Ten tips for avoiding post-operative sensitivity with posterior composite restorations

Patients increasingly seek tooth-coloured restorations in their posterior dentition, and with the anticipated decline in the use of amalgam as a result of the Minamata Agreement, this will increase. However, the incidence of post-operative sensitivity has been variously assessed as being between 0% and 51%, therefore information on its avoidance is essential. This article reviews the reasons for such sensitivity by examining the potential materials' factors, plus clinical aspects, such as the configuration factor and bonding to tooth substance. CPD/Clinical Relevance: There is a significant incidence of post-operative sensitivity after placement of a posterior composite restoration, so information on how to avoid this may be of value.

Lung carcinoma presenting as bilateral metastases in the mandibular gingivae: a case report and literature review

This case report describes the rare presentation of lung carcinoma as bilateral masses affecting the mandibular gingivae. Although metastatic disease to the mouth is rare, accounting for only 1% of oral malignancies, it is essential to ensure that the presence of cancer is included in any differential diagnosis. CPD/Clinical Relevance: All oral abnormalities persisting for longer than 3 weeks should be referred urgently for specialist assessment and biopsy.

Current COVID-19 vaccine epidemiology and dentistry

The coronavirus disease 2019 (COVID-19) vaccine story is continuously unfolding. Since our previous COVID-19 commentaries, much new information has transpired on the subject, and here we revisit this topic, which has practical implications for all stakeholders in dentistry, as well as the public. This article, on current vaccine epidemiology, provides an account of why vaccines fail in general, and the particular concerns in relation to the new Delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and related ‘variants of concern’. Issues related to vaccine failure are fundamentally dichotomous in nature, appertaining either to the vaccine strain (type) per se, and/or the numerous endogenous factors of the vaccine recipient/vaccinee. Societal factors such as vaccine hesitancy and its impact on herd immunity appear to overarch the long-term goal of total or partial global suppression of SARS-CoV-2, and its eventual endemicity. CPD/Clinical Relevance: To describe the reasons for the failure of currently administered COVID-19 vaccines, particularly in relation to the advent of the SARS-CoV-2 ‘variants of concern’, and discuss implications for clinical dental practice.

The opioid crisis: evaluating the safety and efficacy of opioid analgesia in the management of acute post-operative dental pain

The use and misuse of opioid analgesics have been highlighted in recent years. This review assesses dental opioid use, the effectiveness of opioid-containing analgesics versus non-opioid alternatives and the implications for post-operative pain management strategies in the dental practice. Guidelines for the management of acute post-operative dental pain differ from country to country. The UK has a low dental opioid use rate when compared to the US. The combination of paracetamol and ibuprofen has similar, if not better, analgesic properties compared to opioid-containing alternatives, with fewer adverse effects. CPD/Clinical Relevance: Non-opioid analgesics are both a safe and effective alternative to opioid analgesics in the management of post-operative dental pain.

Aesthetic dental challenges for the paediatric patient

Advancements in material science have contributed greatly towards aesthetic dentistry. However, achieving satisfactory aesthetics for children in the developing dentition poses unique challenges. Challenges include, but are not limited to: (1) patient co-operation; (2) optimum moisture control; (3) continuing gingival maturation and bone growth; and (4) the increased need for minimally invasive and non-irreversible techniques to maintain future treatment options. This article addresses the common paediatric dental aesthetic challenges of uncomplicated crown fractures (ie those confined to enamel and dentine), localized, discrete enamel opacities and intrinsic discolouration of anterior, root canal-treated teeth. Treatment techniques and helpful tips for the general dental practitioner are presented. CPD/Clinical Relevance: This article focuses on common dental aesthetic challenges that present in the paediatric dental population and suggests methods to manage this effectively in primary and secondary care.

The Seven-year Journey of an Ectopic Canine: Multidisciplinary Management of a Dentigerous Cyst in the Early Mixed Dentition

The Aberdeen Royal Infirmary oral and maxillofacial surgery department is involved in the joint planning of cases with the orthodontic and restorative departments of the Aberdeen Dental Hospital to agree an optimal treatment plan for patients, with input from all three specialties. A 7-year-old girl was referred to the orthodontic department by her GDP due to non-eruption of the upper left central incisor. This was related to an associated dentigerous cyst. This presentation illustrates the phases of treatment involving marsupialization of the dentigerous cyst; surgical extraction and orthodontic treatment in order to provide the patient with the optimal outcome for her dentition. A retrospective assessment of the case is presented through photographs and radiological imaging outlining the chronology of the treatment and the outcome of marsupialization of the dentigerous cyst. It highlights this more conservative surgical approach as giving the best chances of preserving unerupted teeth in a younger patient. Marsupialization of a dentigerous cyst associated with UL1 and conservative management of cystic pathology led to preservation and natural mesial eruption of UL3 into the position of UL1. The unerupted UL1 associated with cystic pathology was extracted due to its ectopic position and root dilaceration. Seven years after diagnosis of the dentigerous cyst associated with the unerupted UL1, surgical and orthodontic management has facilitated the for patients tooth to erupt into the UL1 position. Restorative treatment is being planned following orthodontic treatment to restore for patients tooth to simulate the missing UL1. CPD/Clinical Relevance: This case encourages the appropriate referral of young patients with dentigerous cysts to achieve a satisfactory outcome.

Disinfection of the root canal system: what should the protocol be?

The presence of micro-organisms within the root canal system is the critical aetiological factor in peri-radicular periodontitis. During root canal treatment (RCT) it is imperative that this infection and other organic debris are removed from the root canal system. This is challenging because complex tooth anatomy, the presence of a biofilm and the smear layer complicate the process. There are a number of irrigant chemicals and adjunctive systems available in contemporary endodontic practice that are used to disinfect the root canal system during root canal preparation. This article reviews the available evidence concerning these disinfection methods and concludes by presenting a clinical protocol supported by the literature. CPD/Clinical Relevance: A clinical protocol, supported by the literature, is presented for effective decontamination of the root canal system during root canal therapy.