Forty years of suffering chronic TMJ dysfunction: lessons learnt.

Temporomandibular joint dysfunction (TMD) is a common condition, with patients reporting symptoms to both dentists and doctors. The aetiology of TMD is likely to be multifactorial, with occlusal, parafunctional and psychological factors all potentially playing a part to varying degrees in different individuals. A personal account by a dentist, suffering from TMD for over 40 years, chronicles their experience of different treatments and concludes that supporting a patient to 'learn to live' with TMD is pivotal to management.

UK Dental Medicines Advisory Service: questions asked by dentists - part 4: prescribing of high-strength fluoride toothpastes and use of fluoride varnishes in dental practice.

The UK Dental Medicines Advisory Service (UKDMAS) provides advice to dentists and other dental healthcare professionals concerning the use of medicines and medical devices in dental prescribing, administering, or dispensing. The commonly asked questions posed to the UKDMAS concerning the prescribing of high-strength fluoride toothpastes and use of fluoride varnishes in dental practice are discussed with answers, supplemented by relevant information from clinicians. These include: the prescribing of high-strength fluoride toothpastes and application of fluoride varnish in particular patient groups; issues concerning the amounts of fluoride toothpaste that can be prescribed; regulations related to the supply of fluoride toothpastes by dental hygienists and therapists; and the constituents and selection of fluoride varnishes.

UK Dental Medicines Advisory Service - questions asked by dentists: part 3 - prescribing of anxiolytic medications in dental practice.

The UK Dental Medicines Advisory Service (UKDMAS) provides advice to dentists and other dental healthcare professionals concerning the use of medicines and medical devices in dentistry. The commonly asked questions posed to the UKDMAS concerning the prescribing, administering or dispensing of oral anxiolytic medicines in dental practice are discussed with answers supplemented by relevant information from clinicians. These include: types of oral anxiolytics available, prescribing guidelines, appropriate dosing regimens, indications and contraindications to prescribing and drug interactions.

UK Dental Medicines Advisory Service: questions asked by dentists - part 2: drugs used for medical emergencies in dental practice.

The UK Dental Medicines Advisory Service (UKDMAS) provides advice to dentists and other dental healthcare professionals concerning the use of medicines and medical devices in dentistry. The commonly asked questions posed to the UKDMAS concerning the prescribing and administering of dental emergency drugs in dental practice are discussed, with answers supplemented by relevant information from clinicians. These include the drugs that need to be stocked in the emergency drugs kit in dental practice, their formats and storage, and the restrictions on which members of the dental team can administer the drugs.

Lung cancer: a potential role for dentists.

Lung cancer is the leading cause of death from cancer worldwide and causes more deaths than breast, colorectal and cervical cancers combined. The five-year survival rate for lung cancer in the UK is approximately 15%. Over many years, lung cancer has failed to attract the attention and resources given to other cancers; it has also been stigmatised by a culture of blame, attributable to the sufferer because of smoking.

Management of proliferative verrucous leukoplakia: Justification for a conservative approach.

Background: Proliferative verrucous leukoplakia (PVL) is a progressive, multifocal, exophytic form of leukoplakia with high rates of malignant transformation. The purpose of this study was to evaluate a cohort of patients with PVL in a single tertiary referral clinic.

Method: Cases meeting accepted diagnostic criteria were reviewed with regard to their pathology, demographic characteristics, management, and outcomes.

Warfarin and Drug Interactions: Prescribing Vigilance.

A patient taking warfarin presented to the Oral Medicine Clinic at Liverpool University Dental Hospital, having been prescribed metronidazole and miconazole by his general dental practitioner (GDP) for his oral mucosal problem. He subsequently developed bruising on his torso following mild trauma. Having read the drug information leaflet provided with his metronidazole and miconazole, he noted the potential drug interactions between these and warfarin.

Trends and regional variation in the incidence of head and neck cancers in England: 2002 to 2011.

Recent studies show an increased incidence of head and neck cancers worldwide. The present study evaluated the trend in the incidence of head and neck cancers in England during 2002-2011. Data were extracted from the database of Office for National Statistics.

Ocular and oral grading of mucous membrane pemphigoid.

Background: A variety of methods have been described for grading ocular mucous membrane pemphigoid (MMP), each with their own limitations. In contrast, there are no reported grading systems for involvement of the oral mucosa. We wished to evaluate two ocular (one established and one proposed) and an oral mucosal grading system for MMP.

Two case reports of orofacial paraesthesia demonstrating the role of the general dental practitioner in identifying patients with intracranial tumours.

The following case reports describe the clinical features, diagnosis and management of two patients who presented to their general dental practitioner with a complaint of orofacial paraesthesia. After appropriate investigations, both patients were diagnosed as having benign intracranial tumours and were managed by a neurosurgeon. These cases illustrate the important role the general dental practitioner has in the early recognition of potentially life-threatening conditions.

p16 Promoter methylation is a potential predictor of malignant transformation in oral epithelial dysplasia.

Management of the patient with oral epithelial dysplasia depends on the ability to predict malignant transformation. Histologic grading of this condition fails in this regard and is also subject to interpathologist and intrapathologist variability. This study uses longitudinal clinical samples to explore the prognostic value of a previously validated panel of methylation biomarkers in a cohort of patients with histologically proven oral dysplasia.

Myelodysplastic syndrome with trisomy 8 associated with Behçet syndrome: an immunologic link to a karyotypic abnormality.

Myelodysplastic syndrome (MDS) in children is often associated with chromosomal anomalies and trisomy 8 is a characteristic karyotypic feature in up to 20% of the cases. Behçet disease is a rare multisystem inflammatory disorder characterized by recurrent mouth and genital ulcers. MDS with trisomy 8 has been observed in adult patients with Behçet syndrome with some cases developing prior to the clinical manifestations of the latter.

The statins: drug interactions of significance to the dental practitioner.

Unlabelled: This report outlines the potential for concomitant use of dentally prescribed medication to increase the risk of statin-induced myopathy. The associated signs and symptoms of statin-induced myopathy are also highlighted, as well as the need for an accurate and updated drug history for all dental patients.

Clinical Relevance: This article describes the recognized adverse interactions associated with concomitant drug therapy for patients on statins.

Case report: exfoliative cheilitis managed with antidepressant medication.

Exfoliative cheilitis is an unsightly and uncommon, chronic superficial inflammatory disorder that affects the vermilion zone of the lips. This case report describes the presentation of exfoliative cheilitis in a young man, and his subsequent management with antidepressant medication. The differential diagnosis of chronic exfoliative cheilitis is outlined.

Mental nerve anaesthesia; a complication of sickle cell crisis during childbirth.

This report describes the case of an Afro-Caribbean lady diagnosed with sickle cell anaemia, who presented with permanent mental nerve anaesthesia as a result of a sickle cell crisis during childbirth.

Knowledge of oral cancer, distress and screening intentions: longer term effects of a patient information leaflet.

Study aim was to determine the influence of a patient information leaflet (PIL) on mouth cancer to improve knowledge, reduce distress and increase intention to accept a mouth screen over a 2-month period. The design was a randomised controlled trial. Two dental practices in the northwest of England participated.

Angioedema of the lips and tongue induced by angiotensin-converting enzyme inhibitor. A report of two cases.

The following case reports describe the clinical presentation, diagnosis and management of two patients who attended Liverpool University Dental Hospital with rapidly increasing swelling of the lips and tongue. Both patients were suffering from angioedema and were taking an angiotension-converting enzyme (ACE) inhibitor (ACEI). A provisional diagnosis of ACEI-induced angioedema was made.

Drug profile of adult patients attending five general dental practices in Merseyside: oral side-effects and potential interactions with dentally prescribed medication.

Objective: To evaluate the drug profile of patients attending general dental practice and to assess the significance of this for the provision of dental care.

Design And Setting: Prospective study of adult patients attending five general dental practices in Merseyside.

Materials And Methods: Patients were questioned about prescribed medication.

Validation of the Sicca Symptoms Inventory for clinical studies of Sjögren's syndrome.

Objective: Oral, ocular, and other dryness are the hallmark features of Sjögren's syndrome (SS). We constructed a new measure of sicca symptoms, the Sicca Symptoms Inventory, for the evaluation of patients with primary SS.

Methods: Female Caucasian groups of patients with primary SS, systemic lupus erythematosus, and rheumatoid arthritis and healthy controls were assessed for tear and saliva production and also completed a symptoms-profiling inventory construct-validated from primary SS patients' own vocabulary, augmented with sicca items from publications and participating clinicians.

The development and initial validation of the Liverpool sicca index to assess symptoms and dysfunction in patients with primary Sjögren's syndrome.

Background: A validated measure to assess sicca-related symptoms in patients with primary Sjögren's syndrome (1 degrees SS) is required for clinical studies.

Methods: A self-administered questionnaire was developed to assess sicca-related symptoms and dysfunction in 1 degrees SS. This was administered to three groups of 40 respondents to measure construct validity: 1 degrees SS patients, non-SS patients reporting xerostomia and a non-patient group.

Health-related quality of life in patients with primary Sjögren's syndrome and xerostomia: a comparative study.

Objective: To compare the health status of groups of Primary Sjögren's and Xerostomia patients, using the Medical Outcomes Short Form 36 (SF-36). The SF-36 is a generic measure, divided into eight domains, used in the assessment of health-related quality of life.

Patients And Methods: The SF-36 was given to 2 groups: Group 1 comprised 43 patients diagnosed with Primary Sjögren's Syndrome (1 degrees SS) and an unstimulated whole salivary flow rate (UFR) of <0.

Orofacial paraesthesia: an unusual presentation of acoustic neuroma.

Patients with acoustic neuromas commonly present with unilateral hearing loss, tinnitus and unsteadiness. An uncommon initial feature is involvement of the trigeminal nerve. The unusual feature in the case reported here was orofacial paraesthesia, which preceded hearing loss by 3-4 years.