Immediate dentures: 1. Treatment planning.

The treatment planning, clinical stages and construction of immediate dentures pose challenges to both dentist, dental technician and patient. In this two-part series, the various principles for successfully providing patients with immediate dentures will be discussed. This first paper examines the advantages and disadvantages, as well as the treatment planning involved in providing immediate dentures.

From autonomy to relationships: productive engagement with uncertainty.

This paper argues that we are at a point of change in ID services, that new ideas and different frames of reference are required to take services forward in the 21st century. We describe how contemporary thinking in architecture, philosophy and organisational theory can assist in generating service principles for specialist services that allow us to better address the continuing isolation that is the experience of many people with ID, and the moral judgements that can limit service possibilities. We do not seek to offer a rigid blueprint for any particular service but one that allows for agency from its participants and relationships between them.

Surveillance of air-travel-related tuberculosis incidents, England and Wales: 2007-2008.

The potential spread of tuberculosis (TB) from infectious passengers during air travel has recently received increasing attention in the media and from public health authorities. We reviewed all air travel-related tuberculosis incidents reported to the Health Protection Agency Centre for Infections between January 2007 and February 2008 in England and Wales and investigated the effectiveness of contact investigation. Incidents involving air travel were defined according to the World Health Organization's guidelines on TB and Air Travel. We collected data on the index case, the incident and the outcome of contact investigation where available. We identified 24 incidents involving 39 flights. The median flight duration was 8.9 hours (inter-quartile range (IQR) 8 to 11.7). Most flights (36) were from or to a high burden country and 19 of the 24 incidents reported had a smear-positive index case. Two index cases had multidrug-resistant tuberculosis. In 17 incidents, no further investigation could be undertaken due to the lack of passenger information. In the remaining seven incidents, the quality of contact information obtained was variable. No further cases of TB infection or disease were identified. This study suggests that the process of investigating passenger contacts of a TB infected individual travelling by air is complicated and usually unsuccessful without dedicated resources and availability of high-quality contact information from airlines. Further research into the effectiveness of contact investigation in this setting is needed.

An undiagnosed case of malignancy: case report.

The following report describes the treatment carried out by a UK high street dental technician on an elderly patient with a large malignancy invading the oral cavity through the hard palate from the nose. The lesion remained undiagnosed during treatment for three months. The consequences of this error, and the future role of the clinical dental technician are discussed.

The provision of dental implants and a fixed prosthesis in the treatment of a patient with scleroderma: a clinical report.

This clinical report highlights some of the problems in providing a suitable prosthesis for a patient who suffers from systemic sclerosis. A conventional removable partial denture may not have been suitable because of the lack of denture bearing area, changing peripheral seal, and insufficient teeth to support and retain the denture. An implant-retained FPD overcame these difficulties. One would hope that, with regular maintenance and monitoring, quoted prosthesis success of 15 years can be achieved.

Use of a modified twin block appliance following partial maxillectomy: case report.

A case is described in which a Class II malocclusion with severe Class II skeletal pattern was treated with a modified Twin Block Appliance. The patient, an 11-year-old girl, had initially presented with an ameloblastoma located in the right maxilla. The subsequent defect produced by surgery was obturated by the appliance during her orthodontic treatment, which was undertaken during her pubertal growth spurt. Two years later the result was stable, allowing the provision of a more definitive prothesis to restore the occlusion.

Attachment and learning disability: a theoretical review informing three clinical interventions.

Attachment theory makes sense of two phenomena observed in some people with learning disabilities: it provides a reason for their limited exploration of the world, and it explains discontinuities in the pattern and intensity of their expressions of anger. Applying this framework to three enmeshed relationships occurring between an adult with learning disabilities and a member of care staff achieved at least partial resolution of their problems. Attachment theory's critics have set a number of challenges for its proponents, including emphasizing an interactional rather than a unidirectional approach to relationships; prioritizing social context; and understanding the attachment dynamic dimensionally rather than as a set of categories. The latter issue is pertinent for residential services: facilitating secure attachment relationships for distressed clients may be difficult for professionals, but partial assuagement of their attachment needs is a realistic clinical goal.

Atlanto-axial instability in adults with Down's syndrome--a survey of a long-stay hospital population.

A survey was performed on the patients with Down's syndrome living in three long-stay hospitals for the mentally handicapped in Bristol. Each patient had a chromosomal analysis, lateral X-rays of the cervical spine in flexion and extension and subsequent measurement of the atlanto-odontoid distance, and a neurological examination. Out of a total of 59 patients, with ages ranging from 23 to 65 years (average age 48.27 years), three (5%) were found to be in the high risk category radiologically, but of these two were in the medium risk group on neurological examination and one low risk. Of five (8.5%) patients in the medium risk group on X-ray, four were in the medium risk group neurologically. Therefore a total of eight patients (13.6%) could be considered to be at risk of atlanto-axial instability.

Fundamentals of prosthetic practice. Part I--The laboratory.

Prosthetic dentistry in general practice produces many challenges for both the newly qualified trainee and the long-standing practitioner. If these challenges are not appreciated, met and dealt with effectively, the dentist may be left disillusioned with his skills and expertise, and stressed at the thought of treating patients requiring dentures. The economic need for rapid treatment while maintaining good standards of work, can result in pressure, and the temptation to 'cut corners' can prove costly. These articles, far from being a definitive text, seek to illuminate some potential problems and to lead the clinician to establish his own solutions in the areas of the laboratory, the prescription, communication and some alternative clinical techniques.

Fundamentals of prosthetic practice. Part II--The surgery.

It is important for the smooth running of appointments that everyone, patient, receptionist, dental surgery assistant (DSA), the laboratory and, of course, the dental surgeon should know what is happening. Obviously, they do not all require the same information, but certain points will be essential to each of them for maximum efficiency of treatment.

Immediate obturation for partial maxillectomy.

Modifications of the split maxillectomy prosthesis, secured with a transnasal wire, are recommended to ensure ease of obturation of the surgical cavity and, subsequently, rapid replacement of the original stent.

The dismantling of the mental hospital? Glenside Hospital surveys 1960-1985.

Results of the sixth quinquennial survey of the resident population of Glenside Hospital, Bristol, are reported. The total population continues to fall, but the rate of decline has slowed; the implications of this are discussed. Many patients live in an emotionally impoverished state, friendless and rarely leaving the hospital. Few in-patients are employed, even within the hospital. Considerable provision is made, however, for the employment of day-patients. To effectively resettle and support in the community those currently remaining in hospital will require increasingly extensive provision.