Clinical Dentistry

Front Cover
Churchill's Pocketbooks Clinical Dentistry
Copyright Page
Preface to the Fourth Edition
Contributors
Table Of Contents
1 Dental public health, epidemiology and prevention
	Dental public health
	Oral health epidemiology
	The prevention of oral diseases
	The wider determinants of health
	Oral health promotion
		Prevention.
		Health education.
		Health protection.
	Common risk factors
	Barriers to healthy behaviours
	Changing disease levels
	Caries risk
		Population basis.
		Individual basis.
	Diet and dental caries (see also Chapter 3)
		Evidence that sugar causes caries
			Factors influencing cariogenicity of foods
		Dietary advice
			Diet diary
				Non-sugar sweeteners.
				‘Tooth-friendly’ sweets.
				Chewing-gum.
				Carbonated beverages.
				Detersive foodstuffs.
	Fluoride
	Modes of action
		Systemic (pre-eruptive) effect.
		Topical (post-eruptive) effect.
		Evidence that fluoride prevents caries
		Mechanisms for delivering fluoride
			Water fluoridation
			Fluoride toothpaste
			Fluoride drops and tablets
			Fluoridated salt
			Fluoridated milk/fruit juices
			Fluoride gels
			Fluoride mouthwashes
				Indications.
			Fluoride varnishes
			Fluoride foams
			Fluorosis
			Safety of fluoride
				Antidote.
	Smoking and oral health
	Smokeless tobacco and oral health
	Electronic cigarettes and oral health
	Hookah (shisha) and oral health
	Alcohol consumption and oral health
	Other substance abuse and oral health
	HIV infection and oral health
	Prevention of dental neglect
	Sport trauma
	Temporomandibular disorders
	Frequency of dental attendance
	Routine scale and polish
	Prevention in older patients
		Factors complicating disease prevention in older patients
			Plaque control
			Diet
			Denture care
			Advanced restorative care
	Pregnancy and oral health
	Oral health in special population groups (see also Chapter 20)
	Conclusion
	References
2 Social and psychological aspects of dental care
	The social determinants of oral health
		1. Social class
		2. Gender
		3. Age
		4. Disability status
		5. Ethnicity
	Communication and the dental team
		Providing structure
		Building the relationship
		The consultation
	Changing oral health-related behaviour
		Providing information about behaviour change
			Improving the understandability of information
			Improving the recall of information
		Creating an intention to change (Motivation)
		Creating a plan to implement change (Volition)
	Dental anxiety and phobia
		Assessment of dental anxiety
		Interventions for individuals with low levels of anxiety
		Interventions for individuals with moderate levels of anxiety
		Interventions for individuals with high levels of anxiety
	Psychological management of pain
		Acute pain
			Reducing anxiety
			Distraction
				Increasing perceptions of control.
			Language
		Chronic pain
	References and further reading
		The social determinants of oral health
		Communication and the dental team
		Changing oral health-related behaviour
		Dental anxiety and phobia
		Psychological management of pain
3 Dental disease
	Health
		WHO (World Health Organization) definition of health
	Oral health
		Disease
		Oral health and disease
	Teeth: health and disease
		Dental caries
			Microbiology of dental caries
				Consequences if caries is not treated
			Pain and dental caries
			Diet and dental caries
			Factors protective of caries
			Particular patterns of caries
				Arrested caries.
				Dentine caries.
				Early childhood caries (ECC).
				Enamel caries.
				Fissure caries.
				Occult caries.
				Radiation caries.
				Rampant caries.
				Recurrent caries.
				Root caries.
				Secondary caries.
			Prevention of caries
			Diagnosis of caries
				Clinical diagnosis
				Radiographic diagnosis
				Fibreoptic transillumination (FOTI)
				Lasers
				Electronic caries detector
				Caries detection dyes
				Caries charting
			Caries risk
			Assessing caries prevalence and treatment needs in populations
		Attrition
		Abrasion
		Erosion
		Trauma
		Abfraction
			Consequences of tooth surface loss
				Periapical abscess (Dental abscess)
				Infections of dental origin (odontogenic infections)
					Apical (dental) abscess.
					Periodontal abscess.
					Pericoronitis.
					Spreading infection.
	Other dental disease (see also Box 3.2)
		Tooth eruption problems
		Delays in eruption
			Impacted teeth
				Malocclusion.
				Pericoronitis.
		Variations in tooth number
			Hypodontia (too few teeth)
				Missing premolars.
				Missing lower central incisor.
			Hyperdontia (too many teeth)
		Anomalies of tooth form, position or structure
			Abnormalities of tooth form
				Dens-in-dente.
				Dilaceration.
			Abnormalities of tooth position
				Impacted first molars.
				Abnormal position of crypts.
				Ectopic upper canines.
				Transposition.
			Abnormalities of tooth structure
				Abnormal enamel
					Enamel hypoplasia.
					Enamel hypomineralization.
						Local aetiology.
						General aetiology.
						Hereditary.
						Amelogenesis imperfecta.
				Abnormal dentine
					Dentinogenesis imperfecta.
			Discoloured teeth
		Fluorosis
		Tooth (dentine) hypersensitivity
			Abnormal cementum
				Hypercementosis.
				Hypocementosis.
		Malocclusion
		Pain
		Halitosis
	Periodontal health and disease
	Other infections
		Dry socket (focal alveolar osteitis)
		Sinusitis
			General aspects
			Clinical features
			General management
			Dental aspects
	References
4 The dental team
	Introduction
	Regulation of dentistry
	Dental undergraduate education and training
		The Dental Schools Council
		The role of the General Dental Council (GDC)
			The GDC requirement regarding the aims of dental education
			Dental undergraduate student fitness to practise
	Dental postgraduate education and training
	Specialist dentists
	The dental team
		Scope of practice
			Dentists
			Dental nurses
			Orthodontic therapists
			Dental hygienists
			Dental therapists
			Dental technicians
			Clinical dental technicians (CDTs)
		Direct access to dental care professionals
		Registered dentists
		Dentists who can practise in the UK
			Specialists
5 Law, ethics and quality dental care
	Practising lawfully, professionally and ethically
		Legislation
		Ethical guidance, standards and regulation
			The nine principles dental registrants must keep
			Duty of candour
		The General Dental Council’s guidance to patients
			Standards for the dental team and how they are upheld
			Education for dental registrants
	Continuing Professional Development (CPD)
		CPD requirements for registrants
			Minimum CPD hours
				Verifiable CPD
				General or non-verifiable CPD
		CPD requirements – dentists
		CPD requirements – dental care professionals
	Professionalism and fitness to practise
		Fitness to practise procedures
			The Investigating Committee
			The Interim Orders Committee
			The Practice Committees
			The Health Committee
			The Professional Performance Committee
			The Professional Conduct Committee
		Appeals to decisions made by committees of the GDC
		Support for registrants
			The Dentists’ Health Support Trust and Programme (see Figure 5.3)
	Treating patients
		Duty of care
		Confidentiality
		Consent
		Contractual considerations
		Referring patients
		Carrying out treatment
	Record keeping – clinical records
		Record keeping – other records
	Equality and diversity
	Quality dental care
		Clinical governance
		Clinical audit
			Audit and research
			Peer review
		Reflective learning
	Evidence-based dentistry
	Clinical effectiveness
		Improving clinical performance
		Protocols
		Patient and stakeholder involvement
		Significant event analysis
	Complaints
	Underperformance
		Data collection and retention
	Conclusion
	References
6 Practice management
	Introduction
	Management skills
		Communication
			Staff meetings
		Delegation
		Teamwork
		Staff training
		Pay
	Financial management
		Cost analysis
		Financial ratios
			Cost control and budgets.
			Budgets.
		Fee setting
		Cash flow
		Borrowing and repayment methods
		An awareness of economic influences
		Financial record keeping
		The role of financial advisers
		Monitoring performance (KPIs)
		Interest free/Finance options
	Marketing
		Product
		Place
		Price
		Promotion
	Employing staff and management
		Recruitment
		Person specification
		Pay structure
		Advertising
		Screening applications
		The interview
		Job offer
		Employment contract
		Ending employment
			Minimum legal notice entitlement
				Exit interviews.
		Post-employment restrictions
	Information for patients
	Data protection, information governance and Freedom of Information
		Further considerations
		Freedom of Information Act (FOIA)
	General Dental Council regulations and obligations (see Chapter 4)
		The internet and social media guidelines
		Fitness to practise proceedings (see Chapter 5)
	Health and safety in the dental practice
		Hazardous substances
			Mercury safety
			Latex allergies
			Nitrous oxide
		Disposal of dental waste
		Cross Infection Control
		RIDDOR (2013) Reporting of Injuries, Diseases, and Dangerous Diseases
		Medical devices directive
		Water supply and dental unit water lines
		X-rays, CBCT machines and radiography
		Fire safety
		Practice electrical equipment
			Electrical inspections
			Visual inspections
				Portable Appliance Testing (PAT)
			Computers and Visual Display Units (VDUs)
			Autoclaves and compressors
			Lasers
	Dental radiographs and regulations (see Chapter 8)
		The Ionising Radiations Regulations 1999 (IRR99)
		The Ionising Radiation (Medical Exposure) Regulations 2000 (IRMER) (Amendments 2006 and 2011)
			Legal responsibility and staff appointments
				Legal Person
				Radiation Protection Supervisor
				IRMER practitioner
				IRMER referrer
				Operator
			External appointments
				Radiation Protection Advisor (RPA)
		Dental Cone Beam Computerized Tomography (CBCT)
			Justification
			CBCT training
	Building design
		Basic design features
		Ergonomic design
			Reception and waiting areas
			Non-clinical consultation rooms
			Clinical areas
				Implications of HTM 01-05 to the design of dental practices
		Design features of the whole dental practice for cross infection control
			Steri-walls (Sterilization walls)
	Cross infection prevention
		Personal Protective Equipment (PPE) and Infection Control Protocols
		Sharps safety and needle-stick injuries
		Work surfaces
		Immunization
		Blood spillages
		Laboratory impressions and clinical appliances
	Time management
	Dental Foundation Training, Dental Core Training and Dental Career Development Posts (DCDP)
		Dental Foundation Training (DFT1)
			Dental Foundation study days
			Contracts and completion of DFT
			Dentists who have not completed DFT
				Who may need to be admitted by assessment?
		Dental Core Training posts
		Dental Career Development Posts (DCDP)
	Clinical governance, clinical audit, peer review and Continuing Professional Development (see Chapter 5)
		Clinical governance
			Main components of clinical governance
			Clinical governance effects the following areas of dental practice
		Clinical audit and peer review (see Chapter 5)
			Legal/Contract requirement
			Aims of clinical audit
			Audit outline
			Mechanism of clinical audit
		Continuing Professional Development
			For dentists
			For DCPs
			Personal Development Plan (PDP)
	References
7 History and examination
	History
		The purpose of a history
		Presenting complaint
			History of presenting complaint (HPC)
				Determine
					Location.
					Initiating or relieving factors.
					Character.
					Severity.
					Spread/radiation.
		Previous dental history (PDH)
			Establish
		Previous medical history (PMH)
		Social history (SH)
	Examination
		Extraoral examination
			Look for
			Palpate
		Intraoral examination
	Diagnosis
		Provisional diagnosis
		Special tests and investigations
			Radiographs.
			Sensitivity (vitality) tests.
			Study models.
			Tests often sent for referral
		Definitive diagnosis
	Treatment planning
		Factors influencing treatment planning
			Patient-related factors
			Dentist-related factors
			Cost-related factors
			Other factors in treatment planning
8 Dental and maxillofacial radiology
	The nature of X-rays, their production and interaction
		Photoelectric absorption
		Compton scatter
	Image formation
		Film-based imaging
			Developing
			Intermediate washing
			Fixing
			Final washing
			Drying
		Digital imaging
			Advantages
			Disadvantages
	Radiation dose measurement and radiation protection
		Doses for common radiographic examinations and their comparative risk
		The biological effects of radiation
			Deterministic effects
			Stochastic effects
		Dose limitation in dental radiography
			Justification
			Optimization
				Equipment
					X-ray generator.
					Voltage.
					FSD.
					Film holders.
					Collimation.
					Image capture.
				Technique
				Quality assurance (QA)
					Inspection of X-ray equipment.
					Checks on darkroom, films and processing.
					Digital systems.
					Programme of staff training.
					Image quality.
					Audit.
		Lead aprons and radiography in pregnancy
	Ionizing radiation regulations
		Notification.
		Risk assessment.
		Radiation Protection Adviser (RPA).
		A controlled area.
		Local rules.
		Personnel.
		Training.
		Justification and optimization.
		Quality assurance (QA).
	Radiographic technique
		Intraoral views
			Periapical radiography
				Paralleling technique.
				Bisecting angle technique.
			Bitewing
			Occlusal radiographs
				Upper standard occlusal.
				Upper true (vertex) occlusal.
				Upper oblique occlusal.
				Lower standard occlusal.
				Lower true occlusal.
				Lower oblique occlusal.
		Extraoral projections
			Panoramic
				Oblique lateral
				Posteroanterior (PA) jaw
				Reverse Towne’s projection
				Occipitomental (OM)
				Submentovertex (SMV)
				Lateral cephalometric view
		Advanced imaging techniques
			Computed tomography (CT)
			Cone beam computed tomography (CBCT)
			Magnetic resonance imaging (MRI)
			Ultrasonography (US)
			Radiographic contrast techniques in the head and neck
				Sialography
					Indications.
					Contraindications.
				Angiography
				TMJ arthrography
				Radionuclide imaging
					Indications.
	Guidelines for the prescription of radiographs
		Patients in pain (Table 8.7)
		Diagnosis of caries
		Periodontal assessment
		Oral surgery
			Radiography before routine extractions
			Surgical procedures
			Third molar assessment
			Trauma
			Salivary gland disease
	Interpretation of radiographs
	Differential diagnosis of radiographic lesions
	References
9 Pain and anxiety management
	Local anaesthesia (LA)
		What are the general properties of local analgesics?
		Why vasoconstrictors?
			What dose of local analgesic is ‘safe’?
		Which LA techniques and where?
			Topical
			Infiltration
			Regional nerve block
			ID nerve block
				Tissues anaesthetized
					ID nerve.
					Lingual nerve.
					Not anaesthetized fully.
				Assessment of effect of the block
			Mental nerve block
				Tissues anaesthetized.
			Infraorbital nerve block
				Tissues anaesthetized.
			Greater palatine nerve block
				Tissues anaesthetized.
			Nasopalatine nerve block
				Tissues anaesthetized.
			Intraligamental
				Tissues anaesthetized
				Intrapapillary
				What if the LA fails?
				What complications may occur?
				Systemic complications
					Vasovagal syncope (faint).
					Allergy.
					Toxicity.
					Local complications.
					Haematoma.
					Trismus.
					Physical or chemical trauma to the nerve.
					Facial paralysis.
					Needle fracture.
					Needle-stick injury.
	Conscious sedation (CS)
		When might sedation be indicated?
		What is involved in patient assessment for sedation?
		What are the commonly used sedation techniques in dentistry?
		Inhalation sedation (or relative analgesia: RA)
			Equipment.
			Technique for inhalation sedation
			Postoperative instructions after inhalation sedation
			Chronic exposure of staff to nitrous oxide
		Intravenous sedation
			IV midazolam technique
			Are there other sedation techniques available?
				Oral and transmucosal (intranasal spray) sedation
				IV sedation with other drugs.
			Postoperative instructions after intravenous sedation
	General anaesthesia (GA)
		What is involved in patient assessment for dental general anaesthesia?
		How is the general anaesthetic administered?
		How is the dental treatment performed?
	Cognitive behavioural therapy (CBT)
	Hypnotherapy
	Acupuncture
	Further reading
10 Drug prescribing and therapeutics
	Hypersensitive (allergic) reactions
		Anaphylaxis (see also Chapter 21)
			Recognize, treat, reassess
			Recommendations
			British National Formulary
				Controlled drugs
					CD3.
					CSM (Committee on Safety of Medicines).
					POM (Prescription-Only-Medicine).
		Prescription writing
			Note
		Warnings to patients
		Patients at particular risk from drugs
			Children.
			Older people.
			Pregnancy.
			Breastfeeding.
			Liver disease.
			Kidney disease.
	Therapeutics
		Dental and orofacial pain
		Chronic orofacial pain
		Neuropathic pain
		Anxiety
		Infections
		Drugs commonly used in primary care dentistry
	Areas of recent controversy
		Infective endocarditis
			Anticoagulants.
11 Dental materials
	Properties of materials
		Metals.
		Polymers.
		Ceramics.
		Composites.
		Mechanical properties
			Stress.
			Strain.
			Elastic modulus (E).
			Elastic deformation.
			Plastic deformation.
			Brittleness.
			Ductility.
			Malleability.
			Hardness.
			Fracture toughness.
			Fatigue strength.
		Physical properties
			Electrical conductivity.
			Thermal conductivity.
			Thermal expansion.
			Radio-opacity.
			Optical properties.
		Chemical properties
			Corrosion.
			Solubility.
			Oxide layer formation.
		Biocompatibility properties and safety procedures
		Testing materials
			Problems with testing
	Dental amalgams
		Basic properties
		Components and metallurgy
			Silver (Ag).
			Tin (Sn).
			Copper (Cu).
			Mercury (Hg).
			Setting reaction (low Cu-content amalgams)
			Setting reaction (high Cu-content single-phase amalgams)
			Alloy formation
				Lathe cut.
				Spherical.
				Dispersion.
		Uses
		Practical tips
		Safety and biocompatibility
			Safety concerns, because of mercury release
			Environment
			Amalgam allergy (to mercury, ammoniated mercury or amalgam)
			Disposal
	Resin-based composites
		Basic properties
		Components
			Filler.
			Resin.
		Setting
			Two paste (base and catalyst system).
			Visible light cure.
		Resin composite types
			Coarse.
			Heterogeneous microfills.
			Hybrid.
			Flowable composites.
		Uses
			Direct composites
				Microfills.
				Hybrid.
				Flowable.
			Indirect composites
			Practical tips
				Problems with direct composites.
		Indirect composites
			Problems with indirect composites.
		Light curing units
			Light Emitting Diode (LED).
			Halogen.
			Plasma-arc.
			Practical tips
	Glass ionomers
		Typical constituents
		Setting reaction
			Dissolution phase.
			Gelation phase.
			Maturation phase.
		Tooth surface pretreatment
		Properties
		Uses
			Clinical tips
	Resin ionomer hybrid materials
		Types of materials
			Modified composites.
			Compomer (polyacid-modified composite).
			Resin-modified glass ionomers.
		Properties
		Uses
	Adhesion and bonding agents
		Micromechanical adhesion
		Molecular attraction
		How to achieve adhesion
		Factors promoting adhesion
			Clean surface
			Increased surface roughness.
			Wettability.
			Bond type.
			Adhesive cure.
		Bonding to tooth tissue
			Total-etch (etch-and-rinse)
				3-step:
				2-step:
			Self-etch
				2-step:
				1-step:
			Properties
				Etch-and-rinse
				Self-etch
		Metal bonding
		Ceramic bonding
	Luting cements, linings and bases
		Basic principles
			Calcium hydroxide
				Properties.
				Uses.
			Zinc oxide-eugenol
				Composition.
				Properties.
				Uses.
			Ethoxybenzoic acid (EBA)-based cements
				Composition.
				Uses.
			Zinc phosphate
				Composition.
				Properties.
				Uses.
			Zinc polycarboxylate
				Composition.
				Properties.
				Uses.
			Glass ionomers and resin-modified glass ionomers
	Temporary cements and restorations
		Temporary cements
		Temporary restorations
			Other temporary restorations
				Gutta-percha
					Properties.
				Temporary putties
	Impression materials
		Properties of ideal material
		Classification
			Rigid
			Elastic
		Rigid impression materials
			Impression compound
				Type I low fusing.
				Type II high fusing.
				Composition.
				Properties.
				Clinical tips
			Zinc oxide–eugenol
				Properties.
		Elastic impression materials – hydrocolloids
			Setting reactions.
			Properties
				Syneresis.
				Imbibition.
				Evaporation.
				Clinical tips
			Reversible hydrocolloid
				Agar.
			Irreversible hydrocolloid
				Alginate.
				Composition.
		Elastic impression materials – elastomers
			Basic types
			Polyethers
				Composition.
				Properties.
				Uses.
			Polysulphides
				Properties.
				Uses.
			Addition silicones
				Properties.
				Uses.
			Condensation silicones
				Properties.
				Uses.
				High viscosity silicones (Lab Putty).
	Dental ceramics
		Dental ceramic processing
			Traditional processing.
			Laboratory handling
				Slip-casting.
				Hot-pressing.
				CAD-CAM.
		Metal–ceramic crowns
			Uses of dental porcelain:
			Aesthetics
				Hue –
				Chroma –
				Value –
				Problems in choosing shades
					Metamerism.
					Colour washout.
					Observer errors.
					Technical problems.
				Tips for choosing aesthetic shades
	Casting and wrought alloys
		Basic metal microstructure
			Metal lattices
				Two basic types of alloys
					Interstitial solid solution.
					Substitutional solid solution.
				Altering metal properties
					Work hardening.
					Annealing.
					Cooling.
					Polishing.
					Etching.
					Oxide layer.
			Dental gold alloys
				Composition.
				Properties.
				Uses.
					Type I.
					Type II.
					Type III.
					Type IV.
				White gold.
			Cobalt–chromium alloys
				Composition.
				Properties.
				Uses.
			Nickel–chromium alloys
				Composition.
				Properties.
				Uses.
			Steel alloys
				Composition.
				Types
					Martensite.
					Stainless steels.
	Denture base materials
		Two types
		Polymer denture base materials
			Composition.
				Powder.
				Liquid.
			Curing reaction.
			Properties.
			Uses.
			Developments
				High-impact acrylics.
				Radio-opacity.
				Bonding to cobalt–chromium.
				Methacrylate sensitivity.
			Alternative denture base materials
				Polycarbonates.
				Nylon.
		Soft linings
			Temporary
				Uses.
			Permanent
				Uses.
	Endodontic materials
		Root canal cleansers
			Sodium hypochlorite.
			EDTA (ethylenediaminetetraacetate) solution.
			EDTA and urea peroxide.
			Chlorhexidine.
		Preformed root canal fillings
			Gutta-percha cones.
			Heated gutta-percha.
			Silver points.
		Root canal sealers
			Zinc oxide–eugenol based.
			Calcium hydroxide based.
			Glass ionomer based.
			Dentine bonding agents.
			Formaldehyde-containing sealers.
		Retrograde root filling materials
		Intra-canal medicaments
	Implant materials
		Types of implants (Chapter 12)
			Subperiosteal
			Transmandibular
			Osseointegrated
				Uses.
				Commercially pure titanium.
				Properties.
			Other materials used for osseointegration
				Titanium alloys.
				Plasma-sprayed surface to titanium.
				Aluminium oxide.
	Miscellaneous
		Waxes
			Types of wax in dentistry
				Inlay wax.
				Sheet casting wax.
				Sticky wax.
				Carding wax.
				Modelling wax.
				Shellac resin.
		Fissure sealants
			Properties of ideal sealant.
			Materials used for fissure sealing.
		Periodontal materials
			Periodontal pack or dressing.
			Uses.
		Investment materials
			Properties.
			Types of dental investment
				Low temperature.
				High temperature.
		Polishing
			Abrasion polishing
			Relief polishing
		Temporary crown materials
			Properties.
			Materials in use
				Epimine polymers.
				Polyethyl or polybutyl methacrylate.
				Composite.
				Preformed polycarbonate crowns.
				Preformed stainless steel crowns.
		Denture teeth
			Types
				Acrylic.
				Porcelain.
	Current ‘growth areas’ in dental materials
12 Implantology
	Introduction
	Dental implant materials (see also Chapter 11)
		Types of dental implant
			Subperiosteal.
			Blade.
			Ramus frame.
			Osseointegrated.
			Uses
			Materials
			Surfaces
			Connection
			Platform
		Clinical use of dental implants
			Uses
			Case selection
			Consent
	Restorative aspects
		Restorative planning
		Radiological investigations
	Prosthesis design
		Removable implant-retained prostheses
		Fixed implant-retained prostheses
	Surgical aspects
		Surgical planning
			Patient-specific factors
			Site-specific factors
		Implant placement surgery
		Surgical complications
		Interim restoration
	Maintenance
		Technical complications
		Biological complications
			Peri-implant diseases
			Implant loss or removal
	Current developments in implant treatment
		Immediate placement of implants into extraction sockets
		Immediate loading of implants
		Short or narrow implants
		Flapless implant surgery
		CAD-CAM framework manufacture and design
		Full-arch immediate tooth replacement
	References
13 Oral medicine
	Oral infections
		Bacterial infections
			Tuberculosis
				Clinical features.
				Investigations and diagnosis.
				Treatment.
			Gonorrhoea
				Clinical features.
				Investigation and diagnosis.
				Treatment.
			Syphilis
				Clinical features
					Primary syphilis.
					Secondary syphilis.
					Tertiary syphilis.
					Congenital syphilis.
				Investigation and diagnosis.
				Treatment.
		Fungal infections
			Candidosis (candidiasis)
				Clinical features
					Pseudomembranous.
					Erythematous.
					Denture-related stomatitis.
					Angular cheilitis.
					Median rhomboid glossitis.
					Chronic hyperplastic.
				Investigation and diagnosis.
				Treatment.
					Antifungal agents.
		Viral infections
			Primary herpetic gingivostomatitis
				Clinical features.
				Investigation and diagnosis.
				Treatment
					Mild cases.
					Moderate and severe cases or infections occurring in immunosuppressed patients.
			Recurrent herpetic infection
				Treatment.
			Chickenpox
				Clinical features.
				Investigation and diagnosis.
				Treatment.
			Shingles
				Clinical features.
				Investigation and diagnosis.
				Treatment.
			Herpangina
				Treatment.
			Hand, foot and mouth disease
			Human papillomaviruses (HPV)
				Squamous cell papilloma.
				Verruca vulgaris.
				Condyloma acuminatum.
				Multifocal epithelial hyperplasia (Heck’s disease).
	Recurrent oral ulceration
		Oral ulceration
		Recurrent aphthous stomatitis
			Clinical features.
			Aetiological factors.
				Genetic.
				Nutritional deficiencies.
				Systemic diseases.
				Endocrine.
				Stress/anxiety.
				Trauma.
				Allergy.
				Infection.
				Smoking.
			Investigation and diagnosis.
			Treatment.
		Behçet’s syndrome
			Clinical features.
			Investigations and diagnosis.
			Treatment.
	Vesiculobullous lesions
		Angina bullosa haemorrhagica (localized oral purpura)
			Clinical features.
			Investigation and diagnosis.
			Treatment.
		Pemphigus
			Pemphigus vulgaris.
				Clinical features.
				Investigation and diagnosis.
				Treatment.
			Pemphigus vegetans.
			Mucous membrane pemphigoid.
				Clinical features.
				Investigation and diagnosis.
				Treatment.
			Bullous pemphigoid.
		Erythema multiforme
			Clinical features.
			Investigation and diagnosis.
			Treatment.
		Epidermolysis bullosa
		Dermatitis herpetiformis
		Linear lgA disease
	White patches
		Classification.
		White sponge naevus
			Clinical features.
			Investigation and diagnosis.
			Treatment.
		Darier’s disease (follicular keratosis)
		Pachyonychia congenita
		Dyskeratosis congenita
		Chemical burns
		Frictional keratosis
		Smokers’ keratosis
		Nicotinic stomatitis
		Renal failure
	Potentially malignant lesions and conditions
		Leukoplakia and erythroplakia
			Leukoplakia.
			Erythroplakia.
			Factors associated with increased rate of malignant transformation
				Site of lesion.
				Presence of epithelial dysplasia.
				Clinical nature of lesion.
		Chronic hyperplastic candidosis (candidal leukoplakia)
			Predisposing factors.
			Management.
		Oral submucous fibrosis
	Pigmented lesions of the oral mucosa
		Exogenous causes of pigmentation
			Superficial mucosal staining.
			Black hairy tongue.
			Foreign bodies.
			Heavy metal salts.
		Endogenous causes of pigmentation
			Developmental causes of melanin pigmentation.
			Acquired causes of melanin pigmentation
			Neoplastic
				Malignant melanoma.
	Mouth cancer
		Aetiological factors
			Tobacco.
			Alcohol.
			Diet and nutrition.
			Ultraviolet light.
			Chronic Candida infection.
			Human papillomavirus (HPV).
			Immunosuppression.
			Syphilis.
			Chronic trauma.
		Clinical features.
			Early lesion.
			Advanced lesion.
		Prognosis.
			Early versus late diagnosis.
			Extent of disease.
			Site.
			Pathology.
			Age.
		Treatment.
		Verrucous carcinoma
			Clinical features.
			Treatment.
	Miscellaneous lesions
		Geographic tongue (benign migratory glossitis)
		Fissured tongue (scrotal tongue)
		Sarcoidosis
			Lungs.
			Skin.
			Eyes.
			Heart.
			Oral.
	Salivary gland disorders
		Xerostomia
			Possible causes.
			Sjögren’s syndrome
				Clinical features.
					Primary.
					Secondary.
				Investigation and diagnosis.
				Treatment.
		Salivary gland neoplasms
			Pleomorphic adenoma
			Monomorphic adenomas
				Adenolymphoma
				Mucoepidermoid carcinoma
			Acinic cell carcinoma
			Adenoid cystic carcinoma
			Carcinoma arising in pleomorphic adenoma
		Salivary mucoceles
			Mucous extravasation cysts.
			Mucous retention cysts.
			Clinical features.
			Treatment.
		Bacterial sialadenitis
			Clinical features.
			Investigation and diagnosis.
			Treatment.
		Mumps
			Clinical features.
			Investigation and diagnosis.
			Treatment.
		Sialosis (Sialadenosis)
			Clinical features.
			Histological features.
			Management.
	Effects of drugs on the teeth, oral mucosa and salivary glands
		Discoloration of teeth.
		Oral candidosis.
		Oral ulceration.
		Gingival swelling.
		Erythema multiforme.
		Lichenoid reactions.
		Mucosal pigmentation.
		Xerostomia.
		Salivary gland pain and swelling.
	Disorders of the temporomandibular joint (TMJ)
		Common disorders of the TMJ
		Rare disorders of the TMJ
		Myofascial pain dysfunction syndrome
			Symptoms.
			Signs.
			Treatment options.
		Anterior disc displacement with reduction
			Symptoms.
			Signs.
			Treatment.
		Acute anterior disc displacement without reduction
			Symptoms.
			Signs.
		Chronic anterior disc displacement without reduction
			Symptoms.
			Signs.
			Treatment.
		Osteoarthrosis
		Rheumatoid arthritis
	Facial pain
		Burning mouth syndrome (oral dysaesthesia)
			Type 1.
			Type 2.
			Type 3.
			Investigation.
			Treatment.
		Persistent idiopathic facial pain
			Clinical features.
			Treatment.
		Trigeminal neuralgia
			Clinical features.
			Investigation and diagnosis.
			Treatment.
		Glossopharyngeal neuralgia
		Giant cell arteritis (Temporal or cranial arteritis)
			Clinical features.
			Investigation and diagnosis.
			Treatment.
		Periodic migrainous neuralgia (cluster headache)
			Treatment.
				Acute episode.
				Prophylaxis.
	Oral manifestations of systemic disease
		Oral manifestations of skin disease
			Lichen planus and lichenoid reactions
				Clinical features.
					Reticular.
					Papular.
					Plaque.
					Atrophic.
					Erosive or ulcerative.
					Bullous.
					Desquamative gingivitis.
				Histological features.
				Treatment.
			Lupus erythematosus
				Systemic lupus erythematosus (SLE)
				Chronic discoid lupus erythematosus (CDLE)
			Vesiculobullous disorders
		Oral manifestations of gastrointestinal disease
			Crohn’s disease
				Clinical features.
			Orofacial granulomatosis (OFG)
			Ulcerative colitis
				Clinical features.
				Treatment.
			Brown Kelly–Paterson syndrome (Plummer–Vinson syndrome)
			Gardner syndrome
				Hard tissue ‘tumours’.
				Soft tissue ‘tumours’.
			Peutz–Jegher’s syndrome
		Oral manifestations of neurological disease
			Facial nerve palsy
				Upper motor neurone lesions.
				Lower motor neurone lesions.
				Sensory loss
			Bell’s palsy
		Oral manifestations of haematological disease
			Anaemia
			Leukaemias
			Myeloma
			Leucopenia
			Cyclic neutropenia
	HIV infection and acquired immune deficiency syndrome (AIDS)
		Group I.
		Group II.
		Group III.
		Erythematous and pseudomembranous candidosis
		Hairy leukoplakia
		Kaposi’s sarcoma
		Non-Hodgkin’s lymphoma
		Linear gingival erythema
		Acute necrotizing ulcerative gingivitis
		Acute necrotizing periodontitis
		HIV salivary gland disease
	Halitosis (Oral malodour)
		Diagnosis.
		Treatment.
14 Oral and maxillofacial surgery
	Tissue healing
		Phases of wound healing
			Inflammatory phase (0–4 days after injury)
			Proliferative phase (3–21 days after injury)
			Remodelling phase (21 days after injury onwards)
		Healing by primary and secondary intention
			Primary intention
			Secondary intention
		Bone healing
			Healing by primary intention.
			Healing by secondary intention.
			Extraction socket healing
				1st week.
				2nd week.
				4-6 weeks.
				After 10 weeks.
		Factors influencing healing
			Tissue factors.
			Infection.
			Operator.
	Exodontia
		Local anaesthesia (Chapter 9)
		Extraction technique
		Complications of exodontia
			Potential complications
			Prevention
			Preoperatively
			Perioperatively
			Postoperatively
		Dry socket (focal alveolar osteitis)
			Incidence.
			Aetiology.
			Diagnosis.
			Treatment.
	Dentoalveolar surgery
		Surgical removal of teeth
			Principles of flap design
			Elevators
			Bone removal
		Impacted third molars
			Indications for removal
				Pericoronitis.
				Caries.
				Orthodontic.
				Associated pathology.
			Radiographs in third molar diagnosis
				Position
					Angulation
					Depth of impaction.
					Tooth morphology.
					Root morphology.
				Surrounding structures.
					Trabeculation of bone.
					Pathology.
					Other structures.
					Access.
			Removal of impacted third molar
				Elevation of a buccal flap.
				Elevation of a lingual flap.
				Surgical removal.
				Nerve damage.
				Closure.
				Postoperative care.
		Maxillary canine exposure/removal
			Assessment
				History.
				Examination.
				Radiography.
			Treatment
				Palatal flap.
				Labial flap.
				Canine exposure.
				Surgical removal.
		Apicectomy (Apical end or root end surgery: Chapter 19)
			Indications for apicectomy
			Technique (see Figure 14.6)
	Biopsy technique
		Excisional biopsy.
		Incisional biopsy.
		Punch biopsy.
		Technique.
	Suturing
		Suture materials
			Resorbable.
			Non-resorbable.
		Needles
		Suture techniques
			Interrupted suture.
			Suture removal.
	Laser surgery, cryosurgery and piezosurgery
		Laser surgery
			Cutting lasers
			Non-cutting lasers
			Carbon dioxide (CO2) laser
		Cryosurgery
		Piezosurgery
	Infections
		Infection of dental origin
			Localized infections
				Apical (dental) abscess.
				Periodontal abscess.
				Pericoronitis.
			Spreading infection
		Other infections of the head and neck region
			Facial cellulitis.
			Osteomyelitis.
			Ludwig’s angina.
			Necrotizing fasciitis.
			Cavernous sinus thrombosis.
			Cancrum oris/noma.
		Infection of non-dental origin
			Salivary gland.
			Skin.
			Bone.
			Other.
		Patient assessment in infection
			History.
			Examination.
			Microbiology.
			Other tests.
			Differential diagnosis
				Management.
	Swellings of mouth, face and neck
		History.
		Examination.
			Look.
			Feel.
			Transillumination.
			Auscultation.
			Examine lymph nodes.
		Special tests
			Vitality tests.
			Ultrasound (US) examination.
			Radiography.
			Fine needle aspiration (FNA).
		Differential diagnosis
			Developmental.
			Inflammatory.
			Infective.
			Neoplastic
			Traumatic.
			Endocrine.
	Bone pathology
		Fibrous dysplasia
		Paget’s disease of bone
		Osteopetrosis
		Osteogenesis imperfecta
		Hyperparathyroidism.
		Ossifying fibroma.
		Giant cell lesions.
			Peripheral giant cell granuloma (giant cell epulis).
			Central giant cell granuloma.
			Brown tumour
			Cherubism.
			Aneurysmal bone cyst.
	Tumours – benign and malignant
		Hamartomas
			Pigmented naevi (moles).
			Vascular malformations.
			Odontomes.
			Exostoses.
		Neoplasms
			Benign neoplasms
				Lipoma.
				Neuroma.
				Papilloma.
			Locally invasive neoplasms
				Ameloblastoma.
				Basal cell carcinoma (BCC).
				Keratocystic odontogenic tumour (KCOT).
			Malignant neoplasms
			Odontogenic neoplasms
				Epithelial odontogenic tumours
					Ameloblastoma.
					Calcifying epithelial odontogenic tumour.
				Mesenchymal odontogenic tumours
					Odontogenic myxoma.
					Cementifying fibroma.
				Mixed odontogenic tumours
					Odontomas (odontomes).
					Ameloblastic fibroma.
	Mouth (oral) cancer
		Assessment
			History.
			Examination.
			Special tests.
				Blood tests.
				Imaging.
				Biopsy
				Examination under anaesthesia (EUA).
		Treatment
			Potentially malignant disorders and carcinoma in situ.
			T1 and T2 lesions.
			T3 and T4 lesions.
			Neck metastases.
			Prognosis.
	Cysts of the jaws
		Pathogenesis
		Treatment
			Endontotic therapy
			Enucleation and primary closure
			Marsupialization
	Maxillary sinus
		History
		Examination
		Special tests
		Oral–antral fistula (OAF)
		Closure of OAF
			Buccal flap with periosteal release (Figure 14.11)
			Palatal rotation flap
			Buccal fat pad transfer
			Postoperative care
		Displacement of a fractured root into the maxillary antrum
			To retrieve the root
		Fractured maxillary tuberosity
	Pre-prosthetic surgery
		Bone irregularities
			Maxillary and mandibular tori
			Local alveolar ridge architecture problems
			Resorption problems
				In the maxilla.
				In the mandible.
				Classification.
		Soft tissue problems
	Implants (See also Chapter 12)
		Factors influencing implant success
			Implant factors.
			Surgical factors.
			Soft tissue.
			Bone.
			Postoperative.
			Prosthetic factors.
	Maxillofacial trauma
		Emergency receiving
			Airway/cervical spine
			Bleeding/Circulation
		Consolidation
			History
			Examination
			Specific oral and facial examination
				Extraoral.
				Intraoral.
				Radiographs.
			Glasgow Coma Scale (GCS)
			Lacerations
		Facial skeleton fractures
			Classification
				Mandibular fractures.
				Maxillary (middle third of face).
				Zygomatic complex fractures.
				Nasal fractures.
			Treatment
	The temporomandibular joint (TMJ) (Figure 14.16)
		Acquired conditions of the TMJ
			Temporomandibular disorder (TMD)
				Myofascial pain
				Internal meniscal derangement
				Osteoarthrosis
				Arthritis
			Dislocation
				Treatment.
			Fracture
				Condylar neck.
				Diacapitular (intracapsular).
				Treatment.
			Ankylosis
				True.
				False.
				Treatment.
		Congenital conditions of the TMJ
	Facial and dental asymmetry (Figure 14.17)
		Differential diagnosis
			Congenital (intrauterine growth).
			Developmental (growth post birth).
			Occlusal cant
			Open bite.
	Orthognathic and cleft surgery (Chapter 16)
		Orthognathic surgery
			Indications
				Function.
				Aesthetics.
			Planning.
			History.
			Examination
				Head and neck assessment.
				Intraoral assessment.
				Other assessments.
				Special tests.
			Treatment
				Hard tissue discrepancy.
				Soft tissue discrepancy.
		Cleft lip and palate
			Cleft surgery
				Surgical interventions include.
	Reconstruction
		Flaps
			Random pattern.
			Axial pattern.
			Regional flaps.
			Free flaps.
		Grafts
			Autogenous grafts.
			Allografts.
			Heterografts.
			Alloplastic materials.
				Internal fixation plates and screws.
				Resorbable materials.
				Orbital wall/floor reconstruction material.
				Bone substitutes.
				Contour materials.
				Soft tissue crease/wrinkle obliterative materials.
	Salivary glands
		Surgical management
			Enucleation
			Operations on the duct
				Meatoplasty.
				Ductal reimplantation.
				Removal of stone.
			Excision of gland
				Parotidectomy.
				Submandibular gland excision.
15 Orthodontics
	Introduction
		What is orthodontics?
	What is malocclusion?
		Prevalence of malocclusion
			Based on morphology.
			Based on need for treatment.
		Who provides orthodontic care?
		Timing of orthodontic intervention
			Primary dentition.
			Early mixed dentition.
			Late mixed/early permanent dentition.
			Later treatment.
			Why do orthodontic treatment?
		Scope of orthodontic treatment
	Risk/Benefit considerations in orthodontic treatment
		Potential benefits of orthodontic treatment
			Improved dental health/function
				Masticatory function.
				Dental caries.
				Periodontal disease.
				Overjet.
				Temporomandibular joint dysfunction (TMD).
				Tooth impaction.
				Overbite.
				Anterior crossbite.
				Conclusion.
			Improved appearance
				Self-esteem.
				Social response.
				Stereotyping.
				Conclusion.
		Potential risks of orthodontic treatment
			Decalcification.
			Root resorption.
			Gingival problems.
			Pulp damage.
			Ulceration of the oral mucosa.
			Facial profile changes.
			Enamel damage at debond.
			Headgear injury.
			Temporomandibular joint dysfunction.
			Relapse.
			Treatment failure
				Conclusion.
	Classification and occlusal indices in orthodontics
		Incisor classification
			Class I.
			Class II.
				Class II division 1.
				Class II division 2.
				Class III.
		Skeletal classification
			Class I skeletal pattern.
			Class II skeletal pattern.
			Class III skeletal pattern.
		Index of orthodontic treatment need (IOTN)
			Dental Health Component (DHC) of IOTN
				Limitations.
			Aesthetic component of IOTN
				Potential uses of IOTN
					Resource allocation.
					Uniformity of assessment.
					Screening.
					Patient advice.
		Peer assessment rating index (PAR)
			Limitations.
	Patient assessment/examination
		Patient background
			Note.
		Clinical examination
			Extraoral examination
				Hard tissues
					Anterior–posterior.
					Vertical.
					Symmetry.
				Soft tissues
					Lips.
					Tongue.
			Intraoral examination
				Lower arch
					Labial segment.
					Buccal segment.
				Upper arch
					Labial segment.
					Buccal segment.
				In occlusion.
				Incisor relationship.
				Overjet.
				Overbite.
				Centrelines.
				Arch anterior/posterior relationship.
				Arch buccolingual relationship.
				TMJ assessment.
		Diagnostic records
			Study models
			Radiographs
	Cephalometrics
		Analysis of a lateral cephalograph
			Frankfort plane.
			Facial plane.
			Maxillary plane.
			Mandibular plane.
			Occlusal plane.
	Principles of treatment planning
		Aims of treatment
		Considerations
			Space requirements.
			Tooth movement.
			Anchorage demands.
			Retention.
		Treatment options
			No appliance.
			Removable appliances.
			Fixed appliances.
			Functional appliances.
			Orthognathic surgery.
	Management of the developing dentition
		Primary dentition
			Natal teeth
			Early loss of deciduous teeth.
				Early loss of deciduous incisors.
				Early loss of deciduous canines.
				Early loss of primary molars.
				Early loss of first primary molars.
				Early loss of second primary molars.
			Space maintenance, balancing and compensatory extractions
				Balancing extraction.
				Compensating extraction.
		Mixed dentition
			Sucking habits.
			Non-palpable maxillary canines.
			Traumatic loss of upper central incisor.
			Incisors in crossbite.
			Treatment of posterior crossbite.
			Skeletal problems.
			First permanent molars of poor prognosis.
	Class I malocclusion
		Crowding
			Cause.
			Dental health.
			Stability.
			Treatment options.
		Spacing
			Cause.
			Dental health.
			Stability.
		Transverse problems – crossbites
			Crossbite.
				Local crossbites.
				Segmental crossbites.
			Unilateral crossbite with associated displacement
				Cause.
				Dental health.
			Unilateral crossbite with no displacement
				Cause.
				Dental health.
			Bilateral crossbite
				Cause.
				Dental health.
		Vertical problems – open bite
			Anterior open bite (AOB).
			Posterior open bite.
		Bimaxillary proclination
	Class II Division 1 malocclusion
		Occlusal features
			Overjet.
			Overbite.
			Buccal segments.
			Alignment.
		Skeletal features
			Anterior/posterior.
			Vertical.
		Soft tissues
		Mandibular position/path of closure
		Why treat?
		Treatment options
			No treatment.
			Extractions only.
			Removable appliances.
			Two-arch fixed appliances.
			Functional appliance.
			Orthognathic surgery.
			Key factors in treatment planning.
		Post-treatment stability
	Class II Division 2 malocclusion
		Occlusal features
			Overjet.
			Overbite.
			Buccal segments.
			Alignment.
		Skeletal features
			Anterior/posterior.
			Vertical.
			Transverse.
		Soft tissues
		Mandibular position/path of closure
		Why treat?
		Treatment options
			No treatment.
			Extractions only.
			Removable appliance.
			Two-arch fixed.
			Functional appliances.
			Orthognathic surgery.
		Post-treatment stability
	Class III malocclusion
		Occlusal features
			Overjet.
			Overbite.
			Buccal segments.
			Alignment.
		Skeletal features
			Anterior/posterior.
			Vertical.
			Transverse.
		Soft tissues
		Mandibular position/path of closure
		Why treat?
		Treatment
			Key factors in treatment planning.
			No treatment.
			Extractions only.
			Removable appliance.
			Single-arch fixed.
			Two-arch fixed.
			Functional appliances and protraction headgear.
			Orthognathic surgery.
		Post-treatment stability
	Removable appliances
		Indications
			Treatment options with removable appliances
				Simple tipping movement of teeth.
				Overbite reduction.
				Elimination of occlusal interferences and crossbite correction.
				Extrusion of teeth.
				Space maintainer.
				Retainer.
				Habit deterrent.
			Contraindications
		Components of removable appliances
			Retentive components
			Active components
				Springs.
				Points to remember
					Bows.
					Screws.
					Elastics.
			Baseplate
				Flat anterior bite plane.
				Posterior bite plane.
		Designing a removable appliance
		Appliance fitting
		Appliance check visits
		Problems with removable appliance treatment
			No tooth movement
				Is the tooth free to move?
				Active components adjusted correctly?
				Lack of wear?
			Incorrect tooth movement
			Anchorage loss
				Signs (if retracting a tooth).
				Action.
		Advantages of removable appliances
		Disadvantages of removable appliances
	Fixed appliances
		Components
			Attachments
				Brackets.
				Bands.
			Archwires
			Auxiliaries
				Springs or elastics.
		Indications for fixed appliances
		Contraindications for fixed appliances
		Advantages of fixed appliances
		Disadvantages of fixed appliances
	Functional appliances
		Classification
		Mode of action
		Case selection
		Advantages of functional appliances
		Disadvantages of functional appliances
	Orthodontic management of cleft lip and palate
		Incidence (UK)
		Classification
			Cleft lip ± cleft palate.
			Cleft palate.
		Aetiology
		Cleft lip and palate associated problems
			Dental
				Teeth.
				Occlusion.
			Skeletal pattern/growth.
			Facial deformity.
			Hearing.
			Speech.
			Psychological.
		Management of cleft lip and palate problems
			Typical stages in management
	Orthodontic aspects of orthognathic surgery (see also Chapter 14)
		Aims of presurgical orthodontics
		Treatment
16 Paediatric dentistry
	Organizing dental treatment for children
		Aims of treating children
		History
		Examination
			Extraoral.
			Intraoral.
		Treatment planning
			First visit.
			Second visit.
			Third and subsequent visits.
		Preventive versus restorative care
		Choice of preventive regimen
		Practical points
		Role of parents or carers
			Remember
	Managing behaviour in children
		Behaviour management techniques
			Tell–show–do.
			Enhancing control.
			Modelling.
			Behaviour shaping and positive reinforcement.
			Distraction.
			Desensitization.
			Hypnotherapy and neuroLinguistic programming (NLP)
	Development of the dentition
		Pre-teeth
		Development of primary dentition
		Mixed dentition to permanent dentition
		Late changes
	Maintenance of the dental operating field
		Retractors.
		Saliva ejector.
		High-volume aspirator.
		Cotton-wool rolls.
		Absorbent pads.
		Dental dam (Rubber dam)
			Advantages
			Technique
	Pit and fissure sealants
		Sealants
		Selection of patients
			Children at high caries risk.
			Children with additional modifying factors.
			Teeth at high risk.
			Intermediate fissure sealants
			Technique for application of fissure sealant
	Restoration of carious primary teeth
		Primary molars
		Anterior primary teeth
		Materials (see also Chapter 11)
			Preformed metal crowns (PMC).
			Hall technique versus conventional preparation
			Conventional procedure:
			Hall technique procedure:
		Atraumatic Restorative Treatment (ART)
		Chemomechanical caries removal
	Pulp therapy
		Pulp therapy in primary teeth
			Advantages of pulp therapy
			Pulp therapy is contraindicated when
			Pulpal pain diagnosis and choice of therapy
				Transient pain.
				Spontaneous pain.
			Pulp therapy techniques
				Indirect pulp capping.
				Direct pulp capping.
				Pulpotomy.
				Technique
			Pulpectomy
				Difficulties with analgesia and cooperation
			Review and follow-up
		Pulp therapy in immature permanent teeth (open apices)
			Caries
			Trauma
			Vital permanent teeth with open apices
				Indirect pulp cap.
				Direct pulp cap.
				Coronal pulpotomy.
					Partial coronal (Cvek) pulpotomy.
				Technique
					Full coronal pulpotomy.
				Technique
			Non-vital permanent teeth with open apices
				Pulpectomy.
				Technique
	Traumatic injuries
		Prevalence
		Aetiology
		Predisposing oral factors
		Classification of trauma
			Classification
		History
		Examination
			Extraoral
			Intraoral
			Special tests
				Sensitivity (vitality) testing.
				Radiographs.
		Treatment
			Objectives of treatment
				Immediate.
				Intermediate.
				Long-term.
		Treatment in the primary dentition
		Treatment in the permanent dentition
			Treatment of tooth fractures
				Enamel only.
				Enamel and dentine fracture.
				Fractures involving enamel, dentine and pulp.
				Root fractures
					Fracture involving the gingival third.
					Fracture not involving the gingival crevice.
					Longitudinal fractures.
			Treatment of displacement injuries
				Concussion and subluxation.
				Lateral displacement.
				Extrusion.
				Intrusion (Mild <7mm; severe >7mm)
					Incomplete root.
					Complete root.
				Avulsion.
			Replantation
				Immediate treatment.
				After 10-14 days.
				Complete root.
				Incomplete root.
			Splinting (Table 16.1)
				Functions of splint
				Types of splint
					Resin splint.
					Composite and wire splint.
			Duration
			Review
	Oral pathology in children (see Chapters 3 and 13)
		Hard tissue pathology
			Abnormalities of tooth number
				Supplemental teeth.
				Supernumerary teeth.
					Conical.
					Tuberculate.
				Hypodontia.
					Missing upper lateral incisors.
					Missing premolars.
					Missing lower central incisor.
			Abnormalities of tooth form
				Dens invaginatus.
				Dilaceration.
			Abnormalities of tooth position
				Impacted first permanent molars.
				Abnormal position of crypts.
				Ectopic upper canines.
				Transposition.
			Abnormalities of tooth structure
				Abnormal enamel
					Enamel hypoplasia.
					Enamel hypomineralization.
						Local aetiology.
						General aetiology.
						Hereditary.
						Amelogenesis imperfecta.
				Abnormal dentine
					Dentinogenesis imperfecta.
				Abnormal cementum
					Hypercementosis.
					Hypocementosis.
			Bone pathology
		Soft tissue pathology
	Children with special needs (see also Chapter 20)
		Learning disability.
		Physical disability.
		Sensory disability.
		Medically compromised.
		Prevalence of disease
		Risk factors
			Oral hygiene.
			Diet.
			Medication.
			Muscular function.
		Management of children with special needs
			History.
			Examination and treatment.
			Restorative care.
		Factors hindering treatment
			Availability of treatment.
			Access to dental premises.
			Attitude of parents/carers.
		Prevention
	Safeguarding children in dental practice
		What is abuse?
		Role of the dental team
		Signs of abuse and neglect
		What to do when concerned about a child
17 Periodontology
	Periodontal health and disease
	Gingivitis
		Necrotizing ulcerative gingivitis (NUG)
		Desquamative gingivitis
	Chronic periodontitis
		Contemporary microbiology of periodontitis
		Contemporary immunology of periodontitis
		Systemic risk factors for periodontitis
		Lifestyle risk factors for periodontitis
		Impact of systemic diseases on periodontitis
		Impact of periodontitis on systemic diseases
			Atherogenic cardiovascular disease
			Diabetes
			Adverse pregnancy outcomes
	Diagnosis and risk assessment for periodontal diseases
	Management of periodontal diseases
	Reference
18 Removable prosthodontics
	Introduction
	Treatment planning
		History taking
			Factors required in prosthodontic history
				Patient complaints.
				Denture history.
				General dental history.
				Medical history.
				Social history.
		Examination
			Extraoral examination
			Intraoral examination
				Mucosa.
				Periodontal health.
				Caries.
				Restorations.
				Occlusion.
				Endodontic status.
				Support of edentulous areas.
				Mouth and peri-oral opening.
				Aesthetics.
			Denture examination
				With existing dentures in situ consider
				With existing dentures out of the mouth, consider
			Radiographic examination
			Additional features of prosthodontic examination
				Study casts.
				Surveying.
				Full occlusal assessment.
				Diagnostic wax-up.
				Digital photography.
				CBCT and three-dimensional printing.
		Diagnosis and management
			Diagnosis in edentulous patients
				Good denture wearers whose dentures require replacement because they are worn, lost, broken, aesthetically poor or loose.
				Good denture wearers with poor dentures.
				Poor denture wearers who, if provided with very well designed and constructed dentures, may tolerate their dentures.
				Poor denture wearers who do not tolerate dentures despite very well designed and constructed dentures.
			Diagnosis in partially dentate patients
				Design changes.
				Denture alternatives.
			Management
				Preprosthetic management.
			Management options in prosthodontics
				Who?
				What?
				When?
				Where?
				How?
	Changes following extraction of teeth
		Facial changes.
		Intraoral changes.
		Psychological changes.
	Complete dentures
		Principles
			Aims
			Features of complete dentures
				Retention
				Support
				Muscle balance
				Occlusal balance
				Stability
		Design
			Maximal extension of denture base.
			Peripheral seal.
			Postdam.
			Fraena.
			Relief areas.
			Retruded contact position.
			Balanced articulation.
			Freeway space.
			Tooth position
				Upper anterior.
				Lower anterior.
				Upper posterior.
				Lower posterior.
			Aesthetics.
			Materials.
		Clinical stages
			1. Examination, diagnosis and treatment
			2. Primary impressions
				Aims.
				Clinical technique.
			3. Master impressions
				Aims.
				Types of impressions
					Mucocompressive.
					Mucostatic.
				Types of individual impression trays.
				Clinical technique.
					Maxilla.
					Mandible.
				Suitable materials for master impressions.
			4. Jaw registration
				Aims.
				Clinical aspects
			5. Trial of teeth
				Aims.
				Clinical aspects
			6. Insertion of prosthesis
				Aims.
				Clinical aspects
			7. Review
				Aims.
				Clinical aspects
		Other clinical aspects of complete dentures
			Special impression techniques
				Denture space technique.
				Upper displaceable ridge.
				Lower unemployed ridge.
			Occlusal pivots
		Common denture problems
			Inadequate retention.
			Inadequate support.
			Muscle balance problem.
			Occlusal balance problem.
			Appearance problems.
			Speech problems.
			Retching.
			Acrylic allergy.
	Partial dentures
		Principles
			Aims
				The problems in failure to restore lost natural teeth.
				The negative effect of partial dentures.
			Design (Table 18.1)
				Stage 1: Classification of support for each saddle
					Typical examples are.
				Stage 2: Connect saddles together
					Types of connectors in the maxilla
						Anterior palatal bar.
						Mid palatal bar.
						Posterior palatal bar.
						Palatal horseshoe connector.
						Full-coverage palatal plate.
					Types of connectors in the mandible
						Lingual bar.
						Lingual plate.
						Lingual bar and continuous clasp.
						Buccal bar.
						Sublingual bar.
				Stage 3: Choose the path of insertion and delineate undercuts
				Stage 4: Resistance of movement away from the teeth
				Stage 5: Indirect retention
					Example of indirect retention – free end saddle.
				Stage 6: Resistance of movement towards the teeth and tissues
				Stage 7: Resistance to horizontal movement
					Resistance to forward movement.
					Resistance to backward movement.
					Resistance to lateral movement.
				Stage 8: Simplification
			Clasp design
				Undercuts.
				Clasp flexibility.
				Aesthetics.
				Bracing.
				Minor connectors.
				Common types of clasp include.
			Rests
				Occlusal rests.
				Cingulum rests.
			Guide planes
			Choice of material
				Reasons for choosing acrylic.
				Reasons for choosing cobalt–chromium.
			Bilateral free end saddle dentures
			Specific partial denture designs
				Two part.
				Hinged flange.
				Disjunct.
				Swinglock.
		Clinical stages
			Some important differences
				Planning stages.
				Primary impressions.
				Master impressions.
				Jaw registration.
				Trial.
				Insertion.
				Review.
	Precision attachments
		Uses.
		Types
			Extracoronal.
			Intracoronal.
		Advantages of precision attachments.
		Disadvantages of precision attachments.
	Copy dentures
		Indications.
		Advantages.
		Disadvantages.
		Clinical stages
	Overdentures
		Advantages of overdentures.
		Disadvantages of overdentures.
		Indications for overdentures.
		Clinical aspects
			Abutment selection.
			Attachments.
			Impression technique for overdentures.
			Care of abutments.
	Immediate dentures
		General features.
		Treatment planning.
		Reasons for immediate dentures.
		Problems with immediate dentures.
		Clinical aspects
			Removing teeth from cast.
			Aesthetics.
			Flanges.
			Follow-up.
	Other prosthetic appliances
		Appliances for obstructive sleep apnoea appliances.
		Bleaching splints.
		Gingival veneers.
		Gumshields.
		Implant planning appliances.
		Mouthpieces for diving and wind instrument playing.
		Nightguard splints.
		Palatal lift appliances.
		Tooth borne orthodontic retainers as dentures.
		Trismus screws.
	Repairs, relines and additions
		Repairs
			Common types of fracture.
			Reasons for fracture.
			Repair protocols
				Simple.
				Lost part of prosthesis.
				Unrepairable.
				Acrylic–cobalt–chromium.
				Temporary repairs.
		Relines
			Types of reline
				Temporary.
				Soft.
				Permanent.
				Clinical aspects.
		Additions
			Indications
				Immediate addition.
				Post-immediate addition.
				Retention.
			Clinical aspects.
	Craniomandibular disorders
		Alternative names.
		Diagnosis
			Differential diagnosis.
			History.
			Symptoms and signs.
			Examination
				Joint examination.
				Static examination.
				Dynamic examination
					Mobility.
					Sounds.
				Muscle examination.
				Occlusal examination.
		Management
			Management goals in CMD.
			Management options
				Patient education and palliative home care.
				Behaviour modification.
				Drug therapy.
				Exercise therapy.
					Repetitive exercises.
					Isotonic exercises.
					Isometric exercises.
				Mobilization.
				Physical agents.
				Splint therapy.
				Types of splints
					Stabilization splints.
					Repositioning splints.
					Provisional splints.
					Occlusal therapy.
					Other therapy.
	Maxillofacial prosthetics
		Types of defects
			Extraoral.
			Intraoral.
		Maxillectomy
			Initial treatment.
			Interim treatment.
			Definitive treatment.
			Types of obturators.
		The role of the dentist in head and neck cancer care
			Screening.
			Post cancer follow-up.
			Prosthodontic rehabilitation.
		Cleft palate
			Unrepaired congenital clefts.
		Mandibular defects
			Types.
		Craniofacial prostheses
			Types.
	The shortened dental arch
		Advantages.
		Disadvantages.
	Prescription to dental technicians
		General aspects.
		Specific instructions
			Casts.
			Individual trays.
			Record blocks.
			Trial setting of teeth.
			Processing of denture.
			Partial denture design.
	Advice to patients: managing expectations
		Coping with new dentures.
		Eating with new dentures.
		Speaking with new dentures.
		Discomfort with new dentures.
		Looseness of new dentures.
		Cleaning of dentures.
		Specific advice for patients with immediate dentures.
19 Operative dentistry
	Restorative dentistry
	Diagnosis of pulpal pain
		Types and features of pulpal and related pain
			Reversible pulpitis.
			Irreversible pulpitis.
			Periapical periodontitis.
			Cracked tooth/cusp syndrome.
		History
			Pain quality
				Sharpness.
				Dullness.
				Throbbing.
			Duration
				Short.
				Constant.
			Stimuli
				Reaction to heat.
				Reaction to cold.
				Reaction to pressure.
				Reaction to sweet stimuli.
			Site and radiation
			Timing
		Clinical examination
			Visual
			Probing
			Percussion
		Special tests
			Sensibility testing
			Vitality testing
			Radiographs
				Periapical radiographs.
				Bitewing radiographs.
			Transillumination
			Tooth ‘slooth’/FracFinder
		Problems in diagnosing pulpal pain
			The mouth is heavily restored.
			Multiple pathology.
			Non-odontogenic pain.
			Dual pathology.
			Anxious patient or one with learning disability.
	Treatment planning
		History taking
			Factors required in history
				Patient complaints.
				History of treatment to teeth.
				General dental history.
				Medical history.
				Social history.
		Examination
			Extraoral examination
			Intraoral examination
				Soft tissues.
				Periodontal health.
				Caries.
				Restorations.
				Tooth wear.
				Occlusion.
				Symptomatic teeth.
				Endodontic status.
				Saddles.
				Removable prostheses.
			Radiographic examination
				Useful radiographs in fixed prosthodontics:
				Useful radiographs in endodontics:
			Additional in the dentate patient
		Diagnosis in the dentate patient
		Management
			Prevention and Stabilization Phase Care
				Control aetiology of problem.
				Stabilization phase.
				Reassess response to treatment.
			Definitive Reconstructive Phase Care
			Management options in operative dentistry
				Who?
				What?
				When?
				Where?
				How?
	Occlusion
		Border (Posselt’s) movements of the mandible
		Retruded Contact Position (RCP)
		Mandibular movements
			Protrusive movement
			Retrusive movement
			Lateral movement
		Occlusal interferences
		Examination of the occlusion
			Aids to occlusal examination.
			Features to be noted in occlusal examination.
		Occlusal aims in fixed prosthodontics
	Principles of cavity preparation
		Objective of cavity preparation
			Basic principles of cavity preparation
			1. Outline form
			2 & 3. Resistance and retention forms
				Resistance form.
				Retention form.
			4. Management of remaining caries
			5. Enamel margin finishing
			6. Cavity cleansing
		Classification of cavities
			Class I cavity
				Preventive resin preparation/enamel biopsy
				Class I cavity – amalgam or composite resin
			Class II cavity
				Occlusal approach – composite
				Occlusal approach – amalgam
			Alternatives
				Traditional MO/DO (mesio-occlusal/disto-occlusal) amalgam
				Tunnel preparation
				Direct access
			Class III cavity – composite resin
			Alternative
			Class IV cavity
			Alternative technique
			Class V cavity (cervical caries)
		Core restorations
			Vital teeth
				Slots and grooves
				Adhesive approach
				Dentine pins
				Technique
			Root-filled teeth
				Technique.
		Choice of restorative material
	Management of the deep carious lesion
		Techniques for management of the deep carious lesion
			Indirect pulp capping
				Technique
			Direct pulp capping
				Technique
					Mode of action of tricalcium silicate based cements in pulp capping.
						Antibacterial action.
						Remineralization.
						Reactive dentinogenesis.
						Low porosity.
					Mode of action of calcium hydroxide in pulp capping.
						Antibacterial action.
						Remineralization.
						Reparative dentine formation.
		Carious exposures
			Use of corticosteroid–antibiotic preparations in management of the deep carious lesion.
				Mode of action: anti-inflammatory.
	Alternative cavity preparation techniques
		Ultrasonic preparation
		Air abrasion
	Crowns
		Types of crowns
			Full coverage.
			Post-retained crowns.
			Partial coverage.
		Assessment of teeth for crowns
		Clinical stages in making crowns
			1. Shading and surface characteristics
			2. Preparation
			3. Temporization/Provisional crown
				Types of provisional crowns
					Anterior teeth.
					Posterior teeth.
			4. Impression
			5. Prescription for technicians
			6. Cementing/Bonding a crown
		Common faults with crowns
			Overhanging margin.
			Negative margin.
			Poor gingival emergence angle.
			Poor contact point.
			Poor aesthetics.
			Persistent debonding.
		Anterior crowns
			Indications.
			Types of anterior crowns
				Metal–ceramic crown.
				Porcelain jacket crown.
				All-ceramic crowns.
		Post retained crowns
			Indications.
			Assessment of teeth for post crowns.
			Root length.
			Root width.
			Root alignment.
			Root canal filling.
			Problems with post crowns
				Root perforation.
				Root fracture.
				Post debonding.
				Fractured post.
				Corrosion.
			Types of post crowns
				Basic types.
				Cast post core systems.
					Indirect.
					Direct.
				Prefabricated post core systems.
					Advantages.
					Disadvantages.
				Core materials.
			Clinical tips
				The ‘first bite of the cherry’ principle.
				Cementation/Bonding.
				Variations
					Posterior teeth.
					Diaphragm.
					Angulated teeth.
					Apicected teeth.
		Posterior crowns
			Indications.
			Types of posterior crowns
				Metal–ceramic crown.
				Full-veneer crown.
				Other posterior crowns.
	Veneers
		Types of veneers
		Labial veneers
			Uses.
			Materials.
			Case selection.
			Types of laminate veneer preparation (Figure 19.7)
				Intra-enamel.
				Feathered incisal.
				Overlapping incisal.
				No preparation.
		Clinical stages
			1. Shading and preparation
			2. Impressions
			3. Temporization
			4. Bonding
				Alternative
					Direct placement composite veneer.
					Preparation.
		Palatal veneers
			Uses.
			Types
				Direct composite veneers.
				Gold palatal veneers.
				Nickel–chromium backings.
				Ceramic palatal veneers.
		Adhesive-/Dentine-bonded crown
			Uses.
			Advantages
				Advantages over porcelain laminate veneer.
				Advantages over porcelain jacket crown.
			Disadvantages.
			Common problems with veneers include.
	Inlays and onlays
		Inlays
			Types.
			Uses.
			Advantages.
			Disadvantages.
			Clinical techniques.
		Gold inlays
			1. Preparation
			2. Impressions
				Indirect.
				Direct indirect.
			3. Temporization
			4. Inlay insertion
		Composite inlays
			1. Preparation
			2. Impressions
			3. Temporization
			4. Cementation
		Porcelain inlays
			1. Preparation
			2. Impressions
			3. Temporization
			4. Cementation
		Onlays
			Types.
			Uses.
	Fixed bridges
		Definitions
			Indications for bridgework.
			Disadvantages of bridgework.
		General considerations in bridgework
			Patients.
			Saddle.
			Abutment teeth.
			Occlusion.
			Support.
		Complications of bridgework
			Short term.
			Long term.
		Ante’s Law
		Pontic design
			Broad principles of pontic design
				Occlusal surfaces.
				Buccal and palatal lingual surfaces.
				Contact angle.
				Contact area.
				Mucosal contact.
				Interdental spaces (embrasures).
				Material in contact with mucosa.
		Retainers
			Usual retainers are:
			Other retainers used include:
		Conventional fixed–fixed bridges
			Clinical procedures
		Cantilever bridges
			Indications.
			Advantages.
			Disadvantage.
	Fixed–movable bridges
		Uses
			Malaligned abutment teeth.
			Pier abutment.
			Retrievability.
			Combination of materials.
			Mobile teeth.
		Joints
			Laboratory made.
			Precision attachments.
		Spring cantilever bridges
			Indications.
			Design.
	Adhesive bridges
		Case selection
		Modern types of adhesive bridges
			Unperforated framework.
			Perforated framework.
			Provisional/Temporary.
		Design of bridge
			Anterior design.
			Posterior design.
		Clinical tips
			Preparation of metal surface.
			Electrolytic or chemical etching.
			Grit-blasting.
			Cementation.
			Types of cements available
				Composite resins.
				Chemically active resins.
			Recementing debonded adhesive bridges.
	Tooth wear (see also Chapter 3)
		Aetiology of tooth wear
			Aetiology of attrition
				Factors involved in bruxism.
			Aetiology of abrasion
			Aetiology of erosion
			Abfraction
		Diagnosis and assessment of tooth wear
			Case history.
			Clinical examination.
			Assessment.
			Measurement of tooth wear.
			Prevention of tooth wear
				Practical aspects of tooth wear prevention
					Dietary advice.
					Oral hygiene.
					Fluoride.
					Splint therapy.
					Hypnotherapy.
					Tricyclic antidepressants.
			Monitoring tooth wear
			Management of tooth wear
			Tooth wear failures
	Tooth whitening
		Causes of staining
			Chemistry
			Mechanisms of action
		Clinical techniques
			Vital teeth
				Over-the-counter (OTC) products
				Professional home-use products
					Technique
					Notes.
					Sensitivity management.
				Professional surgery applied products
					Technique
					Notes.
			Non-vital teeth
				Preoperative assessment.
				Chairside bleaching
				Walking bleach technique
				Inside–outside bleaching
	Microabrasion
		Technique
	Endodontics
		Causes of pulpal damage
		Diagnosis
		Conventional root canal therapy
			Aims of root canal treatment
			Instrumentation
				Files.
				Rotary files.
				Broaches.
				Side-cutting burs.
				Spiral paste fillers.
				Spreaders and compactors.
			Dental dam
			Access cavity preparation
				Maxillary and mandibular canines and incisors.
				Maxillary and mandibular premolars.
				Maxillary molars.
				Mandibular molars.
			Working length determination
				Working length radiograph.
				Electric apex locators.
		Techniques for canal preparation
			Manual preparation with ISO instruments
				Step-back technique.
				Step-down technique.
					Technique.
					Advantages.
				Balanced force technique.
				Technique
					Advantages.
			Manual preparation with increased taper instruments
				Technique
			Rotary preparation
			Root canal disinfection
			Intracanal dressings
			Root canal obturation
				Criteria for root canal obturation.
				Materials used for root canal obturation.
					Gutta-percha.
					Sealers.
				Common obturation techniques
					Laterally condensed cold gutta-percha (GP).
					Vertically condensed hot gutta-percha (Schilder’s technique).
					Hybrid technique.
					Thermomechanical compaction of gutta-percha.
					Thermoplasticized gutta-percha.
					Injection techniques with thermoplasticized gutta-percha.
			Successful root canal treatment
			Restoration of the root canal treated tooth
			Single-visit root canal treatment
				Indications for single-visit root canal treatment
					Disadvantages.
					Contraindications.
			Problems in conventional root canal therapy
				Fractured/separated instruments.
				Perforation.
				Zipping (or transportation).
				Failures.
	Surgical endodontics
		Peri-radicular surgery (including apicectomy)
			Indications for apicectomy.
			Retrograde root filling.
			Other types of procedures in surgical endodontics
				Root amputation.
				Hemisection.
				Periapical curettage.
				‘Through and through’ root filling.
				Reimplantation of teeth.
				Transplantation of teeth.
				Incision and drainage of endodontically associated swellings.
				Perforation repair.
	Relationships within restorative dentistry
		Perio-endo lesions
		Crowns and partial dentures
		Surgical crown lengthening
20 Special care dentistry
	Disability and impairment
		UK disability facts and figures
		Capacity to make decisions about treatment
		Clinical holding (or planned physical intervention)
		Vulnerable adults
		Barriers to oral health care
			Patient/carer barriers
				Physical barriers
	Patients with physical disabilities
		Muscular dystrophies
		Spina bifida
			Impact of physical disabilities on oral health
	Patients with learning disabilities
		Causes of learning disability
			Down syndrome
				Characteristics
			Fragile X syndrome
			Epilepsy and learning disabilities
			Communication with people with learning disabilities
			Impact of learning disabilities on oral health
			Treatment modalities for patients with learning disabilities
			Prevention for patients with learning disabilities
	Patients with mental ill health
		Depression
		Anxiety and phobia
		Bipolar disorder
		Schizophrenia
		Dementia
		Management
		Impact of mental ill health on oral health
	Medically complex patients
		ASA Physical Status Classification System
		Risk analysis
			Risk control
	Medical conditions of relevance to dental practice
		Cardiovascular disease
			Ischaemic heart disease
			Cardiac failure
			Hypertension
			Infective endocarditis (IE)
		Respiratory disease
			Asthma
			Infection and chronic obstructive pulmonary disease (COPD)
			Bronchial carcinoma
			Cystic fibrosis
			Sarcoidosis
		Gastrointestinal (GI) disease
			Primary.
			Secondary.
			Dysphagia
			Gastro-oesophageal reflux disease (GORD)
			Gastric carcinoma
			Gastritis and peptic ulceration (PU)
			Coeliac disease
			Irritable bowel syndrome
			Crohn’s disease
			Ulcerative colitis
			Colorectal cancer
			Antibiotic-associated pseudomembranous colitis
			Liver disease
				Acute viral hepatitis.
				Chronic hepatitis.
				Chronic liver disease.
			Pancreatic disease
				Acute pancreatitis.
				Chronic pancreatitis.
		Haematological system
			Anaemia
				Causes.
				Types
					Microcytic anaemia (MCV < 80 fl).
					Normocytic anaemia (80 fl > MCV < 100 fl).
					Macrocytic anaemia (MCV > 100 fl).
			Haemoglobinopathies
				Variation in Hb structure.
				Defective synthesis of Hb.
				Persisting foetal haemoglobin.
				Sickle cell anaemia.
			Thalassaemias
			Haematological malignancy
			Bleeding disorders
				Blood vessel defects
					Hereditary haemorrhagic telangiectasia.
					Vascular purpuras.
				Platelet defects and anti-platelet drugs
					Thrombocytopenia
					Thrombocythaemia.
				Other defects
					Thrombasthenia.
				Anti platelet drugs
				Coagulation cascade defects
					Hereditary
					Acquired
					Hereditary
						Haemophilia A (factor VIII deficiency).
						Haemophilia B (factor IX deficiency; Christmas disease).
						von Willebrand’s disease.
					Acquired
				New Oral Anticoagulants (NOACs)
		Renal disease
			Infections
			Chronic Kidney Disease (CKD)/Chronic renal failure (CRF)
			Haemodialysis, peritoneal dialysis and transplantation
		Endocrine disorders
			Diabetes mellitus
				Management of patients taking insulin to treat DM
					Treatment under LA.
				Management of patients not taking insulin to treat DM
					Treatment under LA.
			Thyroid and parathyroid disease
				Hyperthyroidism.
				Hypothyroidism.
				Hyperparathyroidism.
				Hypoparathyroidism.
			Pituitary and adrenal gland disorders
				Hypopituitarism.
			Corticosteroid prophylaxis
				Mineralocorticoid effects.
				Glucocorticoid effects.
			Pregnancy and the menopause
				Pregnancy.
				Menopause.
		Locomotor system disease
			Developmental bone disease
				Osteogenesis imperfecta (brittle bone disease)
				Osteopetrosis (Albers–Schönberg or marble bone disease)
				Cleidocranial dysostosis
				Achondroplasia
			Metabolic bone disease
				Fibrous dysplasia
					Mono-ostotic.
					Polyostotic.
				Cherubism
					Rickets and osteomalacia
					Osteoporosis
					Paget’s disease of bone
			Connective tissue disorders
				Systemic lupus erythematosus (SLE)
				Polymyalgia rheumatica
			Joint disease and prosthetic joints
				Osteoarthritis (OA)
				Rheumatoid arthritis (RA)
					Ankylosing spondylitis.
					Psoriatic arthritis.
					Systemic-onset juvenile chronic arthritis (Still’s disease).
					Gout and pseudogout.
					Behçet’s disease.
					Reiter’s syndrome.
		Neurological disorders
			Cranial nerves
			Palsy and neuropathy
			Neuralgia
			Headache and migraine
			Epilepsy
				Partial.
				Generalized.
			Multiple sclerosis
			Parkinson’s disease
			Myasthenia gravis
			Chronic fatigue syndrome
		Dermatology
			Malignant lesions
				Basal cell carcinoma (or rodent ulcer)
				Squamous cell carcinoma
				Malignant melanoma
				Mycosis fungoides
			Premalignant skin lesions
				Actinic keratosis
				Bowen’s disease (carcinoma in situ)
				Dysplastic naevi
		Immune deficiency disorders
			Congenital (primary) immunodeficiency
			Acquired (secondary) immunodeficiency
	References and Further reading
21 Emergencies
	Introduction
	Emergency equipment and drugs
		Emergency equipment
			Airway and breathing
			Circulation
			Disability
		Emergency drugs
			Airway and breathing
			Circulation
			Disability
	Acute chest pain – Cardiac
		Differential diagnosis
		Symptoms and signs of cardiac chest pain
		Management
			Assess patient – ABCDE
	Adrenal insufficiency
		Signs and symptoms
		Management
	Anaphylactic reactions
		Signs and symptoms
		Management
	Asthma
		Signs and symptoms
			Acute severe asthma:
			Life-threatening asthma:
		Management
	Cardiorespiratory arrest
		Signs
		Management
	Cerebrovascular accident (‘stroke’)
		Signs and symptoms
		Management
	Choking
		Signs and symptoms
		Management
	Epilepsy
		Signs and symptoms
		Management
	Fainting
		Signs and symptoms
		Differential diagnosis
		Management
	Hypoglycaemia
		Signs and symptoms
		Management
	References
Appendices
	Appendix A Average dates of mineralization and eruption of the primary dentition
	Appendix B Tooth notation
		FDI
			Permanent teeth
			Deciduous teeth
		ZSIGMONDY–PALMER
			Permanent teeth
			Deciduous teeth
	Appendix C Tooth eruption
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	X
	Y
	Z