The role of primary dental care practitioners in the long-term management of patients treated for head and neck cancer.

Patients treated for head and neck cancer may be susceptible to a higher incidence of dental disease due to long-term sequelae of treatment for head and neck cancer. Most patients with head and neck cancer are discharged from a hospital environment and responsibility for long-term dental care is transferred back from the restorative dentistry team to the dentist and dental care professionals in primary care. Treatment of these patients should be undertaken in a supportive environment, taking into account the physical and psychological repercussions of previous treatment. With the exception of some surgical procedures, routine dental care is not contraindicated in patients after head and neck cancer treatment and it is expected that the dentist and dental care professionals will be responsible for long-term routine dental treatment. Primary dental care practitioners should be aware of the process to refer patients back to the head and neck cancer multidisciplinary team if they note a suspicious change during their routine clinical examinations. Referral to a restorative dentistry consultant for planning and carrying out complex items of care may sometimes be necessary, but patients should always remain under the long-term care of their primary dental care practitioner.

Quality of life and other psychological factors in patients with tooth wear.

Aim To investigate the relationship between generic and condition-specific (CS) quality of life, general psychological wellbeing and personality in patients with tooth wear.Materials and methods Ethical approval was granted (REC:10/H0709/21). Patients aged 18-70 years with tooth wear completed the Oral Impact on Daily Performance (OIDP) quality of life questionnaire, the NEO-FFI Personality questionnaire and the General Health Questionnaire-12 (GHQ). Tooth wear was measured with the Basic Erosive Wear Examination (BEWE).Results In total, 102 subjects were recruited. Increased BEWE scores were correlated with older age and worse generic and CS-related quality of life. Increased neuroticism was correlated with increased: generic and CS OIDP scores; generic and CS eating scores; CS smiling scores; and CS carrying out major work scores. Increased GHQ scores were positively correlated with increased: generic and CS OIDP scores; generic and CS eating scores; CS speaking scores; generic and CS cleaning scores; generic relaxing scores; generic and CS smiling scores; and generic emotional state scores (p <0.05). Multivariable linear regression analyses showed that increased neuroticism and decreased GHQ both had an independent effect on generic and CS OIDP scores when adjusted for tooth wear severity (p <0.05).Conclusion Quality of life perception is complex and was not only affected by worsening levels of tooth wear.

Crown Lengthening surgery: An overview.

The term 'crown lengthening surgery' refers to a variety of techniques which aim to expose a greater amount of tooth structure around a tooth or group of teeth. The decision to treat and which technique to use will depend upon: the underlying aetiology; a thorough history and examination; results of any supporting investigations and a clear understanding of the intended outcome of treatment. This paper aims to provide an overview of crown lengthening surgery and is illustrated with clinical cases.

The Emergency Dental Appointment: Restorative Emergencies Part 2 - Dental Implant Related Problems.

This is the second paper in a two-part series discussing the management of common restorative dental emergencies. The first paper focussed upon problems relating to conventional fixed and removable restorations, and this paper discusses the management of common dental implant related emergencies. With dental implant treatment becoming an increasingly popular method of replacing missing teeth, it is very likely that dentists working in general practice will routinely come across patients who have previously undergone this form of treatment, even if they themselves are not directly involved in placing or restoring dental implants. This paper is aimed at general dental practitioners (GDPs) who have some experience in managing dental implants, and those who want to gain further insight into how such situations may be managed.

The Emergency Dental Appointment: Restorative Emergencies Part 1 - Tooth Related Problems.

Dental emergencies affect a large proportion of the population. While there is ample information in the literature on how to manage medical emergencies in dental practice, there is little information on common dental emergencies and how to manage them. In the UK, the 2009 Adult Dental Health Survey reported 9% of dentate adults reporting pain at their clinical examination. 1 The prevalence of non-pain related restorative dental emergencies is estimated to be higher, and will be a common presenting situation in the dental clinic. Often these unplanned events cause difficulties for dental practitioners, who are already constrained by time, to fit in these patients and manage them. Over and above this, the increasing life spans, retention of teeth into later life and finite life of dental restorations all add to the challenges encountered by the dental practitioner. Prompt and effective management of these conditions often leads to optimising patient experience, but also offers better outcomes. This two-part series provides an overview of the more common dental emergencies encountered by the dental practitioner and their management. Paper 1 focuses on the management of common tooth-related emergencies and includes non-odontogenic and odontogenic pain. Paper 2 focuses on the management of osseointegrated dental implant related emergencies.

An Update on Crown Lengthening. Part 2: Increasing Clinical Crown Height to Facilitate Predictable Restorations.

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.

An update on crown lengthening. Part 1: Gingival tissue excess.

This is the first article in a two-part series which aims to provide an overview of the different techniques used to increase clinical crown height. In the first paper, the focus will be on the management of patients who present with gingival tissue excess. The different aetiologies are discussed and illustrated with clinical cases, following which a range of procedures that may be employed in the management of these patients are presented. With an increasingly ageing population, more patients are taking regular medications prescribed from their general medical practitioner, and so having a working knowledge of the specific drugs that may cause gingival enlargement is essential. Clinical Relevance: When patients with gingival tissue excess present in primary or secondary care, a clinician must have a good knowledge of the possible causes of the condition, as well as an idea of how the patient may be managed.

Rare case of bizarre parosteal osteochondromatous proliferation presenting in the zygoma.

Bizarre parosteal osteochondromatous proliferation is a rare benign lesion that tends to occur within the bones of the hands and feet. To our knowledge this is the third published case of its occurrence in the head region. We report the case of a 31-year-old man with an eight-month history of an asymptomatic, slowly enlarging lump on the right zygomatic area diagnosed as bizarre parosteal osteochondromatous proliferation. Diagnosis depends on specific radiological and histopathological features. Treatment is by complete excision, and recurrence has been reported in up to 50% of cases. Awareness of the condition will expedite its correct diagnosis and management.

What is the role of senior house officer or dental foundation year two posts in professional careers? Exploring the motivations for, and perceived benefits of, undertaking SHO posts in two London hospitals.

AIMS: To investigate the motivations for, and perceived benefits of, undertaking senior house officer (SHO) posts, and to explore the career pathways of those who do, examining trends in successive cohorts. METHOD: Postal cross-sectional questionnaire survey of all dental and maxillofacial SHOs (DF2s) who had worked for two South London hospitals within the previous nine years (n=137). Respondents were grouped into three cohorts to enable responses to be examined in relation to respondents' entry to their first SHO post. RESULTS: There were responses from 83 (61%) potential participants. The most frequent motivation for carrying out SHO posts from 79 (95%) of the respondents was the desire to 'learn from experienced clinicians'. The most common perceived benefit reported by those who had completed posts at the time of the survey was 'an improved understanding of the role of the hospital dental service' from 68 (97%) of those who answered this question. Difficulty in securing a job in general dental practice was not reported as a notable motivating factor, either before or after the implementation of the new dental contract. 'Fulfil approved training post requirements for postgraduate examinations' reduced as a motivator from 28 (88%) for the earlier cohort of SHOs to nine (36%) for the more recent cohort. Fifty-four of 78 (69%) respondents declared a definite plan to seek admission to the General Dental Council Specialist Lists in future, 24 (83%) in the first cohort, compared with 11 (46%) in the last (P=0.05). Of the males, 13 (52%) were significantly more likely to report that they were currently working in general practice compared with 15 (27%) females (P=0.028). CONCLUSION: The findings suggest that multiple benefits are identified from undertaking SHO posts. However, some of the motivations for undertaking SHO posts may have changed over the nine-year period investigated. Possible influences are discussed. This paper highlights the perceived benefits of junior training posts at a time of significant transition within the profession.

An audit to assess the quality and efficiency of complete and partial dentures delivered by junior hospital staff.

The average number of visits for the construction of metal-based and acrylic dentures by junior hospital staff was 10 visits. Our hypothesis was that supervision would optimise the number of visits and reduce any need for remakes. The first audit cycle was retrospective and included all patients treated by SHOs in the Prosthodontics Department. The standard of care was compared to the British Society for the Study of Prosthetic Dentistry. The re-audit showed that the time taken to completion was reduced by 2 visits for both denture types and the average length of time was reduced from 31 weeks to 22 weeks. These improvements were directly related to improved supervision by senior staff.