Doctors' Drugs and the Dangers of Dental Decay.

Many "anti-something" medications, which are prescribed by medical doctors for older patients, often for dubious reasons, result in a serious reduction in the quantity and quality of saliva. That drug-induced xerostomia can produce dangerous dental decay, particularly in already compromised dentitions.This article suggests that doctors should undertake a personalised "benefits, risks, alternatives, nothing" (BRAN) analysis including an assessment of the possible dental decay risks, especially before prescribing combinations of "anti-" drugs for marginal conditions.Doctors should consider carefully if alternative approaches are feasible which could produce acceptable outcomes without incurring those serious dental decay risks. Alternative approaches may include patients altering their diet and lifestyle to include more physical exercise for controlling conditions such as marginal hypertension, for example, or perhaps prescribing counselling/talking therapies for depression or anxiety.If various "anti-" drugs really do have to be prescribed, this article describes cheap, pragmatic, and effective ways of mitigating the risks of already compromised dentitions developing new decay.

How the General Dental Council and NHS UDAs crushed the compassion out of dentists.

Various actions and policies of governmental agencies and the General Dental Council (GDC) have crushed the compassion out of many dental professionals. Compassion is not the same as sympathy or empathy; compassion involves doing something practical to overcome a patient's problems. However, many compassionate dental professionals now think of the GDC as a bit like being trapped in a lift with a wasp. The statistical probability is that nothing really terrible is going to happen to you for trying to solve a patient's problems pragmatically, but the tension and the worry that it might is always present. One effective way to reduce the chances of a painful experience is not to undertake slightly risky procedures. It is far, far safer to make copious notes but then to refer on anything potentially problematic, especially under the flawed NHS Units of Dental Activity system, 'just to be on the safe side', while bowing low to the GDC and claiming it is 'outside of one's competence'. The net result is a lack of clinical engagement in solving patients' problems practically, coupled with an ongoing lack of experience and confidence in solving similar patients' problems, as well as shifting some problems unnecessarily on to overloaded hospital departments. Who benefits from those perverse outcomes?

Darwinian Dentistry? Social Media, Smartphones and Selfie Sticks.

The COVID-19 pandemic produced numerous challenges for clinical dentistry which necessitated adaptation and innovation. This article will illustrate the use of selfie stick devices and ring lights for dental care practitioners to create customised 'selfie' videos of them using very effective cleaning devices on the patient's own smartphone. Because these short, engaging videos are now readily available to the patient at their home it reminds them which brushes to use, where and how. Patients are empowered by these videos which put them at the centre, reinforcing the key preventive message that they can improve and maintain their oral health by introducing effective oral hygiene behaviours. The many advantages, both for patients and for their practice teams, will be discussed in detail.

Changes in Occlusal Philosophies for Full Mouth Rehabilitation.

This article reviews some of the main tenets of different occlusal philosophies involved in 'full mouth rehabilitation' and evolved since the late 19th century. This review is not intended as a comprehensive historical review of all the people who wrote, researched, or taught on the topic, and it is certainly not intended to disparage their well-meaning contributions. It is intended to highlight some of the changes that occurred in relation to full mouth rehabilitation occlusal concepts along with the dates when they were articulated.

Facts and Fallacies About Occlusal Philosophies for Full Mouth Rehabilitation.

This article reviews various full mouth rehabilitation occlusal concepts along with their main beliefs and controversies. Many of those occlusal teachings were well-meant at the time they were introduced. However, closer examination reveals that many of them involved serious destruction of sound tooth tissue - without delivering many of their purported benefits.The biologic and structural disadvantages of 'subtractive' dental procedures, which were, and still are, undertaken to provide traditional full mouth rehabilitation are discussed. Those approaches are contrasted with the proven advantages of minimally destructive additive techniques, which can solve frequently encountered clinical problems previously deemed to require traditional 'full mouth rehabilitations'. Pragmatic clinical cases are used to illustrate how to solve common clinical problems by using minimally destructive means, without causing structural damage to residual sound tooth tissue.

Instagram Dentistry.

Instagram, a photo and video social networking site, is gaining popularity in the dental world and it is easy to see why this is so. Instagram's potential to share information in an engaging way allows dental professionals to share clinical work and provides a unique way of learning.Advertising on Instagram has blossomed. Some of this is for self-promotional reasons, for practice building, or for marketing of new techniques and products by manufacturers. One ought to be cautious about the implications of some patients' quest for 'dental perfection'. That is especially the case when destructive dentistry is being undertaken by dentists trying to replicate what they have seen on Instagram in potentially much more challenging patients. Some of those demanding patients request very ambitious treatments with sometimes hugely unrealistic expectations. Arguably, Instagram could be the new major trend in dentistry.

The legal fallacies about 'if it was not written down it did not happen', coupled with a warning for 'GDC experts'.

It is a fallacy that 'if it was not written down it did not happen'. The expression has become something of a mantra among certain dental 'educationalistas' and has been recited so often by some plaintiffs' tame 'experts' and by some lawyers that many people now believe that it is true. As a matter of law, it is not. This article challenges the correctness of that oft-repeated assertion - because it is not a law of evidence and neither is it even a law of logic.A lot of truly important diagnostic information can be gleaned by listening carefully to a patient with both of an interested clinician's eyes and ears being fully open and being 'fully present', rather than furiously scribbling notes. In fact, overtly concentrating on writing or typing notes, rather than sympathetically engaging face-to-face with a patient, can often detract from the chances of that patient being open and honest enough to reveal the bits of information that are so vital in getting the full diagnostic picture. A dictaphone is a useful, traditional and acceptable way of summarising all the important and available information immediately after the consultation.The second part of the article draws attention to the potential for imprisonment for up to two years of 'pseudo-experts' who stray beyond their remit - or who make false, rash or inappropriate allegations in their report when this is accompanied by a statement of truth.

Facts and Fallacies About Restorative Philosophies for the Management of the Worn Dentition.

This article addresses facts and fallacies about managing worn teeth and challenges some traditional concepts and beliefs about occlusion. Whilst it is accepted that many of the historic occlusal concepts were well intended, closer examination reveals that many were unnecessarily destructive of sound tooth tissues and did not deliver all of their purported benefits. Those fallacies make them less appropriate in the litigious environment of contemporary dental practice. This paper discusses the disadvantages of 'subtractive' dental procedures for the management of tooth wear, and highlights the benefits of proven minimally destructive 'additive' techniques.

Is 'Digital Dentistry' Dangerous for Teeth? Problems Associated with Zirconia and CAD/CAM Restorations.

The increasing prescription of metal-free dental restorations has come about as a result of various patient demands and somewhat narcissistic expectations. However, some dental professionals have contributed to the rise in popularity of these materials and techniques. This article highlights the potential pitfalls of undertaking inherently destructive procedures, particularly when performed for questionable "cosmetic" reasons.

The Paradoxes of Phantom Bite Syndrome or Occlusal Dysaesthesia ('Dysesthesia').

Phantom bite syndrome was first described by Marbach over 40 years ago as a mono-symptomatic hypochondriacal psychosis. He used the term to describe a prolonged syndrome in which patients report that their 'bite is wrong' or that 'their dental occlusion is abnormal' with this causing them great difficulties. This strong belief about 'their bite' being the source of their problems leads to them demanding, and subsequently getting, various types of dentistry carried out by multiple dentists and 'specialists'. Sadly, even after exhaustive, painstaking, careful treatment, none of the dental treatments manages to solve their perceived 'bite problems'. This is because they suffer from a psychiatric illness involving a delusion into which they continue to lack insight, in spite of the failures of often sophisticated dental treatments.1,2,3 In summary, dental practitioners, or other specialists, who suspect that they might be dealing with such a problem should refer these patients early on for specialist management by an appropriate specialist within the secondary care settings, preferably before they get trapped into the time-consuming quagmire of their management. A 'Phantom Bite Questionnaire', which is available to download free, might help. Clinical relevance: This article aims to provide professionals in various fields with guidelines on detecting, diagnosing and managing patients with Phantom Bite Syndrome (PBS). This is desirable in order to prevent extensive, or unnecessarily destructive, or unstable dental treatment being undertaken on such patients in a vain attempt to solve their problems with 'dentistry' when, in fact, these are really due to underlying mental health issues.

Dental Trauma Part 1- Acute Management of Luxation/Displacement Injuries.

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 first part of a two-part series on traumatic dental injuries that are commonly encountered in the clinical setting. Part one will cover acute management of luxation/displacement injuries that primarily affect 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: A simple, step-by-step approach in the diagnosis and clinical management of acute luxation/displacement injuries should be part of a dental clinician's knowledge.

Dental Trauma 2- Acute Management of Fracture Injuries.

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.

Patients' Priorities and Attitudes Towards Their Temporo-Mandibular Disorders.

The diagnosis and appropriate management of temporo-mandibular disorders (TMDs) remains controversial. Current scientific evidence highlights the importance of psychosocial factors in sufferers and the reducing emphasis on occlusal or dental/prosthetic factors. This paper describes the findings of a survey of 211 patients reporting pain from their temporo-mandibular joint area and associated structures. This article offers busy primary dental care practitioners a cost effective questionnaire for obtaining relevant information from patients about the history of their condition and highlights what patients hope to achieve through the management of their disorder. It also emphasises the importance of communicating effectively with patients and offers practical tips for the management of TMDs in primary care.

Regulators and regulations: who will guard the guards? (or 'Quis custodiet ipsos custodes' as old Juvenal used to say).

Overbearing regulators with their various labyrinthine regulations have had adverse impacts on dentists and their teams' behaviours. This has produced the perverse outcomes of demoralizing dental teams as well as reducing their capacity and/or desire to deliver compassionate oral healthcare. These adverse outcomes do not seem to have benefited patients, or dentists, or their teams, in any sensible or measurable way. CPD/CLINICAL RELEVANCE: The vastly increased burdens on the UK dental profession of intrusive, bullying regulations, emanating from the various UK agencies, such as the supposedly fair and independent GDC, but including the increasingly politically controlled NHS and the CQC, have had unfortunate, perverse, effects on many dentists' clinical practices and affected dental teams' desires, or willingness, to be as compassionate as they used to be about helping to solve some patients' dental or oral problems.

Bizarre tooth surface loss and the Miswak stick.

Tooth surface loss can present in a variety of ways, some of which can appear rather strange on first examination. This case report demonstrates an unusual presentation of tooth surface loss (TSL) and its subsequent treatment. This loss of hard dental tissue appeared to be affecting the whole of the patient's remaining dentition, both lingually and buccally. Detailed questioning revealed the origins of this problem which turned out to be due to excessive use of an intra-oral Miswak chewing stick. Cinical Relevance: This article will enable clinicians to understand the importance of specific, targeted history-taking, involving a rare case of tooth surface loss as well as the use of minimally destructive restoration composites and a fibre-reinforced composite bridge.

Ethical marketing in 'aesthetic' ('esthetic') or'cosmetic dentistry'. Part 3.

UNLABELLED: This, the third and final article in this series on ethical marketing, makes it clear that cosmetic dentistry is not a guaranteed one-way ticket to happiness for either patients or dentists, but it can be for lawyers. In fact, this area of dentistry is fraught with many dangers for the unwary patient and even for the enthusiastic or experienced dentist. In general, it is not at all wise to raise patient expectations beyond that which is definitely going to be easily achievable in his/her particular case. CLINICAL RELEVANCE: If things go wrong with extensive cosmetic dentistry, or are judged as being suboptimal, or unacceptable, by the patient, then that dentist may become liable for all the remakes of that elective cosmetic dentistry for the lifetime of the patient, together with all the associated general and specific damages. This is because, if the elective cosmetic dentistry had not been done, the patient would not have needed to have the remakes. Informed consent is a major issue with cosmetic dentistry, as is avoiding any possible claims for breach of contract, which could be verbal, implied or written.