Oral prehabilitation for patients with head and neck cancer: getting it right - the Restorative Dentistry-UK consensus on a multidisciplinary approach to oral and dental assessment and planning prior to cancer treatment.

Historically, oral and dental issues for head and neck cancer patients were often not considered until after cancer treatment was complete. As a result, outcomes for oral rehabilitation were sometimes suboptimal. Inconsistencies in service delivery models and qualification, training and experience of staff delivering dental care often compounded this problem, making research and audit almost impossible. Collaborative working by consultants in restorative dentistry from all over the UK as part of a Restorative Dentistry-UK (RD UK) subgroup, renamed more recently as the RD-UK Head and Neck Cancer Clinical Excellence Network (CEN), has re-emphasised the importance of specialist restorative dentistry intervention at the outset of the head and neck cancer pathway to optimise outcomes of patient care. The CEN has driven several initiatives, reflecting Getting It Right First Time (GIRFT) principles aimed at reducing unwarranted variation. This improved consistency in approach and optimised collaborative working of the team now presents a better environment for multicentre audit and research. Ultimately, this should result in a continued improvement in patient and carer experience.

Conservative management of gingival recession: the gingival veneer.

UNLABELLED: Gingival recession is apical migration of the gingival tissues resulting in exposure of the underlying root surface. This can cause significant esthetic concerns for the patient, especially when it affects the anterior teeth. The gingival veneer is a prosthesis indicated for challenging clinical situations where there are esthetic concerns because of gingival recession, particularly loss of interdental papillae. Replacement crowns, surgery, or extraction of teeth, and provision of a removable partial denture are other treatment options; however, these have a significant biologic and financial cost compared with gingival veneers. This article aims to revisit the gingival veneer: its uses, advantages, disadvantages, and its fabrication. The cases discussed here highlight two different clinical situations where the gingival veneer prosthesis helped in achieving optimum esthetics and patient satisfaction thus proving to be a feasible and simple treatment modality in certain clinical cases. This may offer a good interim solution for patients who may wish to have time to consider their options of more advanced and complex treatment. Some patients may choose to wear the veneer as a long-term solution when the burden/risk of further advanced treatment may outweigh the benefits, as perceived by the patients. CLINICAL SIGNIFICANCE: The gingival veneer is a viable treatment option for restoring anterior esthetics in clinical situations where there are esthetic concerns caused by significant gingival recession. Case selection is important for a predictable and successful outcome.

Stanley L Drummond-Jackson. Pioneer of intravenous anaesthesia in dentistry.

Stanley Lithgow Drummond-Jackson was born in Northumberland and qualified from Edinburgh University Dental School in 1931. Even in the early stages of his practice he devoted his energies to the problem of pain control in dentistry, publishing his first paper in 1935. In the early 20th century most dental anaesthetics were inhalational with nitrous oxide, ether, ethyl chloride and chloroform. The introduction of intravenous hexobarbitone in 1931 led to bold and enthusiastic researchers like Drummond-Jackson to pioneer its use in dental practice. He published his major work on intravenous hexobarbitone in 1952. In 1957, Drummond-Jackson and a group of colleagues formed the now well-known organisation called 'Society for the Advancement of Anaesthesia in Dentistry' or SAAD. SAAD has grown from a group of 40 to over 4000 members worldwide. In 1969, the BMJ published an article condemning Drummond-Jackson's technique of intermittent intravenous methohexitone. At his personal expense, Drummond-Jackson brought a libel action against the BMJ and authors of this paper. There were no winners as the case was settled after 38 days and earned the reputation for being the longest and most expensive libel case in the history of the London Courts. Despite this setback the founder of SAAD devoted the last days of his life in research, teaching and abolishing fear and pain in dentistry. He gained international reputation as a teacher in dental anaesthesia and was honoured with fellowships and awards. He died in 1975 at the age of 66. In the early 1900s dental anaesthesia was only inhalational with mainly nitrous oxide on one hand and ether, ethyl chloride and chloroform on the other. Induction was at times stormy and prolonged and recovery was delayed. The synthesis of barbiturates, especially intravenous hexobarbitone (1931), thiopentone (1932) and methohexitone (1959) opened new avenues for dental anaesthesia. Modern anaesthesia owes a lot to early pioneers, many of them being dentists and Drummond-Jackson was among them.