Is it the world or is it me!?

Since 2015 the body known as NHS Improvement has published, and this year updated, its list of never events - defined as 'serious incidents that are entirely preventable because guidance or safety recommendations providing strong systemic protective barriers are available at a national level.' How this is interpreted, however, especially in dental terms, has been very poorly managed in my opinion, leading to the potential for increased risk of such events happening and raising anxiety levels among many colleagues, especially the newly qualified, and responses to them both at a local and national level potentially give the lie to the no-blame culture purported to exist within healthcare in the UK. This paper is intended to stimulate debate among those who lead our profession towards a realistic consensus view on management of these issues for the safety of our patients and the peace of mind of the profession.

A national survey of restorative consultants' treatment provision for head and neck oncology patients.

AIM: To investigate current UK practices in the treatment of head and neck oncology patients by consultants in restorative dentistry. METHOD: A postal questionnaire requesting details of surgical and restorative head and neck oncology care from diagnosis to oral rehabilitation was circulated to all 315 consultants in restorative dentistry in the UK. If a reply was not received within 12 weeks a follow up was sent. RESULTS: One hundred and thirty-two (43%) completed questionnaires were returned. On average 46% of respondents treated head and neck oncology patients, this varied with geographical location. Sixty percent of consultants' weekly workload was less than 25% oncology related, while 13% indicated more than 75%. Of the cohort providing oncology care only 12% thought there was always time for dental screening pre-radiotherapy, furthermore 67% had difficulty liaising with primary care. Within the UK great variety existed between attendance at multidisciplinary team meetings, dental care professional support, and provision of dental implant reconstruction including timing, manufacturer, operator, and funding. CONCLUSION: Significant variation in dental input into head and neck oncology patients' pathways exists, most notably with pre-radiotherapy screening. This study highlights a change in trend for patient rehabilitation with dental implants, and an increase to 52% of restorative dentistry consultants' attendance during a multidisciplinary team meeting.

Risk management in clinical practice. Part 3. Crowns and bridges.

Provision of indirect restorations is associated with more complaints and litigation than any other area of dentistry. In the third part of this series we identify possible causes of such complaints. We explore each of the stages from clinical assessment to treatment, highlighting areas which may trigger litigation when they are not addressed carefully - particularly in relation to cosmetic dentistry. The article is illustrated with clinical examples drawn from the authors' personal experience. With patients' ever-increasing expectations, the pressure to deliver quality dentistry has never been higher and will not diminish.

Management of patients with reduced oral aperture and mandibular hypomobility (trismus) and implications for operative dentistry.

Reduced oral aperture and mandibular mobility/trismus are relatively common conditions that can be encountered in patients attending general dental practice, community dental practice and district general or dental teaching hospitals. All dental specialties may see patients with these conditions, and regardless of which environment or specialty, both patient and clinician may experience significant problems. The purpose of this opinion-based paper is to identify and review the causes of such conditions, to review the development of problems encountered for patients and clinicians, and to identify options to treat or manage the conditions.

Periodontal lesions associated with deep traumatic overbite.

Certain aspects of malocclusion, particularly deep overbite, can be related to periodontal pathology, especially in the presence of poor oral hygiene. The authors have noted an association between deep overbite and unusual periodontal lesions. These lesions often appear on radiographs as circumscribed radiolucencies, remote from the alveolar crest and sometimes close to the apex. Gingival surface injury and food impaction may be important aetiological factors. This is illustrated in this article by a number of case studies.

A double-blind, crossover study of Biotène Oralbalance and BioXtra systems as salivary substitutes in patients with post-radiotherapy xerostomia.

This study assessed the efficacy of the Bioxtra (BX) and Biotène Oralbalance (OB) systems in the treatment of post-radiotherapy xerostomia. In a double-blind, crossover study, 20 patients with post-radiotherapy xerostomia were randomly allocated to receive either OB then BX, or vice versa, each product for 2 weeks, with a 1 week wash-out period in between. Subject-based dry mouth scores derived from 100-mm visual analogue scales were recorded at days 0 and 14 of each 2-week period, together with subjective perception of changes in dry mouth symptoms. Both treatments were effective, resulting in reduction of visual analogue scale scores from day 0-14. Between-groups comparisons identified that BX achieved significantly better improvements compared with OB for the perception of dry mouth and improvements in speech and was also rated as more pleasant to use than OB (P < 0.05). In conclusion, both treatments were effective in alleviating the symptoms of post-radiotherapy xerostomia, although BX achieved superiority in some of the outcomes assessed compared with OB.

Oral health care in diabetes mellitus.

Diabetes mellitus produces many complex changes in the lives of those affected. Elevated blood glucose levels, which may occur in the absence of symptoms, lead to late complications from tissue damage. There is an increased susceptibility to infection, poor wound healing and periodontal disease. Furthermore, chronic oral infection itself may contribute to raised blood glucose levels and hence to the later complications of diabetes. Acute infection in the oral cavity needs specific and aggressive management, just as in the acutely infected diabetic foot.' The dental team may not have made a significant contribution to the shared management of the person with diabetes in the past; however, recent findings suggest that the dental team may contribute greatly to the shared care of diabetes with the diabetic team itself, and regular liaison is strongly recommended.

Case report--hypersensitivity to denture materials.

Hypersensitivity reactions to the commonly used denture base resins are infrequently reported. When they have been reported, most acrylic hypersensitivity reactions have been described as local contact reactions with few reports identifying any significant systemic symptoms. This paper reports a case where the patient suffered extensive systemic symptoms which were strongly linked to denture wear. A variety of alternative dentures of different resin content were constructed over time with varying reactions. The patient was patch-tested and responded with positive reactions to pure dye samples supplied by manufacturers of the resins. She also failed to react to dentures made in a clear acrylic with no dye components. These factors strongly support the hypothesis that the reactions experienced by this patient to some denture resins was the result of the incorporated colouring agents. It is therefore suggested that in cases where a hypersensitivity reaction with systemic manifestations to a denture base resin is suspected, questioning with regard to other reactions to colourants and patch testing for dyestuffs should be considered in addition to the use of a resin with no colouring agents in construction of replacement prostheses.

Oral health care in diabetes mellitus.

Diabetes mellitus produces many complex changes in the lives of those affected. Elevated blood glucose levels, which may occur in the absence of symptoms, lead to late complications from tissue damage. There is an increased susceptibility to infection, poor wound healing and periodontal disease. Furthermore, chronic oral infection itself may contribute to raised blood glucose levels and hence to the later complications of diabetes. Acute infection in the oral cavity needs specific and aggressive management, just as in the acutely infected diabetic foot. The dental team may not have made a significant contribution to the shared management of the person with diabetes in the past; however, recent findings suggests that the dental team may contribute greatly to the shared care of diabetes with the diabetic team itself, and regular liaison is strongly recommended.

The effect of chairside relining materials on rat palatal mucosa.

OBJECTIVES: To investigate the effects of denture relining materials on oral mucosa in vivo in a rat model. METHODS: Denture-like appliances covering the palate in Wistar rats were relined with a resilient soft linting material and a hard 'chairside' relining material. The effects on the palatal epithelium were studied by quantitative analysis using computerized planimetry. RESULTS: The relining materials caused an increase in the thickness of the keratinized layer, while not increasing the total epithelial thickness. CONCLUSIONS: Relining materials are not totally without effect on oral mucosa. Further in vivo research is indicated.

The effect of diet on palatal prosthetic coverage in rats.

UNLABELLED: Previous studies have used a rate model for examination of the histopathology of oral candidiasis or mucosal coverage with dental prostheses. These studies have been complicated by the presence of accumulated debris between mucosa and prostheses. OBJECTIVES: The present study was undertaken to develop further the Wistar rat as a suitable animal model on which to study the effects of dental prostheses on oral mucosa. METHODS: The effects of three dietary regimes, used for 7 and 14 days, upon debris accumulation under denture-like appliances and measurable epithelial parameters were analysed by computerised planimetry. RESULTS: Individual variation in animal weights during the study was noted, with some appliance-wearing animals exhibiting a weight gain while others lost weight. A powdered diet used in a paste form gave the least accumulation of debris under appliances and the least differences between appliance wearers and controls. CONCLUSION: The use of the Wistar rat model utilising the past diet described is indicated for future investigation of the effect of prostheses on oral mucosa.

Case report: an alternative treatment of deep traumatic overbite.

Multidisciplinary treatment of a case of deep traumatic overbite is presented. Complications of therapy and alternative treatment options are discussed. Methods used to provide a satisfactory aesthetic and functional outcome are described.

The provision of hospital maxillo-facial prosthetic services in Scotland.

Maxillo-facial prosthetics can contribute much to the quality of life of patients with congenital problems or those treated surgically for a head and neck neoplasm. The availability of an adequate service varies internationally. The present study examines the current provision and requirements for such a service in Scotland. A questionnaire survey of 90 oral, plastic and ENT surgeons was carried out. Information was sought on numbers and types of cases seen, prosthetic treatment provided and involvement of Consultants in Restorative Dentistry in their management. The results show that most surgeons only treat a small number of such patients with a consequent dilution of experience, and with a possible need for supra-regional specialist centres. In addition there is a need for improvement of multi-disciplinary planning clinics for such cases.

Grinspan's syndrome: a drug-induced phenomenon?

Three cases of apparently drug-induced Grinspan's syndrome involving the triad of oral lichen planus, diabetes mellitus, and hypertension are reported. Because drug therapy for diabetes mellitus and hypertension is capable of producing lichenoid reactions of the oral mucosa, the question arises as to whether Grinspan's syndrome is an iatrogenically induced syndrome.

Clinical effectiveness of occlusal splint therapy in patients with classical migraine.

A clinically similar entity to classical migraine is seen in certain dental patients suffering from temporomandibular joint (TMJ) pain dysfunction syndrome. Patients selected for study gave symptoms of classical migraine on waking. Facial pain on waking is typical of some cases of TMJ dysfunction syndrome and the hypothesis was tested that some patients with symptoms of classical migraine were at the extreme end of the spectrum of dysfunction syndrome. However, rather than experience muscle or temporomandibular joint pain these patients had symptoms on waking which were typical of classical migraine. Nineteen patients with migraine symptoms were provided with acrylic occlusal splints for nocturnal wear. A good clinical response with considerable reduction in frequency and severity of pain attacks was achieved.

Spontaneous regression of some mandibular radiolucencies--case report.

Three cases are presented in which asymptomatic radiolucent areas were discovered on routine orthodontic radiographs and which resolved completely without active treatment.