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Supportive periodontal care is an essential component of maintaining the outcome of periodontal treatment. It is essential to ensure cost benefit to both patients and the health services where millions are spent on treating patients with periodontal disease. The dentist must be able to recognise the crucial and important role they play in providing supportive care and therapy to periodontally compromised patients, either independently or as part of a wider dental team, over and above the various challenges they may experience in the provision of such care in general dental practice. The timely intervention with treatment or referral during this phase will help reduce the risk of tooth loss and adverse consequences to the dentist and their team by way of litigation. The aim of this paper is to provide an update on the delivery of supportive periodontal care in general dental practice with a particular reference to the role of the dentist.

This is the second article in a two-part series on gingival recession. The first article covered the aetiology and prevalence of gingival recession, while this article focuses on the factors affecting decision making and the management, including treatment of gingival recession alongside the evidence base. With more than half of the population suffering from gingival recession, the clinician should be aware of the different options and treatment modalities available to manage gingival recession. This will enable them to engage with the patient, giving them the necessary and required information to make a patient-centred decision about the most suitable treatment option that will address their concerns.CPD/Clinical Relevance:The clinician should be aware of the different options and treatment modalities available to manage gingival recession.

Gingival recession affects more than half of the population and has a multifactorial aetiology. Despite this, the knowledge and awareness of the factors that predispose sites to recession remains limited, with most people associating it with poor oral hygiene. As patients retain their teeth for longer, the risk of recession is likely to grow, thus increasing the need to establish a greater understanding of this very common condition. This two-part series provides a contemporary overview of the condition with the first article discussing its prevalence, aetiology and classification, and the second covering the different management options.CPD/Clinical Relevance:It is important to establish the aetiology of gingival recession to manage the condition effectively.

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic resulted in an unprecedented shut down of all elective dental services, with normal training activity being suspended. This questionnaire-based survey reports on the experiences of a cohort of dental trainees who participated in redeployment during the pandemic.

BackgroundSupportive periodontal care (SPC) is important in maintaining periodontal treatment outcomes. Hospital services provide specialist periodontal care at high costs. On completion of treatment, patients are discharged back to the general dental practitioner (GDP) to provide SPC. This project aimed to evaluate the change in GDPs' understanding of SPC over more than 20 years.

Introduction The extent to which initial therapy has been provided prior to referral for periodontal disease remains unclear despite guidance provided by the British Society of Periodontology.

The term ‘crown lengthening surgery’ refers to a variety of techniques which aim to expose a greater amount of tooth structure around a tooth or group of teeth. The decision to treat and which technique to use will depend upon: the underlying aetiology; a thorough history and examination; results of any supporting investigations and a clear understanding of the intended outcome of treatment. This paper aims to provide an overview of crown lengthening surgery and is illustrated with clinical cases.

While leukocytosis is a common feature of severe periodontitis, a smaller amount of evidence has been produced on erythrocytes counts in periodontitis, suggesting a possible tendency to anemia. The aim of this study was to investigate the associations between periodontitis and circulating leukocytes, erythrocytes, and platelets. The study included 471 patients with periodontitis (including aggressive periodontitis [AgP], and chronic periodontitis [CP]) and periodontal health. A separate sample of 333 patients from a previous study (127 AgP and 206 periodontally healthy) was used as replication. Periodontal clinical data were collected and a blood sample was obtained from each participant for hematological analysis of leukocytes, erythrocytes and platelets. Adjusted linear regression analyses revealed associations between periodontitis and total leukocytes counts (p< 0.001), neutrophil counts (P<0.001) and hematocrit (HCT) levels (P= 0.045). Sub‐analysis revealed no statistically significant differences between AgP and CP. Disease severity was correlated with total leukocyte and neutrophil counts and HCT (P<0.001, P<0.001 and P= 0.004, respectively). In the replication sample, adjusted linear regression analysis revealed associations between periodontitis and decreased hemoglobin (HB) (P= 0.009), mean corpuscular hemoglobin (MCH) (P= 0.023), and MCH concentration (P<0.001). A subset of patients included in these studies (14% to 15.7% of periodontitis versus 8.4% to 10.2% of healthy, respectively, in the two cohorts) were anemic based on the World Health Organization criteria. This paper, reporting results of periodontal examination and blood sampling in over 800 patients, suggest that not just leukocytosis but also tendency to “anemia of inflammation” are typical features of periodontitis.

Chronic inflammation is believed to be a major mechanism underlying the pathophysiology of type 2 diabetes. Periodontitis is a cause of systemic inflammation. We aimed to assess the effects of periodontal treatment on glycaemic control in people with type 2 diabetes.

Dental emergencies affect a large proportion of the population. While there is ample information in the literature on how to manage medical emergencies in dental practice, there is little information on common dental emergencies and how to manage them. In the UK, the 2009 Adult Dental Health Survey reported 9% of dentate adults reporting pain at their clinical examination.1The prevalence of non-pain related restorative dental emergencies is estimated to be higher, and will be a common presenting situation in the dental clinic. Often these unplanned events cause difficulties for dental practitioners, who are already constrained by time, to fit in these patients and manage them.Over and above this, the increasing life spans, retention of teeth into later life and finite life of dental restorations all add to the challenges encountered by the dental practitioner. Prompt and effective management of these conditions often leads to optimising patient experience, but also offers better outcomes.This two-part series provides an overview of the more common dental emergencies encountered by the dental practitioner and their management. Paper 1 focuses on the management of common tooth-related emergencies and includes non-odontogenic and odontogenic pain. Paper 2 focuses on the management of osseointegrated dental implant related emergencies.

This is the second paper in a two-part series discussing the management of common restorative dental emergencies. The first paper focussed upon problems relating to conventional fixed and removable restorations, and this paper discusses the management of common dental implant related emergencies. With dental implant treatment becoming an increasingly popular method of replacing missing teeth, it is very likely that dentists working in general practice will routinely come across patients who have previously undergone this form of treatment, even if they themselves are not directly involved in placing or restoring dental implants. This paper is aimed at general dental practitioners (GDPs) who have some experience in managing dental implants, and those who want to gain further insight into how such situations may be managed.

Aims This audit aimed to assess the effect of implementing referral criteria on the quality and content of referral letters sent by general dental practitioners (GDPs) to the periodontal department of a teaching hospital.Methods Retrospective data were collected from a total of 450 referrals made in: (i) 1997, prior to any changes; (ii) 2000/2001, after referral guidelines were implemented; and (iii) 2004/2005, after referral criteria were redefined and circulated via Primary Care Trusts. A standardised data-collection form was used to record the information that was provided in the referral letters. This information was also compared to the findings at initial hospital consultations.Results There was a small improvement in the administrative details provided in the referral communications in 2000/2001 and 2004/2005. Medical history was often incomplete and was mentioned in 31–34% of referral letters. Use of the Basic Periodontal Examination (BPE) score increased from 17% (1997) to 57% (2004/2005). The information on clinical details otherwise increased in 2000/2001 with a tendency to decrease in 2004/2005. There was little agreement between the clinical details in the referral communications and the findings at consultation in the periodontal department.Conclusions Following implementation of referral criteria, there was an increase in the clinical details provided in referral letters. However, the validity of the information provided by the GDPs was often questionable. The number of referrals that provided medical history details remained unchanged. Use of a pro forma was not associated with an improvement in the quality of referrals in this audit.

Statement of problem.Severe tooth wear localized to the anterior maxillary or mandibular teeth with loss of interocclusal space is difficult to manage. Purpose.This study evaluated the outcome of composite restorations placed at an increased vertical dimension of occlusion in such patients. Methods and material.Sixteen patients were restored with 104 restorations in 2 groups. In group A, Durafill composite and Scotchbond Multipurpose dentine adhesive system were used to place direct anterior restorations (N = 52). In group B, Herculite XRV composite and Optibond dentine bonding agent was used (N = 52). The restorations were placed at an increased vertical dimension of occlusion creating a posterior disclusion of 1 to 4 mm. Results.Clinical follow-up showed that the posterior occlusion remained satisfactorily restored after a mean duration of 4.6 months (range 1 to 11 months). Mean follow-up of 30 months has shown a combined success rate of 89.4% for both groups with 93 of the restorations remaining in service. Maintenance in group A was high with 33 failures, but low in group B with 6 failures. Patient satisfaction was reported as good. Conclusion.Direct composite restorations may be a treatment option for localized anterior tooth wear. (J Prosthet Dent 2000;83:287-93.)

A case of localised periodontitis associated with a subgingival orthodontic separator is presented. The presence of this object was related to quite severe periodontal breakdown around an upper right first premolar tooth in an otherwise unsusceptible individual.