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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: The study aim was to investigate the predictive role of obesity on clinical response following non‐surgical periodontal therapy in individuals with severe periodontitis. Methods: A total of 57 BMI obese and 58 BMI normal non‐smoker adults with periodontitis (defined as probing pocket depths (PPD) of ≥5 mm and alveolar bone loss of >30% with >50% of the teeth affected) received non‐surgical periodontal therapy. Periodontal status was based upon PPD, clinical attachment level (CAL) and full‐mouth bleeding score (FMBS). Mean PPD, percentage sites PPD >4 mm, percentage sites PPD >5 mm and FMBS at 2 and 6 months were outcome variables. Propensity score analysis was used to assess the effect of obesity on outcome variables after adjusting for confounders. Results: Statistically significant higher clinical measures (mean PPD, mean percentage of sites with PPD >4 mm, mean percentage of sites with PPD >5 mm and FMBS) were observed in the obese group than the normal group at baseline, 2 and 6 months after therapy (p <.01). At 2 and 6 months, obesity was associated with worse mean PPD (p <.05), percentage sites with PPD >4 mm (p <.05), percentage sites with PPD > 5mm (p <.05) and FMBS (p <.01), independent of age, gender, ethnicity or plaque levels. Conclusions: Obesity compared to normal BMI status was an independent predictor of poorer response following non‐surgical periodontal therapy. [ABSTRACT FROM AUTHOR]

Background: 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.Methods: 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.Results: 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.Conclusion: 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. [ABSTRACT FROM AUTHOR]

As restorative treatment needs of patients become more challenging, how can funding appropriately support the quality of care? [ABSTRACT FROM AUTHOR]

Specialty registrar training in restorative dentistry is intended to develop mono-specialty knowledge and clinical competence to ensure optimal treatment outcomes and improved quality of life in complex cases. There have been a number of changes to the training programme in recent years, with the introduction of structured curricula and increased emphasis on learning outcomes, assessed via mono-specialty examinations (MSEs). However, the views of trainers and trainees on these changes, the relevance of MSEs to training and their impact on development and future employment prospects are not clear. [ABSTRACT FROM AUTHOR]

This is the second paper in this two-part series. Paper one provided an overview of managing gingival tissue excess and paper two will focus on increasing clinical crown height to facilitate restorative treatment. Crown lengthening is a surgical procedure aimed at the removal of gingival tissue with or without adjunctive bone removal. The different types of procedure undertaken will be discussed over the two papers. In order to provide predictable restorations, care must be taken to ensure the integrity of the margins. If this is not taken into account it can lead to an impingement on the biologic width, which may in turn lead to chronic inflammation resulting in recession or the development of periodontal problems which can be hard to manage. Clinical Relevance: This paper aims to reinforce the need for thorough diagnosis and treatment planning and provides an overview of the various procedures that can be undertaken. [ABSTRACT FROM AUTHOR]

This is the first article in a two-part series which aims to provide an overview of the different techniques used to increase clinical crown height. In the first paper, the focus will be on the management of patients who present with gingival tissue excess. The different aetiologies are discussed and illustrated with clinical cases, following which a range of procedures that may be employed in the management of these patients are presented. With an increasingly ageing population, more patients are taking regular medications prescribed from their general medical practitioner, and so having a working knowledge of the specific drugs that may cause gingival enlargement is essential. Clinical Relevance: When patients with gingival tissue excess present in primary or secondary care, a clinician must have a good knowledge of the possible causes of the condition, as well as an idea of how the patient may be managed. [ABSTRACT FROM AUTHOR]

The article presents a discussion of the role of dental nurses in dental implantation, adapted from the book "Advanced Dental Nursing," edited by Robert Ireland.

Background: Enamel matrix-derived proteins have been shown to regenerate periodontal tissues lost as a result of disease in humans. Emdogain®, a commercial preparation of porcine enamel matrix derivative (EMD), has been shown to induce new cementum, periodontal ligament and bone formation in human periodontal defects. Although a number of studies have reported successful outcomes, local adverse effects have so far not been reported in the literature. This case report describes two examples of external inflammatory resorption following surgical root surface debridement and the use of Emdogain®. Treatment: The treatment in both cases involved raising a full-thickness flap following completion of non-surgical therapy. The granulation tissue from the defect was removed and the root surfaces debrided. Emdogain® was applied following the manufacturers' instructions and involved conditioning the root surfaces with Pref-Gel and applying the Emdogain® to the defect. The flaps were sutured and the site reviewed regularly. Radiographs were taken before the treatment was undertaken and also at 6 months to assess the healing of the defect. Results: External inflammatory root resorption was observed on the treated teeth 6–24 months after therapy. Conclusion: External inflammatory root resorption may be an unusual adverse event following Emdogain® treatment. [ABSTRACT FROM AUTHOR]

Background Supportive 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.Method A validated questionnaire about SPC was sent to GDPs during 1996 (397) and 2020 (300), with a response rate of 74% and 52%, respectively. The anonymous data were entered on a Microsoft Excel spreadsheet for analysis.Results In total, 98.5% of the GDPs in 1996 and 97% in 2020 perceived SPC to be highly important. Additionally, 49% in 2020 had a better understanding of SPC when compared to 1996 (42%). Finally, 70-74% (1996, 2020) of the GDPs indicated that they were responsible for SPC; however, 13-16% said that they were not.Conclusion and clinical relevance Notwithstanding the lower response rate in 2020, there has been an improvement in understanding and awareness of responsibility of SPC among GDPs. Reported challenges of provision were related to education and funding. If GDPs are to effectively deliver SPC, education and current funding should be addressed to prevent compromised treatment outcomes for patients., (© 2024. The Author(s), under exclusive licence to the British Dental Association.)

Introduction The 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.Materials and methods The questionnaires were distributed via Survey Monkey to 47 trainees, before and eight weeks after redeployment.Results A total of 29 trainees completed the questionnaire before redeployment and 32 completed it eight weeks after redeployment finished. The majority of trainees, before the redeployment, reported that inadequate information was given about the redeployment and a minority reported that they were struggling to cope with the pandemic. The post-redeployment questionnaire showed that all trainees felt that they had been well supported, with structured induction and help being given by the hosting service. They also stated that they had learnt skills beyond what they would have obtained as part of their training, with 86% of trainees saying that they would be happy to be redeployed again.Conclusion This survey shows that despite the initial anxiety expressed by the dental trainees at the outset, they had an overwhelmingly positive experience, enhancing their personal development and overall training experience. The survey highlights the need to ensure that appropriate and timely information and guidance is available for trainees, to help support their general and mental wellbeing when unprecedented events occur., (© 2021. The Author(s), under exclusive licence to the British Dental Association.)

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.

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.

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. 1 The 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.

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.

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.