Supernumerary teeth can present in various forms and in any region of the mandible or maxilla, but have a predisposition for the anterior maxilla. They can cause a variety of complications in the developing dentition. This article reviews the epidemiology, clinical features, diagnosis and options for the management of supernumerary teeth. Clinical Relevance: Early diagnosis and appropriate management can minimize the potential complications caused by supernumerary teeth. Dental practitioners should be aware of their clinical signs and the treatment options.

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AIM: To assess the quality of information included in referral letters sent to the orthodontic department at Kingston Hospital, Surrey, UK. METHODS: Referral letters sent by both general dental practitioners (GDPs) and specialist orthodontists were analysed retrospectively in order to ascertain the percentage meeting the inclusion criteria as suggested by Mossey (2006) and the British Orthodontic Society (2008) for the quality of information included in an ideal orthodontic referral letter. Thirty-five consecutive letters sent between May and September 2005 and 206 letters sent in the same period in 2008 were collected by hand and analysed against the inclusion criteria. The numbers of referral letters received from GDPs, specialist orthodontists, and others sources were also determined. RESULTS: Most of the referrals sent in 2005 and 2008 included 40-50% of the referral inclusion points. This was despite an almost twofold increase in the number of referral letters received from specialist orthodontic practitioners in 2008. The majority of the letters, from both GDPs and specialists, did not include details of the oral hygiene or caries status of the patient, or an indication of their motivation towards treatment. None of the referral letters included a plaque score. CONCLUSION: The main weaknesses in the quality of information provided in referral letters were that in more than 80% of the letters there was no mention of the patient's medical history and no comment on caries status, the standard of oral hygiene, patient motivation for treatment, or an Index of Orthodontic Treatment Need score. The quality of information included in referral letters sent to Kingston Hospital orthodontic department needs to be improved.

Early identification of Class II deep bite malocclusion is essential for a successful treatment outcome. Timely treatment with functional appliances is among the most effective treatment approaches available for the management of Class II malocclusion in growing subjects. The Medium Opening Activator belongs to a family of functional appliances known as activators. The aims of this article are to review the clinical management of the Medium Opening Activator and to describe a number of appliance modifications, including:(1) a method of stepwise advancement of the mandible using the same appliance;(2) modifications allowing transverse expansion of the maxillary posterior segments, and anterior movement of the maxillary labial segment in 1 appliance, negating the need for a prefunctional phase of treatment; and (3) placing mandibular fixed appliances early. A case report is described to demonstrate the benefits of the Medium Opening Activator.

Taurodontism is the morpho-anatomical change in the shape of a tooth, which involves enlargement of the body of the tooth and shortening of the roots. It has been reported in permanent and deciduous teeth, in premolars and molars and associated with certain syndromes, particularly in those involving an ectodermal defect. It has clinical implications which are relevant to both the general dental practitioner and the orthodontist. CLINICAL RELEVANCE: This review compiles the available literature concerning taurodont teeth and highlights the management issues raised by the anomaly.

OBJECTIVE The use of a space maintainer appliance, or restoration of a carious primary tooth that can then act as a natural space maintainer, may potentially obviate the consequences of loss of arch length and the need for complex orthodontic treatment at a later stage. Nevertheless, all space maintainer appliances are plaque retentive and may predispose to dental caries and gingival inflammation. Space maintainer appliances may also impinge on the soft tissues, interfere with eruption of adjacent teeth, fracture, and become dislodged or lost. This review article provides a summary of the available evidence, and considers the indications for space maintenance. METHODS Medline and Ovid Medline were scanned, and additionally a hand-search of non-listed peer-reviewed papers written in English was performed. A total of 16 pertinent papers published between 1987 and 2007 that satisfied the inclusion criteria were selected for discussion. CONCLUSIONS There is limited evidence to recommend either for or against the use of space maintainers to prevent or reduce the severity of malocclusion in the permanent dentition. Decisions regarding the use of space maintainers should be guided by balancing the occlusal disturbance that may result if one is not used against the potential plaque accumulation and caries that the appliance may cause.

The clinical ability to alter dentofacial form requires an understanding of facial aesthetics. This is vital for any clinician involved in treatment that will alter a patient's dentofacial appearance, whether through orthodontics, facial growth modification, corrective jaw surgery or aesthetic dentistry. Part 1 of this article covered the historical and theoretical aspects of facial aesthetics and their importance in contemporary dentofacial treatment. Part 2 covers important aspects of the interview and clinical assessment of patients requiring alterations in their dentofacial appearance, including guidelines used in the assessment of facial proportions and symmetry. CLINICAL RELEVANCE: These articles cover the theoretical and clinical aspects of facial aesthetics required by clinicians involved in the treatment of dentofacial deformity.

The clinical ability to alter dentofacial form requires an understanding of facial aesthetics. This is vital for any clinician involved in treatment that will alter a patient's dentofacial appearance, whether through orthodontics, facial growth modification, corrective jaw surgery or aesthetic dentistry. Part 1 of this article aims to cover the historical and theoretical aspects of facial aesthetics and their importance in contemporary dentofacial treatment. Part 2 will cover important aspects of the interview and clinical assessment of patients requiring alterations in their dentofacial appearance, including guidelines used in the assessment of facial proportions and symmetry. Clinical Relevance: These articles cover the theoretical and clinical aspects of facial aesthetics required by clinicians involved in the treatment of dentofacial deformity.

AIMS To evaluate the current evidence identifying risk factors for post-orthognathic mandibular condylar resorption. METHODS Studies published between January 1980 and August 2006 related to post-orthognathic condylar resorption were identified by searching the following databases: PubMed, Medline, EMBASE, PsycInfo, DARE, CENTRAL, and the Cochrane database of systematic reviews. The following keywords were used to identify relevant publications: condylar resorption, progressive condylar resorption, condylar atrophy, dysfunctional remodeling, and condylysis. A hand search of these papers was also carried out to identify additional articles. RESULTS A number of methodological flaws are present within the current literature, including the comparison of nonmatched patient groups and poor imaging techniques, which makes evaluation difficult. Significant risk factors identified for condylar resorption include being female with mandibular retrognathia associated with an increased mandibular plane angle, the presence of pretreatment condylar atrophy, and undergoing posterior condylar displacement and upward and forward rotation of the mandible at the time of surgery. CONCLUSIONS Better-controlled studies are required to fully understand the link between condylar resorption and orthognathic surgery. A number of risk factors have been identified within this article. It is important for orthodontists to consider these, particularly when consulting patients for treatment and identifying patients who may require closer postsurgical follow-up.

Body dysmorphic dsorder (BDD) is characterised by a preoccupation with an imagined defect in one's appearance or, in the case of a minor physical anomaly, the individual's concern is markedly excessive, causing significant distress in their life. One of the most common areas of preoccupation is the dentofacial region, with up to 20% of patients diagnosed with BDD expressing specific concern regarding their dental appearance. With the increased ability to undertake dental aesthetic and reconstructive procedures, in addition to the use of facial aesthetic procedures, it is paramount for all dental clinicians to have an understanding of this condition. BDD patients often request multiple aesthetic procedures, but remain unsatisfied with their treatment results. It is imperative for the dental clinician to diagnose this condition prior to instigating clinical treatment, and to make an appropriate referral.

This article identifies variables that should be assessed in patients with certain dental malocclusions that may require extraction. In addition, by presenting criteria for performing the more popular types of extraction, the article facilitates treatment decision-making. Pre- and post-treatment illustrations demonstrate the desired patient outcomes.

This manuscript illustrates the management of a patient with anterior tooth surface loss. Specifically, the value of dentine-bonded crowns in the restorative management of the case is discussed as well as demonstrating the aesthetic result that can be achieved. Clinical Relevance: Dentine-bonded crowns may be appropriate in treating a patient with advanced anterior tooth surface loss.

Psychiatric disorders after traumatic brain injury (TBI) are frequent. Researches in this area are important for the patients' care and they may provide hints for the comprehension of primary psychiatric disorders. Here we approach epidemiology, diagnosis, associated factors and treatment of the main psychiatric disorders after TBI. Finally, the present situation of the knowledge in this field is discussed.

Tornwaldt's cyst (sometimes called Thornwaldt's cyst) is a rare cause of occipital headache. Owing to the rare occurrence of occipital headache as a symptom of Tornwaldt's cyst, if the patient presented only with occipital headache, this clinical symptom may be falsely perceived as a sign of neurologic disease leading to time-consuming diagnostic examinations that delay the establishment of a correct diagnosis.

Pretibial lacerations are a common injury, particularly in older adults. Patients may present to the emergency department for treatment, be treated in GP surgeries by community nurses or they may self-treat. This article reviews the treatment options available to enable healthcare professionals to make informed decisions regarding the management of patients with such injuries.

We report three patients with visual hallucinations as the initial manifestations of neurocysticercosis (NCC) in whom migraine was the first diagnosis. The correct diagnosis was suspected when electroencephalograms were abnormal and was confirmed by characteristic brain imaging. The visual hallucinations ceased promptly after treatment with antiepileptic and anti-NCC medications. We caution that NCC may present with focal seizures manifesting as visual hallucinations with features of migraine.

Gingival recession is a common condition affecting the dentition. This paper describes the aetiology of gingival recession and discusses the appropriate management of this condition. Clinical Relevance: Careful examination to detect gingival recession, or the factors that may place the patient at risk for recession, are important for prevention.

Needle phobia is a peculiar type of specific phobia, with unique clinical features, that may be encountered in some surgical patients. It may present a serious acute problem to the perianesthesia care team and requires careful psychological and/or pharmacological management. This article provides a clinical report and detailed discussion of severe needle phobia in the perianesthesia setting.

Acquired tracheoceles are rare clinical entities that can cause a variety of chronic and recurrent aerodigestive tract symptoms. The management of acquired tracheoceles is primarily conservative, but surgical intervention may be indicated for patients with refractory symptoms. We present a case of acquired tracheocele and describe a method of successful surgical management.

A case report is presented of the preventive and clinical care of an adolescent with a neglected mouth, complicated by the medical history of cerebral palsy. CLINICAL RELEVANCE: Knowledge of the treatment which ideally may be offered to patients with cerebral palsy may help such patients retain and maintain their dentition.