Conservative Prosthetic Rehabilitation of Medication-Related Osteonecrosis of the Jaw (MRONJ).

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.

Dentifrices - an update

Objectives; The objective of this paper was to review the published evidence concerning the efficacy and potential for adverse reactions of modern dentifrices toothpastes. Data sources; Publications cited on MEDLINE since1990. Some further pre-1990 publications are also referenced. Data selection; Studies concerning the efficacy of dentifrices and their components and any related putative adverse incidents. Data extraction; Papers were scrutinised for scientific and trial data. Data synthesis; Data concerning the efficacy of dentifrice components were summarised. Conclusions; The efficacy of fluoride salts in dentifrices in reducing dental caries is well established.Toothpastes, containing triclosan, are effective in improving plaque control, gingivitis and periodontal health.Other tooth paste formulations are effective in reducing the formation of calculus, extrinsic tooth stain, dentine sensitivity and oral malodour. The consumer now has available a range of toothpastes which deliver oral health benefits. Adverse reactions to toothpastes are rare but should be considered in unexplained skin or respiratory allergies and gingival or lip lesions (AU)

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Dentifrices--an update.

OBJECTIVES: The objective of this paper was to review the published evidence concerning the efficacy and potential for adverse reactions of modern dentifrices toothpastes. DATA SOURCES: Publications cited on MEDLINE since 1990. Some further pre-1990 publications are also referenced. DATA SELECTION: Studies concerning the efficacy of dentifrices and their components and any related putative adverse incidents. DATA EXTRACTION: Papers were scrutinised for scientific and trial data. DATA SYNTHESIS: Data concerning the efficacy of dentifrice components were summarised. CONCLUSIONS: The efficacy of fluoride salts in dentifrices in reducing dental caries is well established. Toothpastes, containing triclosan, are effective in improving plaque control, gingivitis and periodontal health. Other toothpaste formulations are effective in reducing the formation of calculus, extrinsic tooth stain, dentine sensitivity and oral malodour. The consumer now has available a range of toothpastes which deliver oral health benefits. Adverse reactions to toothpastes are rare but should be considered in unexplained skin or respiratory allergies and gingival or lip lesions.

Removable prostheses revisited: challenges for primary dental care. 3. Overdentures.

The overdenture is, perhaps, an under-used form of treatment in the primary dental care sector. In this, the final paper in a series of three, the reader will be reminded of the basic concepts concerning overdentures. The author will outline some of the important changes that are likely to influence overdenture provision in the United Kingdom, and describe clinical aspects of this form of treatment.

Removable prostheses revisited: challenges for primary dental care. 2. Partial dentures.

This is the second in a series of three papers. Its topic, the provision of removable prostheses, remains a significant aspect of primary dental care. In the recent past and in the near future, there have been and will be significant influences on how removable prostheses are provided for patients in the United Kingdom (UK). In this paper, the trends in partial edentulousness in the UK will be summarised and the important changes that are likely to influence removable partial denture provision will be outlined. The paper will then provide an update of clinical procedures in the provision of removable partial dentures. A third paper will consider overdentures.

Removable prostheses revisited: challenges for primary dental care. I. Complete dentures.

The provision of removable prostheses remains a significant aspect of primary dental care. In the recent past and in the near future, there have been and will be significant new influences on how removable prostheses are provided for patients in the UK. In this paper, the first of a series of three, the trends in edentulousness in the UK will be summarised, and important changes that are likely to influence complete denture provision will be outlined. The paper will then go on to provide an update of clinical procedures in complete denture provision. A second paper will consider partial denture provision, and a third paper will deal with overdentures.

The oral health of individuals with dementia in nursing homes.

OBJECTIVE: To determine if moderate to severe dementia has an effect on the oral health of individuals resident in nursing homes. BACKGROUND: A significant proportion of the elderly population lives in nursing homes and suffers from varying degrees of dementia. Dementia might affect an individual's ability to implement oral care. Previous work in this area has focused on individuals with mild dementia living in the community setting. MATERIAL AND METHODS: Two matched cohorts of subjects resident in four nursing homes in Cheshire were recruited (n=135). One cohort's subjects were deemed to have no or mild dementia, whereas the other cohort's subjects were deemed to have moderate to severe dementia. Oral parameters were scored, including Decayed, Missing, Filled Teeth (DMFT) scoring, dental deposit scoring, denture assessment and the noting of any other pathology. RESULTS: There was a statistically significant difference in the relative level of dementia of the subjects between the two cohorts (p<0.01, Student's t-test). The DMFT scores were similar for both groups. The mean number (+/-SD) of decayed and missing teeth for the no/mild dementia group was 1.11 (+/-3.42) and 28.22 (+/-6.64), whilst that of the moderate/severe dementia cohort was 0.80 (+/-1.87) and 27.28 (+/-7.73), respectively. Eleven per cent of the moderate/severe dementia cohort wore an upper denture alone as compared with 16% in the no/mild dementia group. CONCLUSION: For individuals resident in nursing homes, moderate to severe dementia might have a deleterious effect on oral health. Further work in this area is required.

The recharge of esthetic dental restorative materials with fluoride in vitro-two years' results.

OBJECTIVES: A range of esthetic restorative dental materials are now available to dental clinicians. The aim of this study was to evaluate the relative fluoride recharge potential of a number of these materials in vitro over two years. METHODS: Disc samples (12 mm x 2 mm) of each of the materials were placed into artificial saliva at neutral pH. The materials tested were: two glass ionomers (Chemfil; Ketac-Fil), two resin-modified glass ionomers (Photac-Fil Aplicap; Vitremer), two compomers (Dyract; Compoglass) and two composites (Heliomolar; Concise). At 13 intervals over a two years period the discs were subjected to a 2 min fluoride recharge by exposure to sodium fluoride (500 ppm F). The pre- and post-recharge fluoride release values were determined using an ion sensitive electrode. RESULTS: At all time intervals the post-recharge fluoride release of the materials was significantly different (MANOVA p<0.0001). The mean values for post-recharge fluoride release after two years were: Chemfil 10.3, Ketac 3.0, Vitremer 9.0, Photac-Fil Aplicap 12.1, Compoglass 5.0, Dyract 3.6, Concise 0.3, Heliomolar 0.2 (units = microgF/cm(2)/h). SIGNIFICANCE: Esthetic fillings vary significantly in their capacity to absorb and re-release fluoride. The glass ionomer-based materials displayed a far greater potential for fluoride recharge than the composites, in which the recharge was virtually negligible. Whilst it cannot be assumed that fluoride release is directly proportional to cariostatic potential, these results suggest that, where possible, glass ionomer-based materials should be used in patients who have a high caries rate.