Professionalism: what is it,why should we have it and how can we achieve it?

In this paper we argue that the terms 'profession', 'professional' and 'professionalism' provide us with important insights into the practice of dentistry and the priorities for the continuing development of dentistry as a profession. More significantly, we suggest that this understanding can assist us in designing continuing professional development (CPD) programmes aimed at maintaining the professionalism of dentists throughout their working lives. A CPD framework is required to support both the new graduate to develop from novice to expert as well as support experienced practitioners to maintain their expertise within a rapidly changing environment. Rather than an onerous task, CPD should be a positive and enjoyable experience, self-motivated to improve job satisfaction and self-confidence. Research is currently being undertaken to determine what is good CPD for the practising dentist with a view to recommending strategies based on sound educational theory.     

Decoronation: how, why, and when?

Decoronation is a surgical method for treating ankylosed incisors in children and adolescents. The crown and root filling are removed, leaving the root in situ to be resorbed and covered with a mucoperiosteal flap. Early loss of a permanent tooth leads to loss of alveolar bone, especially in buccopalatal width. Decoronation preserves not only the width of the ridge but also the vertical height.     

Toothbrushing: why, when and how?

Toothbrushing is a widely practiced oral healthcare habit which, in conjunction with fluoride toothpaste, can help to prevent dental caries and periodontal disease. The effectiveness of toothbrushing is dependent on many different factors including frequency and duration of brushing, rinsing habits and brush type. Knowledge of how these factors influence effectiveness will allow the dental professional to give appropriate advice.     

Occlusal splints and temporomandibular disorders: why, when, how?

Occlusal splints are one form of treatment in the management of patients with a temporomandibular disorder. Appliances are often used in conjunction with other forms of treatment such as physiotherapy or medication. A variety of splints is described in the literature and the dentist must ensure that the splint prescribed is of a design that has a proven success rate for the specific diagnosis. General principles that apply to the provision of all splints are outlined in this paper.     

Where's the best place to live and raise kids, and incidentally practice dentistry?

Factors involved in the selection of the "best place" to live and raise a family could be related to comparable criteria used in the selection of locations for a dental practitioner interest in providing care for children. A series of state and metropolitan area rankings, developed with voluntary and government agency reports, were reviewed to increase an understanding of the factors that may attract to a particular location (1) families with children and (2) pediatric dental practitioners.     

The prevention of dental caries and periodontal disease from the cradle to the grave: what is the best available evidence?

Increasing weight is being given to applying an evidence-based approach to clinical practice. There is evidence to support a range of preventive measures which the profession and patients can apply to maximize the control of caries and periodontal disease. This paper examines the strength of evidence to support the advice and procedures that may be used by dental professionals to provide an effective preventive programme of advice and procedures for patients of all ages. A hierarchy of evidence is used ranging from Cochrane Reviews at the top, observational studies in the middle, and opinion at the bottom. Whilst the evidence to support preventive advice and procedures in children and adolescents is relatively strong, few studies have been conducted in adults and the elderly.     

Precision dentistry—what it is,where it fails (yet), and how to get there

Clinical Oral Investigations - Dentistry is stuck between the one-size-fits-all approach towards diagnostics and therapy employed for a century and the era of stratified medicine. The present...     

Are the lower incisors the best predictors for the unerupted canine and premolars sums? an analysis of a Peruvian sample

The lower permanent incisor tooth width sum has been proposed as the best predictor for the tooth width sums of the unerupted canine and premolars (SPCP) for populations from different ethnic origins. Only two previous studies have refuted it. The purpose of the present study was to determine which sum or combination of sums of permanent tooth widths presented the best prediction capability for the SPCP in a Peruvian sample, to calculate a specific linear regression equation for this population, and to evaluate the clinical significance. A total of 150 children with complete permanent dentitions were selected. Fifty more children were used as a validation sample for the application of a multiple linear regression equation (MLRE). They did not present clinically visible dental caries or proximal restorations and no active or previous orthodontic treatment. Their dental casts were measured to 0.1 mm with a sliding caliper with a Vernier scale. Three-way analysis of variance, Pearson Correlation Test, Fisher Z values and a MLRE were used for the statistical analysis. The combination of the sums of permanent upper and lower central incisors and upper first molars was the best predictor for the SPCP in this sample. A MLRE was calculated including sex and arch as additional predictor variables. The MLRE determination coefficient was 60% with a standard error of 0.8 mm. This new MLRE underestimates (less than 1 mm discrepancy) the actual SPCP in only 7% of the cases on the basis of a validation sample.     

An enlarged lymph node in the neck; what to do?

A swelling in the neck is often caused by one or more enlarged lymph nodes, usually due to a harmless disorder. Particularly in adults, a swelling in the neck may represent a metastasis of a malignancy in the head and neck region, for instance a squamous cell carcinoma arising from the oral mucosa. Palpation of the neck can provide valuable information, although its reliability is restricted, even when executed by an experienced clinician. Therefore, additional examination is required,for instance by fine needle aspiration cytology, ultrasound examination with or without guided fine needle aspiration, computer tomography and magnetic resonance imaging. In case a malignant tumour has been diagnosed in the upper aerodigestive tract, a sentinel node procedure may be performed. The question arises whether general practicing dentists should examine routinely every patient's neck, or only the necks of patients older than 40 years of age.     

A systematic review and meta‐analysis of 3‐unit fixed dental prostheses: Are the results of 2 abutment implants comparable to the results of 2 abutment teeth?

The purpose of the systematic review and meta‐analysis was to compare the performance of 3‐unit bridges on teeth with 3‐unit bridges on implants, evaluating survival of the bridges, survival of the teeth or implants, condition of the hard and soft tissues surrounding the supports, complications and patient‐reported outcome measures (PROM) after a mean observation period of at least 1 year. A literature search was conducted using a combination of the search terms: fixed partial denture and fixed dental prostheses (FDPs). An electronic search for data published until January 2017 was undertaken using the MEDLINE, EMBASE and Cochrane Library databases. Eligibility criteria included clinical human studies, either randomised or not, interventional or observational, which evaluated the results of 3‐unit FDPs on either 2 implants or 2 abutment teeth. The search identified 1686 unique references. After applying eligibility criteria, 66 articles were included in the analysis. A total of 1973 3‐unit FDPs were supported by teeth, and 765 were implant‐supported. No significant differences were found either in the survival of the supporting abutments (P = .52; 99% vs 98.7% survival per year) or in the survival of the prostheses (P = .34; 96.4% vs 97.4% survival per year). Both treatments show an almost equally low complication rate, but there is a low level of reporting of hard and soft tissue conditions and PROM. It is concluded that implant‐supported 3‐unit FDPs seem to be a reliable treatment with survival rates not significantly different from the results of teeth‐supported 3‐unit FDPs.     

Dental appointment no‐shows: why do some parents fail to take their children to the dentist?

BACKGROUND: Children are considerably dependent on their parents, not least in relation to achieving good oral health. There is a group of children who do not show up for dental treatments or only regular check-ups despite reminders from the dental health clinic. The cost of patients failing to come for scheduled appointments is also considered significant. AIM: The aim of this study was to illuminate the main problem explaining why some parents fail to bring their children to the dental health clinics or to encourage and supervise them when they can take the responsibility themselves for dental treatments or only regular dental check-ups. DESIGN: In-depth interviews were carried out with 16 parents of children who regularly had failed to turn up for appointments at the dental health clinic. The verbatim transcribed interviews were analysed in line with the guidelines for grounded theory. RESULTS: A core category, 'being overloaded in daily life', emerged from the data and formed, together with three additional related categories, a conceptual model. CONCLUSIONS: Our results indicate that these families experience an overload of demands related to their daily living and survival. Health-promoting efforts in the form of regular dental check-ups for their children have low priority for them.     

Issues and considerations in dental implant occlusion: what do we know, and what do we need to find out?

Implant dentistry continues to struggle with what are the appropriate occlusal concept(s) for implant-supported restorations. The biological and mechanical consequences of the loading environment leads to establishing and maintaining an implant interface in a wide variety of bone quality and quantity, implant and prosthesis designs. To the restorative dentist, the role of occlusion is more focused on extending the service life of the restoration and the connecting abutment(s) than protecting the osseous integration of the implant(s). This study reviews the relevant issues regarding implant occlusion along with implant and prosthesis design in order to provide optimal patient care.