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 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.

An evaluation of the clinical utility of C-reactive protein and antibiotic use in patients undergoing major head and neck reconstructive surgery with outcome assessment.

PURPOSE: This ambispective observational study aims to evaluate the local utility of peri-operative CRP testing and prophylactic antibiotics in relation to post-operative complications in patients who have undergone major head and neck oncological reconstructive surgery. RESULTS: A total of 79 patients were identified for inclusion; CRP testing was undertaken within the first 3 days postoperatively in 78/79 cases. Results demonstrated no benefit of extended prophylactic antibiotic use in reducing post-operative infection. Forty-two post-operative complications arose. In the prospective arm, CRP did not influence the decision to commence antibiotic therapy for any of the surgical site infections. Age, diabetes, smoking, or high body mass index (BMI) did not appear to affect the incidence of postoperative infection (p > 0.05). There is no evidence that more than 24 h of antibiotic prophylaxis is indicated for patients undergoing head and neck reconstructive surgery. CONCLUSION: Everyone who is involved in peri-operative patient care should be educated regarding the appropriate use of CRP testing, with the implementation of protocols required to standardize CRP testing and prophylactic antibiotic prescription.

Jaw metastases and the general dental practitioner.

Metastatic spread to the oral cavity is a rare entity, comprising 1% of oral malignancies. However, 25% of oral metastases are found to be the initial sign of metastatic spread; therefore, initial presentation in the oral cavity may indicate significant underlying disease. Common primary sites for men include the prostate, lung, kidney and liver. For women, it is the breast, kidney, colon and genital organs. General dental practitioners are in a unique position to identify and instigate rapid referrals as gatekeepers of primary care whereby patients commonly present to them with symptoms. This clinical review article aims to educate dental practitioners on appropriate recognition of oral metastatic pathology and referral to secondary care.

Deciphering novel chemotherapy and its impact on dentistry.

In the last few decades, the number of targeted chemotherapies approved for cancer treatment and undergoing clinical trials has risen. In comparison to conventional chemotherapy, targeted therapies (TTs) act on specific molecular targets involved in cancer development and progression, with reduced detrimental effects to normal tissues. TTs have now been recognised as key treatments in a number of common cancers, including solid tumours and haematological malignancies. The number of patients undergoing novel cancer treatment will continue to increase, and a significant population will likely present to the dental environment. This paper aims to provide an insight into TTs currently available, including monoclonal antibodies, fusion proteins, tyrosine kinase inhibitors, histone deacetylase inhibitors, mammalian target of rapamycin inhibitors, phosphoinositide 3-kinase inhibitors, proteasome inhibitors and hedgehog pathway inhibitors. The mechanisms of action, indications for use and how to identify the medications will be summarised. Dental implications of these novel therapies include medication-related osteonecrosis of the jaw, delayed healing, immunosuppression and thrombocytopenia. These will be discussed to ensure oral healthcare providers are aware of their impact in a dental setting.