate patients' access to treatment, although no specific provision for maintenance of implant-retained prostheses is made within the NHS Dental Charges Regulations.Materials and methods An online survey was carried out to review services provided within restorative dentistry departments across the UK, investigating departmental protocols for review and maintenance of patients provided with dental implants.Results There was no consensus view on review protocols, discharge or provision of maintenance following implant placement. Fifty-seven percent would indefinitely carry out remake of implant-retained overdentures when clinically indicated, replace worn inserts, housings or abutments. Sixty-one percent would manage loose/lost screw- or cement-retained restorations and 68% would manage fractured restorations. Re-referral for peri-implant disease would be accepted by 64% of respondents. The lack of clear NHS funding for the management of complications was of concern to respondents in this survey.

The restorative management of the deep overbite.

A deep overbite is where the vertical overlap of the upper and lower incisors exceeds half of the lower incisal tooth height. Problems associated with the deep overbite can include soft tissue trauma, lack of inter-occlusal space and tooth wear, all of which can present significant challenges for the restorative dentist. While management options very much depend on the nature of the situation and patient's symptoms, options may range from provision of a simple removable appliance or splint and non-surgical periodontal therapy, to multidisciplinary care involving orthodontics, orthognathic surgery and restorative dentistry. Restorative management may involve an increase in the occlusal vertical dimension with fixed restorations or removable prostheses, and careful assessment and treatment planning is essential. This article discusses the aetiology and restorative management strategies for deep and traumatic overbites.

Temporomandibular disorders, trismus and malignancy: development of a checklist to improve patient safety.

Trismus is a restriction in the ability to open the mouth. Trismus can occur following trauma, surgery, radiation therapy, infection, inflammatory diseases, temporomandibular disorders (TMD) or less commonly as a result of malignancy. Following two cases of delayed diagnosis of carcinoma presenting with features of TMD to a specialist clinic, a checklist was developed for completion in cases of trismus, to alert the clinician to suspicious features suggesting a possible non-TMD cause. The use of this checklist, together with an increased awareness, has improved early recognition of atypical features in patients presenting with trismus and has contributed to the early diagnosis of a further case of malignancy presenting to this clinic. This article discusses the presentation of malignancy with trismus, the relevance of imaging in these cases, and the implementation of a checklist to reduce the risk of future misdiagnosis.

An audit of the quality of base metal cast restorations provided within the restorative department of a UK dental institute.

BACKGROUND: Gold alloy has long been used in dentistry for the fabrication of cast restorations due to its material and clinical properties and known excellent longevity over long-term follow-up. The cost of gold has increased dramatically in recent years (by 450% in the past ten years). The use of base metal alloys as an alternative would lead to a considerable cost saving: a cobalt chromium alloy is around 98% cheaper than gold alloy at the time of writing. NHS regulations state which alloys are permissible for use in cast restorations in dentistry, and certain 'non-precious gold' alloys should not be used. MATERIALS AND METHODS: A prospective audit was carried out in our unit into the standard of cast restorations in cobalt-chromium alloy. The standard set before the audit was established by a prior audit of gold alloy restorations with measures of clinical and technical factors. RESULTS: Base-metal alloy restorations were considerably cheaper; but were of a poorer clinical standard than gold-alloy and required more frequent adjustment and remake (17% compared to 5%).