Annals of the Royal Australasian College of Dental Surgeons最新文献

The optimum management strategy for potentially malignant disorders remains a constant challenge as our present knowledge is still short of being conclusive. In spite of its shortcomings as an accurate predictive marker, the assessment of the severity of epithelial dysplasia continues to be useful in risk assessment. It is important to use a combination of epidemiological, clinical and histopathological input when deciding on the most appropriate management for an individual patient. Advanced research exploring molecular markers for diagnosis and risk predictions appear to be promising. However, these tests have not evolved to a stage that they could be used for routine diagnostics at the clinical setting.

It has been reported that patients with periodontal disease have a greater prevalence of systemic disease than the general population. Furthermore, we are faced with an ageing population that is retaining its teeth for longer, and tends to present for periodontal management with a variety of systemic conditions. There is ample evidence to show that periodontal treatment results in a systemic response, which includes bacteraemia and systemic inflammatory cytokine release. Certain systemic conditions present unique challenges in the treatment of periodontal disease. These conditions include cardiovascular disease, diabetes mellitus and cancer. The various treatment modalities for these systemic diseases can impact on periodontal treatment, and conversely periodontal treatment can influence systemic conditions and their management. Close collaboration with the treating physician and timely provision of periodontal treatment are important considerations of managing the systemically compromised patient.

Obstructive sleep apnoea (OSA) is diagnosed using a sleep study or Polysomnogram. The paper discusses the role of imaging and other examination techniques to assess the nature of OSA and what treatment you can offer a patient. When should a patient be offered a mandibular advancement splint? What type should be used? How do we know it is working? Surgical treatment of OSA is a controversial area. This paper provides an understanding of which patients may benefit from surgery and when is an appropriate time to refer. An overview of the three main types of surgery and their outcomes are discussed. Less experienced practitioners will feel better able to talk to patients about OSA and for those with a special interest in OSA there is new material to stimulate further discussion.

Dental implants and their restorations have become an accepted and predictable modality of treatment. The literature reflects excellent long-term survival rates. However, survival of an implant does not necessarily translate to success, and in between these two outcomes lies the world of implant complications. Complications associated with dental implants occur with both the restorative and surgical components, with the restorative component complications being more frequent and to some extent, more easily managed. Surgical complications are difficult to manage, and can be the result of many aspects of the implant surgery. Potential complications can arise from poor planning, poor case selection, and poor execution. Complications can also occur where no technical or surgical errors are apparent, but where biology and the fundamental flaw of the trans-mucosal design of dental implant prostheses, adversely affects the outcome. This presentation outlines the nature of potential complications and looks at practical and pragmatic methods, first to try to prevent complications, through improved case selection and execution; secondly, it discusses the most effective methods to prevent complications in implants already installed, by adequate maintenance programmes. Lastly, it deals with those cases which require clinical management of the complications. This presentation provides the clinician with a greater understanding of the difficulties in managing implants that are not progressing as we, the clinicians, and the patients, had originally expected.

Managing patients with dementia requires a practitioner to exercise diverse skills. Communicating with the patient (as their dementia allows), relatives, caregivers and medical personnel are essential elements in the care process. Diagnosis of oral health problems may not be straightforward, clinical examination and treatment planning may be hampered by poor cooperation from the person with dementia. Practitioners must view any treatment from the patient's perspective and balance this with the requirements for sound clinical care. The consent process must be approached in a manner that fulfils the ethical responsibilities that acknowledge patient rights. This can be difficult when managing a patient with dementia. This paper will explore issues surrounding the consent process and the provision of oral health care to people suffering from dementia. It is hoped that readers will be stimulated to review their practice; especially related to informed consent, whether they routinely manage patients with dementia or not. Such practice evaluation should consider the wants and needs of patients and families on a broader than clinical basis and thus enhance the care that is brought to this group of interesting and often challenging patients.

Management of a tooth with persistent periradicular disease primarily involves management of persistent intraradicular infection. Conventional endodontic re-treatment is the main modality that will manage this condition although endodontic surgery with or without retreatment is a viable option in cases. Case selection involves an appreciation of the disease aetiology and expected outcomes and consideration of patient, tooth and clinician factors. Both conventional endodontic re-treatment and surgery have high long-term success and survival rates and it has been shown that an endodontically treated tooth with persistent periradicular pathology that can be managed by conventional endodontic re-treatment or surgery and restoration has comparable, and potentially more beneficial, outcomes to treatment options involving tooth loss and rehabilitation, such as an implant supported crown. As such endodontic retreatment should be the prime treatment modality unless a tooth has reached a stage where these techniques cannot manage ongoing disease and/or structural integrity.

The widespread availability of non-prescription medications has a significant potential impact on dental practice. Dentists are trained to provide scientifically-based advice on the appropriate use of medications, but it is not uncommon for patients to take matters into their own hands, especially if it is felt that the treatment provided is not solving a specific problem, or is insufficient. Well-meaning but often ill-informed family and friends frequently have an opinion as to what should be done. Not only may the suggested treatment not be effective, it may also be harmful. Over-the-counter medications can easily be obtained, and there is nothing to stop individuals exceeding recommended doses, and if this occurs, there could be adverse medical sequelae. Patient compliance in taking prescription medications is known to be problematic, and when combined with the ready availability of complementary medications, probiotics and illicit drugs, the risk of self-harm can be seen to be a distinct possibility. To compound the position, sometimes there seems to be, in a practical sense, little regulation on the advertising and marketing of non-prescription medications, which can leave consumers not only confused but potentially vulnerable. While complementary medicines may not have a significant role in dental practice in 2012, that may not always be the case as research continues, and reference is made to some aspects of ongoing work. Non-prescription medications are discussed, and some effects on oral health are considered.