Oral surgery: Considerations for the medically complex patient.

As life expectancy and the number of people living with chronic illness increases, the medical complexity of patients requiring oral surgery will also increase. This and the continuously evolving range of medical treatments used to manage their conditions will increasingly challenge dentists in both primary and secondary care to avoid complications and treat this patient group safely.This paper will describe the importance of careful treatment planning including consideration of the timing and location in which oral surgery is undertaken for medically complex patients. The risk of acute medical events, bleeding, infection, and impaired healing which may complicate oral surgical procedures in this group of patients is discussed and the role in their care played by general dental practitioners explored.

Oral surgery: Considerations for the younger patient.

The need for oral surgery will, for many younger patients, precipitate their first significant interaction with healthcare professionals; this will inevitably impact on the planning and delivery of their treatment.This paper will describe the range of oral surgical procedures which are most commonly performed on younger patients. It will explore the indications for treatment, the techniques used to promote successful treatment outcomes, and the role of general dental practitioners in the management of younger patients undergoing oral surgery. Consideration will be given to the unique challenges encountered when undertaking surgical procedures in younger patients with a dentition which is still developing.

When dental extractions go wrong: An overview of common complications and management.

The extraction of teeth carries a risk of associated complications, some of which may be predicted, providing an opportunity for them to be prevented or their effects minimised. Prior to embarking on any extraction, the dentist must be confident that they are able to deal with any complication that may arise. This paper provides an overview of the complications of dental extraction which are commonly encountered, considers the factors which predispose to them arising, suggests how the risk of them occurring can be reduced, and describes how they should be managed.

The use of three implants to support a fixed prosthesis in the management of the edentulous mandible: a systematic review.

BACKGROUND: Dental implants have been widely utilised as a treatment modality for prosthetic rehabilitation. The aim of this study was to evaluate the implant and prosthetic survival rate, changes in marginal bone level, and patient satisfaction outcomes with the use of three implants to support a fixed prosthesis in the edentulous mandible. METHODS: A comprehensive electronic search was performed in the MEDLINE, Embase and Cochrane databases to retrieve studies that met the selection criteria. Sixteen articles were selected which consisted of two randomised controlled trials, eight prospective cohort studies, five retrospective studies and one case series. RESULTS: A total of 2055 implants were placed in 685 patients with a mean age of 62.2 years. The mean cumulative implant survival rate was 96.2% over a mean follow-up period of 3.35 years. Mean marginal bone loss recorded was 1.25 mm and high patient satisfaction rates were reported across the studies. CONCLUSION: The use of three implants to support a fixed prosthesis appears to be a successful approach to restoring the edentulous mandible in the short-to-medium term. Further longitudinal comparative studies are required to support longer-term success, and to guide minimum implant dimension requirements for the technique.

The incidence of medication-related osteonecrosis of the jaw following tooth extraction in patients prescribed oral bisphosphonates.

Aims To determine the incidence of medication-related osteonecrosis of the jaw in patients prescribed oral bisphosphonate medication following dental extraction in a dedicated clinic within the Department of Oral Surgery of King's College Hospital. The effect of factors such as sex, duration of therapy, medical comorbidities and site of extraction, which have previously been reported to significantly affect the risk of developing osteonecrosis of the jaw, was also examined.Materials and methods Data were gathered from the dental records of patients who had extractions over an eight-year period and were included in this retrospective study. Patients with previous or current exposure to intravenous bisphosphonates, denosumab, novel-targeted chemotherapies used in the oncology setting or radiotherapy to the head and neck were excluded from this study.Results The incidence of medication-related osteonecrosis of the jaw following tooth extraction in this group of 652 was 0.8%. A significantly increased risk of developing medication-related osteonecrosis of the jaw was evident in patients prescribed oral bisphosphonates for four years or more (p = 0.02), with an incidence in this group of 1.6%.Conclusion This study demonstrates that, following dental extraction, patients who are prescribed oral bisphosphonates are at risk of developing medication-related osteonecrosis of the jaw and that this risk increases significantly when the patient has been taking the bisphosphonate for four years or more.

Multiple sclerosis and its impact on dental care.

Multiple sclerosis affects approximately 130,000 people in the UK. Due to the wide variation in the symptoms associated with this condition and their variable severity, the provision of dental care for affected patients must be determined by an individual's specific needs. This will often vary significantly over time. This paper reviews the aetiology, presentation and current management of multiple sclerosis, and explores the impact of these on oral health and the provision of dental care.

COVID-19: establishing an oral surgery-led urgent dental care hub.

COVID-19 has changed the face of dentistry in the UK and around the world. The potential for aerosol generation, the presence of the virus within saliva and the fact that dental professionals work with the oral-pharyngeal environment determines that dental treatment poses a risk of viral transmission. At the start of the pandemic, the cessation of routine dental care across the country necessitated the rapid establishment of an emergency dental service at King's College Hospital. This paper describes its evolution to date and the challenges encountered along the way.

A Mouthful of Anomalies.

Isolated bilateral macrodontia of the mandibular second premolars is a rare condition. We believe that the case reported here is the first in which isolated bilateral macrodontia of the mandibular second premolars presents with numerous dental anomalies affecting other teeth. A 14-year-old boy was referred to the Paediatric Dental Department of King's College Hospital with a partially erupted mandibular left second premolar. Clinical and radiographic examination subsequently revealed macrodontia of both mandibular second premolar teeth and multiple other dental anomalies. This report discusses the presentation and multidisciplinary management of this case. Clinical relevance: This case report describes an already rare condition made even more extraordinary owing to its presentation with multiple other dental anomalies.

Outpatient care of the premature infant.

An increasing number of infants in the United States are born prematurely, with current statistics estimating about 13 percent of all births. Although survival rates and outcomes for premature infants have dramatically improved in recent decades, morbidity and mortality are still significant. Infants born prematurely are at increased risk of growth problems, developmental delays, and complex medical problems. To account for prematurity, growth and development monitoring should be done according to adjusted age (age in months from term due date). Premature infants should gain 20 to 30 g (0.71 to 1.06 oz) per day after discharge from the hospital. Growth parameters may be improved in the short term with the use of enriched preterm formula or breast milk fortifier. Each well-child examination should include developmental surveillance so that early intervention can be initiated if a developmental delay is diagnosed. Routine vaccination should proceed according to chronologic age with minor exceptions, and respiratory syncytial virus immune globulin is indicated in preterm infants who meet the criteria.

Nursing the adopted infant.

BACKGROUND: Breast feeding is commonly accepted as the preferred method of infant nutrition for various reasons, both nutritional and emotional. For some who have become parents by adoption, there is a strong desire to induce lactation for adoptive nursing. METHODS: Information regarding adoptive nursing was initially obtained for the author's personal experience from searching the internet and speaking with other adoptive mothers. The medical literature was also searched through OVID/MEDLINE using pertinent terms, including induced lactation, adoptive nursing, domperidone, and metoclopramide. RESULTS: Use of physiologic and pharmacologic methods can help an adoptive mother bring in a milk supply. The quantity may not be sufficient to entirely meet an infant's nutritional needs. However, for many the emotional benefits remain. There is some controversy surrounding the use of domperidone and metoclopramide for induced lactation. Herbals such as fenugreek have not been researched. Physicians can help their patients understand the current tools available to assist them with this unique endeavor.