Doctors' Drugs and the Dangers of Dental Decay.

Many "anti-something" medications, which are prescribed by medical doctors for older patients, often for dubious reasons, result in a serious reduction in the quantity and quality of saliva. That drug-induced xerostomia can produce dangerous dental decay, particularly in already compromised dentitions.This article suggests that doctors should undertake a personalised "benefits, risks, alternatives, nothing" (BRAN) analysis including an assessment of the possible dental decay risks, especially before prescribing combinations of "anti-" drugs for marginal conditions.Doctors should consider carefully if alternative approaches are feasible which could produce acceptable outcomes without incurring those serious dental decay risks. Alternative approaches may include patients altering their diet and lifestyle to include more physical exercise for controlling conditions such as marginal hypertension, for example, or perhaps prescribing counselling/talking therapies for depression or anxiety.If various "anti-" drugs really do have to be prescribed, this article describes cheap, pragmatic, and effective ways of mitigating the risks of already compromised dentitions developing new decay.

Darwinian Dentistry? Social Media, Smartphones and Selfie Sticks.

The COVID-19 pandemic produced numerous challenges for clinical dentistry which necessitated adaptation and innovation. This article will illustrate the use of selfie stick devices and ring lights for dental care practitioners to create customised 'selfie' videos of them using very effective cleaning devices on the patient's own smartphone. Because these short, engaging videos are now readily available to the patient at their home it reminds them which brushes to use, where and how. Patients are empowered by these videos which put them at the centre, reinforcing the key preventive message that they can improve and maintain their oral health by introducing effective oral hygiene behaviours. The many advantages, both for patients and for their practice teams, will be discussed in detail.

Changes in Occlusal Philosophies for Full Mouth Rehabilitation.

This article reviews some of the main tenets of different occlusal philosophies involved in 'full mouth rehabilitation' and evolved since the late 19th century. This review is not intended as a comprehensive historical review of all the people who wrote, researched, or taught on the topic, and it is certainly not intended to disparage their well-meaning contributions. It is intended to highlight some of the changes that occurred in relation to full mouth rehabilitation occlusal concepts along with the dates when they were articulated.

Facts and Fallacies About Occlusal Philosophies for Full Mouth Rehabilitation.

This article reviews various full mouth rehabilitation occlusal concepts along with their main beliefs and controversies. Many of those occlusal teachings were well-meant at the time they were introduced. However, closer examination reveals that many of them involved serious destruction of sound tooth tissue - without delivering many of their purported benefits.The biologic and structural disadvantages of 'subtractive' dental procedures, which were, and still are, undertaken to provide traditional full mouth rehabilitation are discussed. Those approaches are contrasted with the proven advantages of minimally destructive additive techniques, which can solve frequently encountered clinical problems previously deemed to require traditional 'full mouth rehabilitations'. Pragmatic clinical cases are used to illustrate how to solve common clinical problems by using minimally destructive means, without causing structural damage to residual sound tooth tissue.

Instagram Dentistry.

Instagram, a photo and video social networking site, is gaining popularity in the dental world and it is easy to see why this is so. Instagram's potential to share information in an engaging way allows dental professionals to share clinical work and provides a unique way of learning.Advertising on Instagram has blossomed. Some of this is for self-promotional reasons, for practice building, or for marketing of new techniques and products by manufacturers. One ought to be cautious about the implications of some patients' quest for 'dental perfection'. That is especially the case when destructive dentistry is being undertaken by dentists trying to replicate what they have seen on Instagram in potentially much more challenging patients. Some of those demanding patients request very ambitious treatments with sometimes hugely unrealistic expectations. Arguably, Instagram could be the new major trend in dentistry.

The legal fallacies about 'if it was not written down it did not happen', coupled with a warning for 'GDC experts'.

It is a fallacy that 'if it was not written down it did not happen'. The expression has become something of a mantra among certain dental 'educationalistas' and has been recited so often by some plaintiffs' tame 'experts' and by some lawyers that many people now believe that it is true. As a matter of law, it is not. This article challenges the correctness of that oft-repeated assertion - because it is not a law of evidence and neither is it even a law of logic.A lot of truly important diagnostic information can be gleaned by listening carefully to a patient with both of an interested clinician's eyes and ears being fully open and being 'fully present', rather than furiously scribbling notes. In fact, overtly concentrating on writing or typing notes, rather than sympathetically engaging face-to-face with a patient, can often detract from the chances of that patient being open and honest enough to reveal the bits of information that are so vital in getting the full diagnostic picture. A dictaphone is a useful, traditional and acceptable way of summarising all the important and available information immediately after the consultation.The second part of the article draws attention to the potential for imprisonment for up to two years of 'pseudo-experts' who stray beyond their remit - or who make false, rash or inappropriate allegations in their report when this is accompanied by a statement of truth.

Facts and Fallacies About Restorative Philosophies for the Management of the Worn Dentition.

This article addresses facts and fallacies about managing worn teeth and challenges some traditional concepts and beliefs about occlusion. Whilst it is accepted that many of the historic occlusal concepts were well intended, closer examination reveals that many were unnecessarily destructive of sound tooth tissues and did not deliver all of their purported benefits. Those fallacies make them less appropriate in the litigious environment of contemporary dental practice. This paper discusses the disadvantages of 'subtractive' dental procedures for the management of tooth wear, and highlights the benefits of proven minimally destructive 'additive' techniques.

Is 'Digital Dentistry' Dangerous for Teeth? Problems Associated with Zirconia and CAD/CAM Restorations.

The increasing prescription of metal-free dental restorations has come about as a result of various patient demands and somewhat narcissistic expectations. However, some dental professionals have contributed to the rise in popularity of these materials and techniques. This article highlights the potential pitfalls of undertaking inherently destructive procedures, particularly when performed for questionable "cosmetic" reasons.

The Paradoxes of Phantom Bite Syndrome or Occlusal Dysaesthesia ('Dysesthesia').

Phantom bite syndrome was first described by Marbach over 40 years ago as a mono-symptomatic hypochondriacal psychosis. He used the term to describe a prolonged syndrome in which patients report that their 'bite is wrong' or that 'their dental occlusion is abnormal' with this causing them great difficulties. This strong belief about 'their bite' being the source of their problems leads to them demanding, and subsequently getting, various types of dentistry carried out by multiple dentists and 'specialists'. Sadly, even after exhaustive, painstaking, careful treatment, none of the dental treatments manages to solve their perceived 'bite problems'. This is because they suffer from a psychiatric illness involving a delusion into which they continue to lack insight, in spite of the failures of often sophisticated dental treatments.1,2,3 In summary, dental practitioners, or other specialists, who suspect that they might be dealing with such a problem should refer these patients early on for specialist management by an appropriate specialist within the secondary care settings, preferably before they get trapped into the time-consuming quagmire of their management. A 'Phantom Bite Questionnaire', which is available to download free, might help. Clinical relevance: This article aims to provide professionals in various fields with guidelines on detecting, diagnosing and managing patients with Phantom Bite Syndrome (PBS). This is desirable in order to prevent extensive, or unnecessarily destructive, or unstable dental treatment being undertaken on such patients in a vain attempt to solve their problems with 'dentistry' when, in fact, these are really due to underlying mental health issues.

Bizarre tooth surface loss and the Miswak stick.

Tooth surface loss can present in a variety of ways, some of which can appear rather strange on first examination. This case report demonstrates an unusual presentation of tooth surface loss (TSL) and its subsequent treatment. This loss of hard dental tissue appeared to be affecting the whole of the patient's remaining dentition, both lingually and buccally. Detailed questioning revealed the origins of this problem which turned out to be due to excessive use of an intra-oral Miswak chewing stick. Cinical Relevance: This article will enable clinicians to understand the importance of specific, targeted history-taking, involving a rare case of tooth surface loss as well as the use of minimally destructive restoration composites and a fibre-reinforced composite bridge.

Ethical marketing in 'aesthetic' ('esthetic') or'cosmetic dentistry'. Part 3.

UNLABELLED: This, the third and final article in this series on ethical marketing, makes it clear that cosmetic dentistry is not a guaranteed one-way ticket to happiness for either patients or dentists, but it can be for lawyers. In fact, this area of dentistry is fraught with many dangers for the unwary patient and even for the enthusiastic or experienced dentist. In general, it is not at all wise to raise patient expectations beyond that which is definitely going to be easily achievable in his/her particular case. CLINICAL RELEVANCE: If things go wrong with extensive cosmetic dentistry, or are judged as being suboptimal, or unacceptable, by the patient, then that dentist may become liable for all the remakes of that elective cosmetic dentistry for the lifetime of the patient, together with all the associated general and specific damages. This is because, if the elective cosmetic dentistry had not been done, the patient would not have needed to have the remakes. Informed consent is a major issue with cosmetic dentistry, as is avoiding any possible claims for breach of contract, which could be verbal, implied or written.

Ethical marketing in'aesthetic' ('esthetic') or'cosmetic dentistry'. Part 1.

UNLABELLED: Prior to undertaking any elective,'cosmetic' dental procedures, it is vital for the treating dentist to discuss the merits and drawbacks of all viable options. It is important that the patient understands what the consequences and limitations of treatment are likely to be, and what the potential failures could entail later in his/her life. Informed consent should be obtained (preferably in writing) and the clinical notes and records should be clearly documented, with accurate and concise details provided of all the investigations carried out, and their findings, as well as including details of the various discussions that have taken place. Dentists need to be aware of the existence of heightened expectations in this group of patients and be cautious about accepting patients who have unrealistic 'cosmetic' expectations. Where possible, cosmetic or aesthetic dental treatment should be provided which is minimally destructive and, in the long-term, be in the 'best interests' of the patient. Important matters such as the gaining of informed consent and maintaining meticulous, contemporaneous dental records will also be emphasized. It is hoped that the article will provide clear definitions of some commonly used terms such as 'ethical marketing', 'ethics', and 'values', which are often used in association with the marketing, planning and undertaking of supposedly 'cosmetic' dental procedures. The important role of less invasive alternative treatment options will also be emphasized. CLINICAL RELEVANCE: The aims of this article are to consider the common pitfalls that may arise when contemplating the marketing and provision of invasive,'cosmetic, dental restorations and to discuss how best to avoid a dento-legal claim where such treatment plans may not fulfil the patient's desired outcome.

Ethical marketing in 'aesthetic' ('esthetic') or 'cosmetic dentistry' part 2.

UNLABELLED: This is the second article in a series of three. It is essential to find out from patients what it is that they hope to achieve when requesting an improvement in their dental appearance. Their expectations, hopes and fears need to be explored in detail. The long-term biologic costs of some invasive procedures need to be explained to patients in advance so that they can make properly informed decisions. Failure to do so renders the practitioner vulnerable to a charge of behaving unethically. The differences between ethical marketing and selling are explained including the historic development of marketing. CLINICAL RELEVANCE: A practical approach, using a modification of the Edward de Bono Six Thinking Hats model is described to help ethical practitioners to develop sound treatment plans when dealing with complex aesthetic problems.

Biologically based restorative management of tooth wear.

The prevalence and severity of tooth wear is increasing in industrialised nations. Yet, there is no high-level evidence to support or refute any therapeutic intervention. In the absence of such evidence, many currently prevailing management strategies for tooth wear may be failing in their duty of care to first and foremost improve the oral health of patients with this disease. This paper promotes biologically sound approaches to the management of tooth wear on the basis of current best evidence of the aetiology and clinical features of this disease. The relative risks and benefits of the varying approaches to managing tooth wear are discussed with reference to long-term follow-up studies. Using reference to ethical standards such as "The Daughter Test", this paper presents case reports of patients with moderate-to-severe levels of tooth wear managed in line with these biologically sound principles.

A restorative approach to the clinical and aesthetic management of adult patients with Class II division 2 incisor malocclusions.

UNLABELLED: A Class II division 2 incisor malocclusion may be a cause of aesthetic and/or functional concern for some affected patients. Their particular concerns may include dark spaces around the misaligned teeth or uneven gingival contours. Orthodontic and/or orthognathic treatment can address some of these problems but frequently involves lengthy and expensive treatment in the adult dentition. Sadly, such treatment often produces an unstable result, with significant drawbacks such as the requirement for long-term retention. This article aims to describe alternative strategies for managing patients with this incisor malocclusion. CLINICAL RELEVANCE: This paper outlines a quicker, pragmatic and minimally destructive restorative treatment alternative to conventional orthodontic treatment and the associated long-term retention.

Bleaching and bonding for the older patient.

UNLABELLED: Older people who remain reasonably well may wish to maintain or enhance their dental and oral appearance, preferably at minimal biologic and financial costs. Bleaching and bonding represents a very good treatment option and a sensible strategy for this group. Bleaching addresses the discoloration, while direct composite bonding can improve the shape of worn, or otherwise unaesthetic, teeth without damaging the structure or health of the residual tooth tissue. This pragmatic treatment is well tolerated by older patients. The visual and functional improvements are greatly appreciated by this group, partly because of the non-destructive and affordable nature of the benefits. CLINICAL RELEVANCE: Bleaching and bonding represents a proven, sensible, pragmatic, affordable and practical approach to managing the aesthetic problems of older patients, and the benefits are achievable without destroying their residual sound tooth tissue.