The TMD management dilemma.

As temporomandibular disorders (TMDs) become ever more prevalent in both primary and secondary care settings, successful management is increasingly challenging in both sectors. The authors aim to explore the dilemma of TMD management as the patient journeys through from primary to secondary care and offer educational tools to support practitioners in managing this complex patient cohort, as well as outlining alternative solutions for the delivery of TMD management strategies.

The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 3: prostate cancer.

Introduction Metastatic prostate cancer (MPC) patients due to receive bone-targeting agents (BTAs) are expected to undertake a dental assessment before commencing. The aim of this study was to determine the dental status of this tumour group and understand the challenges the dental practitioner faces in attempting to achieve 'dental fitness'.Materials and methods Data were retrospectively collected from a dedicated pre-BTA dental assessment clinic and analysed for MPC. Statistical analysis and observational data were used to compare patient and tumour demographics.Results A total of 111 patients were included in this cohort, with the majority of patients presenting with only bone metastases (BM) and no additional metastatic sites. On average, MPC patients presented with 19.3 teeth and were below the threshold for functional dentition. The 75-84-year-old age group had the worst horizontal bone loss score and subsequently lose six teeth over a decade (p = 0.001). In addition, all MPC tumour sub-categories showed favourable survival rates.Conclusion MPC patients have a high dental burden on presentation, likely associated with their age. Favourable survival prospects and the cumulation of BTAs and dental disease would suggest a heightened risk of medication-related osteonecrosis of the jaw in this group compared to many other tumour sites.

The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 4: miscellaneous cancers.

This article discusses relevant information for the dental sector regarding metastatic cancers beyond breast and prostate cancer. Typically, tumour sites such as lung, renal, colorectal, gastrointestinal, thyroid, hepatic and pancreatic cancers are increasingly being referred for bone-targeting agents upon evidence of bone metastases.The current article explores the presenting dental status of these tumour groups on the background of survival outcomes. In addition, the article provides insight towards the complexity in achieving 'dental fitness' and whether 'dental stability' could be an alternative to consider via palliative dentistry in certain cases.

The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 2: breast cancer.

Introduction Patients with bony metastatic breast cancer (MBC) due to receive bone-targeting agents (BTA) are expected to undertake a dental assessment before commencing. The aim of this study was to determine the dental status of this tumour group and understand the challenges the dental practitioner faces in attempting to achieve 'dental fitness'.Materials and methods Data were retrospectively collected from a dedicated pre-BTA dental assessment clinic and analysed for MBC. Statistical analysis and observational data were used to compare patient and tumour demographics.Results A total of 229 patients were included in this cohort. On average, this cohort loses one tooth per decade (p = 0.003). Classifying the tumour sub-types provided observational differences in dental status with patients with triple negative MBC having the best dentition at presentation. These observations were more clinically profound when overlaid with survival following post-BTA dental assessment as patients with triple negative MBC had the lowest median survival (eight months, p = 0.002). In contrast, patients with luminal A breast cancer had a very complex presenting dentition with a median survival of 20 months.Conclusion A clear difference exists in the outcomes of MBC patients and therefore a pre-BTA dental assessment should consider and integrate both patient and tumour demographics into dental treatment planning.

The presenting dental status of solid tumours with bone metastases requiring bone-targeting agents - part 1: an overview.

Introduction Dental pre-assessment before bone-targeting agents (BTA) in oncology patients is a well-recognised practice; yet, guidance on this has typically been unable to differentiate between the intricacies of varying oncology groups. This study assesses the presenting dental status of oncology patients with bone metastases (BM) due to commence BTA, to determine whether differences exist with varying tumour groups.Materials and methods Data were retrospectively collected from a dedicated pre-BTA dental assessment clinic. Statistical analysis and observational data were used to compare patient and tumour demographics as well as to their peers via the Adult Dental Health Survey.Results A total of 492 patients with a solid tumour diagnosis and BM requiring BTA were included in this retrospective study. Demographics such as sex, age, smoking status and tumour site were all significant for the number of teeth present (p = 0.000). Furthermore, survival data post-BTA identified prostate, breast and thyroid groups surviving over 12 months following dental assessment (p <0.000). In contrast, the remaining groups such as lung, colorectal and gastrointestinal had poorer outcomes (p <0.000).Conclusion Pre-BTA dental assessment should consider and incorporate additional patient and tumour demographics to allow for a tailored and personalised dental treatment plan. Application of this principle would look to optimise oral function while considering tumour prognosis to avoid over- or under-prescribing pre-BTA dental treatment.

Methotrexate-associated osteonecrosis of the jaw: A report of two cases.

There has been a rise in medication-related osteonecrosis of the jaw (MRONJ) predominantly related to antiresorptive and antiangiogenic medications. More evidence is revealing that MRONJ is not limited to these drug groups. With the introduction of newer and varied medications used in the treatment of cancer and autoimmune diseases, reports of possible related osteonecrosis of the jaw (ONJ) are also on the rise. We present 2 cases of ONJ in patients with long-standing arthritis treated with methotrexate in the absence of a lymphoproliferative disorder and antiresorptive or antiangiogenic medications.

Coronectomy and dentigerous cysts: a review of 68 patients.

OBJECTIVE: This large case series retrospectively reviewed the outcomes of coronectomy in conjunction with dentigerous cyst removal in 68 patients at the oral surgery department of Guy's Hospital. STUDY DESIGN: A retrospective review of 68 patients was undertaken in a single department where 73 teeth with associated dentigerous cysts were treated by coronectomy to reduce the risk of inferior alveolar nerve injury or mandibular fracture. RESULTS: One patient experienced permanent injury of the inferior alveolar nerve. There were no intraoperative mandibular fractures in this series. Four coronectomy roots required retrieval at 2, 4, and 20 months and 10 years after the initial surgery due to persistent surgical site infection and incomplete coronectomy with retained enamel and associated cystic tissue leading to symptoms. The longest follow-up in this series was 10 years for 2 patients, and 30 of 68 patients were reviewed between 1 and 3 years postoperatively. CONCLUSION: Coronectomy in conjunction with dentigerous cysts is an effective treatment, with minimal morbidity seen in both short- and long-term periods.

Coronectomy of mandibular teeth other than third molars: a case series.

Coronectomy is gaining popularity for the management of mandibular third molars that pose a risk of injury to the inferior dental nerve, as it considerably reduces the risk when compared with extraction. The technique could also be beneficial to other teeth. We report 17 patients who had coronectomy of mandibular teeth that were not third molars. Clinical and radiographic follow up for a median (range) of 12 (1-79) months showed satisfactory healing and no transient or permanent injury to the nerve. None of the retained roots have required retrieval.

Spontaneous Osteonecrosis of the Maxilla.

In the past decade there has been a rise of osteonecrosis of the jaws (ONJ) predominately related to bisphosphonate therapy and osteoradionecrosis secondary to radiotherapy. However, osteonecrosis can occur in the absence of these agents. A case of idiopathic osteonecrosis of the maxilla is reported and the literature discussed. Clinical relevance: It is not always possible to make a definitive diagnosis.