Teething - filling in the gaps .

Dentists and dental care professionals may be faced with concerns from parents and carers regarding teething in infants and young children. Teething is a normal physiological and self-limiting process; however, the diverse signs and symptoms that have, over time, been attributed to teething, can make diagnosis challenging. Appropriate diagnosis is crucial in preventing the potentially life-threatening sequalae of dismissing symptoms as teething and delaying appropriate treatment of a systemically unwell child. Management of teething can be approached in a five-step process based on the National Institute for Health and Care Excellence clinical knowledge summary on teething. These include: 1) history-taking, clinical examination, diagnosis and referral of systemically unwell or severely distressed children for urgent medical review; 2) providing parental/carer reassurance, information and preventative advice; 3) simple, non-pharmacological management strategies; 4) pharmacological intervention; 5) safety-netting advice in case the child becomes systemically unwell, has prolonged symptoms, or is in severe distress. The purpose of this article is to bridge knowledge gaps regarding teething to enable appropriate diagnosis and encourage dissemination of preliminary information and ensure appropriate referral by frontline dental professionals.

Collaborative approach to paediatric chronic non-bacterial osteomyelitis of the mandible: Great Ormond Street Hospital case series.

This paper outlines a 10-patient case series of chronic non-bacterial osteomyelitis (CNO) of the mandible at a tertiary paediatric hospital in the UK. Our findings highlight the homogeneous presenting signs and symptoms of an intermittently painful, swollen angle and ramus of the mandible. We present the typical laboratory investigative findings (normal inflammatory markers) and imaging appearances (sclerosis and periosteal oedema). Our paper outlines an investigation protocol, including recommendations for extraoral bone biopsies and systemic magnetic resonance imaging (MRI). We explain the importance of multidisciplinary care, with combined care by rheumatologists and infectious disease specialists. Finally we demonstrate the efficacy of our treatment algorithm for oral non-steroidal anti-inflammatory drugs (NSAIDs), and in those cases refractory to NSAIDS, intravenous pamidronate. This paper provides a useful addition to the literature by informing OMF surgeons of this rare condition and given the clinical equipoise in treatments, it can hopefully guide clinicians in an investigation pathway and management protocol.

Macrodontia and double teeth: a review and case series.

Macrodontia is a dental anomaly pertaining to the increased size of a tooth or multiple teeth. Double teeth are dental abnormalities concerning tooth morphology and the term traditionally refers to geminated or fused teeth. These anomalies may manifest in both primary and permanent dentitions and usually become apparent in childhood. They may cause a variety of clinical sequelae, including orthodontic complications, such as crowding, ectopic eruption of adjacent teeth and periodontal concerns. Double teeth are also at a higher risk of developing caries. The aesthetic implications of these dental anomalies can affect the psychosocial development of a patient. This, together with the range of functional repercussions, can often need dental treatment to improve quality of life. The functional and aesthetic complexities that may arise in the affected patients can require endodontic, restorative, surgical and/or orthodontic input as part of the management strategy and execution. We present four clinical cases of paediatric patients where a range of management approaches were employed for both macrodontia and double teeth.