The interdisciplinary management of patients with amelogenesis imperfecta - restorative dentistry.

This paper considers the role of the restorative dentist in the interdisciplinary management of patients with amelogenesis imperfecta. General restorative considerations as well as the techniques available are reviewed. Two clinical cases are described to illustrate this.

Amelogenesis imperfecta: the orthodontic perspective.

Orthodontics in patients with amelogenesis imperfecta can be complicated by commonly occurring dental features in this group as well as patient factors. In this article we examine ways to avoid the common pitfalls of orthodontic management and the importance of adequate and timely liaison between the general dental practitioner and the multidisciplinary team.

Managing the paediatric patient with amelogenesis imperfecta.

A diagnosis of amelogenesis imperfecta can present challenges for patient and clinician alike. This can be further complicated in a child due to cooperation and the ever-changing dentition. This paper looks at the ideals for management at various stages of the developing dentition but also considers the compromises which may have to be made depending on the child's ability to cope. The importance of early diagnosis, prevention and the benefits of a multi disciplinary approach are also discussed.

Amelogenesis imperfecta: an introduction.

Amelogenesis imperfecta (AI) is an inherited disorder that is associated with mutations in five genes (AMEL; ENAM; MMP20; KLK4 and FAM83H) with a wide range of clinical presentations (phenotypes). It affects the structure and appearance of enamel of all teeth, both in the primary and secondary dentition. In this review paper, we look at the epidemiology, classification, aetiology, clinical description and diagnosis of AI. In the following three papers of this series, we aim to describe the role of paediatric dentists, orthodontists and restorative dentists in the clinical management of patients with AI.

Facial aesthetics: is botulinum toxin treatment effective and safe? A systematic review of randomised controlled trials.

BACKGROUND: The use of botulinum toxin type A (BTA) in facial aesthetics for the treatment of wrinkles has recently become more popular as an alternative to surgical techniques. However, its true efficacy and potential adverse effects are still unclear. OBJECTIVES: The primary objective of this study was to review the efficacy of BTA in facial aesthetics. A secondary objective was to determine whether there are any adverse effects associated with the procedure of using BTA in facial aesthetics. SEARCH STRATEGY: We conducted literature searches on Medline (1977 to January 2009), Cochrane Controlled Trials Register (CENTRAL), EMBASE (1977 to January 2009) and CINAHL (1977 to January 2009). The search strategy also included reference lists of located articles and hand searching for randomised controlled trials (RCTs). We contacted authors of studies for further information where required. SELECTION CRITERIA: Randomised studies comparing BTA with placebo in facial aesthetics in a double-blind and crossover or parallel group design. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. The area of face injected, assessment methods, outcome measures, duration of action of BTA and associated adverse effects were reviewed. RESULTS AND DISCUSSION: A total of eleven RCTs involving 1,603 subjects were found, of which 1,203 were enrolled for treatment with BTA. The 11 trials were not directly comparable to each other due to differences in the areas of the face injected with BTA, length of study period, concentration of BTA used and outcome measures. The studies showed similar trends. The use of BTA showed improvements in facial wrinkles over placebo, with a peak effect reported at around one month and the effects lasting between 4-6 months. No studies reported any severe adverse effects. The incidence of blepharoptosis in glabellar lines treated with BTA was reported to be between 0-5.4%, and may be related to the technique of injection into the muscles. The incidence of other side-effects such as headache, pain at injection site and mild bruising was similar in both the BTA and placebo groups. AUTHORS' CONCLUSIONS: The use of BTA in facial aesthetics is more effective than placebo. The incidence of adverse effects associated with BTA is similar to placebo, with the exception of blepharoptosis which is reported to be 0-5.4% after treatment of glabellar lines with BTA.

Traumatic pseudolipoma: herniation of buccal fat pad, a report of two cases.

Traumatic pseudolipoma is a term used to describe intra-oral herniation of the buccal fat pad. A tear of the buccinator muscle and buccal mucosa allows the buccal fat pad to extrude into the oral cavity. Initially, the lesion can suggest a more sinister cause, but a history of trauma, an absence of mass before the accident, anatomical site and fatty appearance should suggest a diagnosis of traumatic herniation of buccal fat pad. This injury is rare, but two cases presented to the authors' hospital over a period of 3 months.

Development of a stain shade guide to aid the measurement of extrinsic dental stain.

BACKGROUND: Accurate and reproducible assessment of extrinsic staining is pivotal to determining efficacy of some tooth whitening oral hygiene products. The aim of this study was: (1) to produce a stain shade guide to aid the in vitro and in vivo stain assessment (2) to assess intra- and inter-examiner reproducibility of stain assessment using the stain shade guide. METHOD: Using chlorhexidine and tea, perspex and acrylic teeth specimens were stained. The amount of staining on the perspex was measured with a spectrophotometer and the values obtained were assigned to the stained acrylic teeth, which were made into a stain guide. Using clinical photographs and a group of 10 volunteers, stain area and intensity were assessed using the stain guide and the recognized Lobene stain index by two examiners. The degree of intra- and inter-examiner reproducibility for these measurements were assessed using Cohen's kappa statistics. RESULTS: For both the clinical examination and use of photographs, intra-examiner reproducibility for stain intensity was improved when using the stain guide compared with the Lobene Index. Similarly, when assessing inter-examiner reproducibility, stain intensity kappa values were greater using the stain guide (kappa = 0.82) compared with the Lobene Index (kappa = 0.57). CONCLUSION: The findings of this study would suggest that the use of the stain guide could be of importance in the assessment of extrinsic dental stain.