Oral cancer. Etiology, recognition, and management.

The cure rate for oral cancers remains dismally low at approximately 50%. The dental profession is, to a large extent, responsible for decreasing the morbidity and mortality of oral cancer even though 50% of the population do not present for routine examination and care. The dental office team must accept the charge of educating all patients concerning the devastating role of tobacco and ethanol in promoting oral cancer, as well as malignancies at other sites. Dental clinicians play a vital role on the oral cancer team. Therefore, they must make themselves well aware of the diverse nature of oral cancer and must have an appropriate triage protocol in place so that lesions will be identified and managed correctly or referred promptly to the correct tertiary health care professionals. Early detection and prompt proper management can make a difference as we await the development of new and better ways of treating oral and oropharyngeal cancers.     

Orthodontic management of the congenital cleft palate patient

Patients with cleft anomalies require extensive and prolonged treatment from birth to adulthood. These patients are subject to the scrutiny of many health disciplines during this comprehensive rehabilitation process. The orthodontist, who is intimately involved from the beginning, must achieve tooth alignment, arch symmetry, and establish a suitable functional occlusion that will provide allied disciplines with the appropriate foundation to optimize their treatment objectives. Each completed treatment phase should be sequential in manner, so as to facilitate and expedite the treatment goals of the other team member. To ensure the continuity of treatment and to satisfy the aesthetic, functional, and socio/psychologic requirements of each case, treatment must be coordinated and closely monitored by periodic team evaluations.     

Reprint of team approach for orthognathic surgery

To ensure that orthognathic surgery is successful, functional aspects such as mastication, pronunciation, swallowing and aesthetic factors must be considered. For successful orthognathic surgery, the orthodontist and the surgeon must constantly study and discuss accurate facial analysis, presurgical orthodontics, choice of appropriate surgical methods, and postsurgical orthodontics. In this article, we will discuss the team approach for successful orthodontic treatment and orthognathic surgery, establishing close cooperation between the orthodontist and surgeon.     

Radiation injuries, triage, and treatment after a nuclear terrorist attack

The treatment of injuries from a nuclear weapon or a radioactive dispersal device most likely will be in a mass casualty scenario. Radiation injuries complicate the treatment process, with increased emphasis on early intervention. The care of patients must proceed in an orderly fashion. If radiation injury occurs as part of a mass casualty, some organized method of triage, decontamination, evacuation, and treatment must be implemented. Oral and maxillofacial surgeons should plan to become integral members of the treatment team, especially considering their wide scope of training. It is important for all health care providers to become familiar with the types of injuries that can be expected after a radiologic attack and the treatment modalities that can preserve life should such a catastrophe occur.     

Team approach for orthognathic surgery

To ensure that orthognathic surgery is successful, functional aspects such as mastication, pronunciation, swallowing and aesthetic factors must be considered. For successful orthognathic surgery, the orthodontist and the surgeon must constantly study and discuss accurate facial analysis, presurgical orthodontics, choice of appropriate surgical methods, and postsurgical orthodontics.In this article, we will discuss the team approach for successful orthodontic treatment and orthognathic surgery, establishing close cooperation between the orthodontist and surgeon.     

Patient-dentist-technician communication within the dental team: Using a colored treatment plan wax-up

Communication among the restorative dental team must include the patient. The patient wants to know the details of the anticipated restorations; but because a patient is not aware of many dental innovations, care must be taken to provide them with a clear explanation of all anticipated treatment parameters. Many patients have little understanding of today's advancements in restorative procedures, and they may or may not understand all of the possibilities. Through effective communication, the patient gains confidence in the dental team and better understands the proposed restorative treatment. Patient satisfaction is significantly enhanced through effective communication. CLINICAL SIGNIFICANCE: This article describes the use of a diagnostic wax-up to facilitate optimal communication between the dental team and the patient.     

The use of mouthguards

A mouthguard is a useful appliance to prevent oral injuries, and their emotional and financial consequences. Most sportsmen are aware of the benefits of a mouthguard. Nevertheless, a relatively small percentage of sportsmen in contact sports are using a mouthguard actually. Whether or not a mouthguard is used, is predominantly determined by its comfort. Therefore, a mouthguard must be optimally comfortable. However, to make sportsmen using an even optimal mouthguard, needs motivation. Stimulating of motivation is the task of parents, coaches, (team) physicians, and (team) dentists. Especially coaches seem to have great influence on sportsmen. Children are very much influenced by their parents. It is the task of general dental practitioners not only to inform sportsmen and their parents, but also their coaches and team physicians about the risks of oral injuries and about the benefits of preparing a mouthguard. General dental practitioners must put themselves disposal to prepare mouthguards for their individual patients as well as for all players of a team who wish to have a mouthguard prepared.     

'Nudging' your patients toward improved oral health

BACKGROUND: Behavioral economics combines research from the fields of psychology, neurology and economics to help people understand how people make choices in complex social and economic environments. The principles of behavioral economics increasingly are being applied in health care. The author describes how dental team members can use behavioral economics principles to improve patients' oral health. CONCLUSIONS: Dental patients must make complex choices about care, and dental team members must provide information to patients to help them make choices. Patients are subject to predictable biases and are prone to making errors. Dental team members can use this information to "nudge" patients in healthy directions by providing an appropriate mix of incentives, default options and feedback. Practice Implications. The suggestions the author presents may help dental team members choose strategies that maximize both patient welfare and the success of their practices, while preserving patient autonomy.     

Esthetic templates for complex restorative cases: rationale and management

Complex restorative cases require difficult clinical decisions regarding the final esthetic outcome in which the operator must visualize the definitive restorative position of the teeth. These critical decisions need to be made before treatment is rendered. Communicating these decisions to the patient and the treatment team are crucial prior to achieving clinical success. The esthetic template is the conduit for providing excellent communication. The selection of the appropriate esthetic template is based on four sequential decisions: (1) dentofacial analysis, (2) blueprint development, (3) matrix management, and (4) template application. When utilizing an esthetic template, the clinician must know where the teeth should be placed based on a dentofacial analysis. The dentofacial analysis must then be communicated to the laboratory, and then a blueprint is developed from the diagnostic casts. A matrix is then fabricated from the blueprint and then related back to the existing dentition. The esthetic template is an invaluable communicator that can be utilized in office, with the patient at home, or even within the multidisciplinary treatment team. Clearly, the effective use of esthetic templates demonstrates a reversible way to visualize difficult esthetic decisions before any irreversible procedures are completed. Esthetic templates are a physical means of communication that provide the patient, technician, and multidisciplinary team an instrument to predictably manage complex restorative cases. The purpose of this article is to present a rationale for esthetic template selection and management of several techniques for complex restorative cases. CLINICAL SIGNIFICANCE: Complex restorative cases require difficult clinical decisions regarding the final esthetic outcome in which the operator must visualize the definitive restorative position of the teeth. The use of an esthetic template commensurate with a rationale for selection enables the operator, patient, and entire interdisciplinary team to visualize the final esthetic outcome.     

Osseointegration. Complications. Prevention, recognition, treatment

Practitioners often have delayed responses to the problems involved with complications. This was especially true in the first years of endosseous implantology. Eventually, hindsight becomes insight. This maturation is a necessary and normal process. It can be enhanced by careful documentation of the procedures and process of care such as numerous clinical photographs during treatment, and treating patients with several members of the team present (example: the prosthodontist scrubbing with the surgeon on very early or complex cases.) It is possible to improve the quality of care. Postsurgical case management conferences are invaluable. It is also important that each team member not only see his or her own role, but also the responsibility to see that the entire treatment is adequately done. Each individual must have a sense of responsibility for the management of the entire case. It is important that the practitioner not take a defensive posture regarding his or her own treatment. Reformatted computerized tomography (CT) including radiographic bone density measurement (Houncefield units) can be very valuable in determining bone quality and anatomy and will provide insight into where and where not to place fixtures. In the event of a complication, it is important that it be recognized early that it not be "covered up" and that the damage be contained and prevented from causing a secondary complication and further morbidity to the patient.     

Care of adolescents with cleft lip and palate: the role of the general dental practitioner

Management of the adolescent with cleft lip and/or palate is ideally undertaken by a cleft palate team which has overseen care since birth, and which provides, in a paediatric hospital setting, the specialist medical, dental and ancillary care services necessary for optimal management. However, in some countries such a team is not available and individual dental practitioners and dental specialists have to undertake the necessary treatment. This is facilitated in Australia by the Federal Government's 'Cleft Lip and Palate Scheme', which subsidizes all medical and dental treatment related to the congenital defect up to 22 years of age. In such circumstances the general dental practitioner or paedodontist may need to assume an important coordinating role. The timing and integration of phases of general dental, minor oral surgical, orthodontic, periodontic and prosthetic treatment with plastic, ENT and maxillofacial surgery, speech therapy and audiology may become his responsibility. In addition, the provision of a high standard of preventive and general dental care for the cleft patient must be maintained. To carry out this coordinating role effectively, the general dentist must know his patient and family well; must understand the current concepts, objectives, treatment and investigatory techniques used in all aspects of cleft palate management; he should be aware of the genetics of the clefting conditions, medical problems which may commonly be associated with clefts and the cleft as one feature of a syndrome. Most importantly, he should be aware of the special social adjustment problems faced by many cleft adolescents in relation to their perceived 'different' facial appearance and speech.     

Beyond cosmetics--the esthetic rehabilitative patient

The evolution of the esthetic movement has been sustained over time because it touches a base psychological need for most people to feel they are attractive, youthful, and a vital part of society. Through well-organized team diagnosis and treatment planning, patients can benefit from a solid diagnostic and prerestorative foundation that can more predictably produce consistent optimal treatment results. As the chief diagnostician and treatment supervisor, the restorative dentist must continue to advance his or her knowledge and training to provide the other team members with a concise treatment vision for the patient. With a newly developed synergy among the disciplines of dentistry for team treatment and tremendous advancement in dental markets and equipment, it is possible to create natural-looking, esthetic rehabilitative treatments.     

Interaction with other health team members in caring for elderly patients

Comprehensive health care of the geriatric patient requires thoughtful communication and coordination of services. Unlike young adults, older patients are likely to be frail, have multiple chronic conditions, and experience disability. Hence they are more likely to depend on others for help and to see a variety of health professionals at different sites. This complexity demands that health care professionals consider their care not in isolation, but as part of a team. They must ensure that other members of the team are kept informed and are consulted as appropriate to ensure safe and effective care. Accomplishing this goal requires being acquainted with the usual care providers, the necessary information for sharing, and the most effective communication methods within the team.     

An international surgical exchange program for children with cleft lip/cleft palate in Manaus, Brazil: patient and family expectations of outcome

Increasingly, surgeons are traveling from the developed to the developing world to volunteer their services. They can often make an enormous difference in the lives of patients they serve, but they must understand that these patients exist in a sociocultural matrix in which the meaning of the condition they have and the future they face are determined by a host of factors over and above the specific surgery itself. This means that programs in which teams quickly go in and out of a country must take into account and plan for longer term follow-up by colleagues within that country as well as develop and target rehabilitation services and educational messages to ensure maximum benefits from the intervention performed. This study examines the long-term implications of a short-term surgical team intervention for pediatric patients with cleft lip/cleft palate and their families in the Amazon region of Brazil.     

Pre‐eruptive intracoronal resorption in a third upper molar: clinical,tomographic and histological analysis

Radiolucent or hypodense lesions in the crown of unerupted teeth may be due to pre‐eruptive intracoronal resorption. Clinicians must be aware of this risk so that they can diagnose and appropriately treat this condition. The purpose of this study is to present a well‐documented clinical case of pre‐eruptive intracoronal resorption in an impacted third upper left molar of a 63 year old female patient. This was an unexpected finding, which occurred after cone‐beam computed tomography was used to investigate the first upper left molar, which had an acute periradicular abscess. A multidisciplinary team followed up the case to describe clinical, radiographic and histological findings. The available treatment options were discussed, and the tooth extraction was the option chosen. Previous case studies describing such resorption in third upper molars have not been reported. This case shows that all permanent teeth in a pre‐eruptive stage must be analysed radiographically to detect early pre‐eruptive intracoronal resorption.     

Successful strategies for matching one or two indirect restorations to natural dentition

One of the most difficult and noble undertakings of a dental restorative team is to provide an indirect restoration for a compromised tooth surrounded by otherwise healthy, natural dentition. Matching one or two indirect dental restorations to adjacent healthy teeth is a herculean task for both the dentist and laboratory technician. The team must be knowledgeable of the natural dentition's characteristics to best mimic and recreate those same characteristics in a man-made restoration. Knowledge of principles in smile design, dental anatomy, color, characterization, material selection, doctor-technician communication, and clinical acumen are necessary to achieve a successful outcome when matching one or two indirect restorations to natural dentition.     

Stomatological management of head and neck cancer patients treated with chemotherapy and radiotherapy

Treatment of head and neck cancer with radiotherapy and/or chemotherapy can cause oral damage. Long-term treatment can damage the salivary glands, the oral mucosa, and the maxilla, leading to altered production of saliva and to multiple infections. These lesions can be prevented, limited or avoided by thorough evaluation prior to treatment and by therapeutic follow-up and preventive measures. The dentist must have strong medical knowledge of the possible short-, medium-, and long-term oral complications of the cancer treatment, and must have knowledge of the protocols for oral management of cancer patients. The availability of a multidisciplinary medical team together with a dentist to attend to the patient prior to the cancer treatment, as well as close communication between team members during and after treatment, is crucial. The aim of the present study was review the stomatological management of head and neck cancer patients treated with chemotherapy and radiotherapy and summarizing current treatments, therapeutic innovation and tissue regeneration perspectives.     

Interdisciplinary treatment for esthetic restorative dentistry

Many of our patients have dental needs that general dentists cannot satisfy and may not even know about. Using an interdisciplinary team will expand the knowledge of all of the team members and can only enhance the restorative result, including function, long-term prognosis, and esthetics. Suggestions have been offered to help develop these teams, which may include general dentists, periodontists, orthodontists, oral surgeons, and endodontists. Team members are chosen based on individual skills needed for a particular case but all must be able to motivate and educate patients while providing excellent dentistry.     

Infantilization of elderly patients by health care providers

Infantilization of the elderly has been defined and clinical examples given Potential effects of the process and their possible contributing factors have been discussed.
As the dental profession increases its awareness of the oral health needs of the elderly, dental personnel must also acquire greater sensitivity to the nuances of communication. The dental delivery team, whether in private practice or in institutions, must appropriately treat elderly patients as adults.     

Electronic dental records: start taking the steps

Converting paper patient records charts into their electronic counterparts (EDRs) not only has many advantages, but also could become a legal requirement in the future. Several steps key to a successful transition includes assessing the needs of the dental team and what they require as a part of the implementation Existing software and hardware must be evaluated for continued use and expansion. Proper protocols for information transfer must be established to ensure complete records while maintaining HIPAA regulations regarding patient privacy. Reduce anxiety by setting realistic dead-lines and using trusted back-up methods.