Managing mental health crises in dental practice.

This paper aims to summarise current evidence and practice relating to mental health crises within dental practice. We review cases occurring within our practice, including management and lessons learnt. We then aim to provide a practical guide to manage such crises.

Systemic medicines taken by adult special care dental patients and implications for the management of their care.

Introduction Significant changes have taken place in the profile of prescription medicines being taken by the adult UK population over the last decade. The aims of this article are to review the literature to understand the overall trends and underlying factors, and then to compare this with the medication profile of a cohort of adult special care dental (SCD) patients. Materials and method Five hundred patient records were examined and retrospective data on systemic medicines being taken were obtained and classified according to the index used in the British National Formulary (BNF).Results The results revealed a high level of polypharmacy with 57% of SCD patients taking three or more medicines compared to 24% of the population in England. Antiepileptic drugs were the most frequently taken group of medicines (42%), followed by antidepressants (39.7%) and antipsychotics (37.6%). Conclusions Our results demonstrate the medical complexity of patients in this cohort and enable clinicians to increase their familiarity with the most commonly taken medicines and the tools available to manage the implications for dental care.

Maternal xylitol and mutans streptococci transmission.

DATA SOURCES: PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials databases and the ClinicalTrials.gov registry were searched with related articles'. Experts were contacted and a manual search of reference lists was undertaken. STUDY SELECTION: Randomised or quasi-randomised controlled trials that evaluated the maternal use of xylitol gum on Mutans Streptococci (MS) colonisation in infants. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers performed data extraction with a third reviewer asked to resolve any disagreements. Cochrane risk of bias tool was used to assess the quality of studies. Two reviewers independently appraised the methodological quality. The primary outcome measure was presence of MS in the saliva or plaque of infants, with the secondary outcome measure being occurrence of dental decay. RESULTS: 11 studies published between 2000 and 2012 involving a total of 601 patients were included. Sample sizes ranged from 60 to 195 and the daily dose of xylitol consumption ranged from 1.95g to 5.28g. Follow-up ranged from six months to 120 months. There was a significant difference between the two groups, with infants in the control group experiencing greater incidences of MS in their plaque or saliva. Risk ratios were 0.44 (95% CI: 0.08-2.40) at 6-9 months, 0.54 (95% CI: 0.39-0.73) at 12-18 months, 0.60 (95% CI: 0.34-1.08) at 24 months, 0.56 (95% CI: 0.40-0.79) at 36 months and 0.61 (95% CI: 0.48-0.76) at 60 months. Caries data could not be pooled. CONCLUSIONS: Xylitol consumption by mothers with high MS levels was associated with a significant reduction in the mother-to-child transmission of salivary MS. These findings are based on evidence that may have suffered from biases.