Dentists are obligated to document and report suspected cases of abuse in all states, and dental hygienists are similarly obligated in some, but not all, states. The obligation is not to prove abuse or neglect, just to report what is suspected. Each state has different regulations on mandatory reporting for healthcare and other professionals, as well as specific reporting requirements for private citizens. It is essential that dental professionals know the potential signs and symptoms of the various types of abuse, are able to identify these, and understand the mandatory requirements for reporting in the state(s) in which they live and practice. It is by identifying, documenting and reporting abuse that victims can be protected and perpetrators prevented from continuing abusive practices and patterns.

This review analyzes the current reports and publications involving the performance and clinical effectiveness of local anesthetics (efficacy) and the rare occurrence of post-operative prolonged numbness or tissue hypersensitivity (paresthesia, dysesthesia). No particular local anesthetic is scientifically singled out as causing this effect. Historically, scientific data on superior performance of one local anesthetic compared to another was lacking. One recently published report, however, showed the statistically significant and superior effectiveness of articaine in obtaining anesthesia of first permanent molars by infiltration when compared to lidocaine. The paresthesia debate regarding the potential of a 4% local anesthetic solution to be allegedly more neurotoxic than other currently administered local anesthetic solutions of lesser concentrations is examined. There is a lack of conclusive and experimentally reproducible evidence, of the cause and effect of specific local anesthetics to chemically result in post-operative sequelae such as paresthesia. An examination of the potential causative factors associated with paresthesia suggests mechanical and/or neurotoxic phenomena. Further evidence and scientific study are required to conclusively determine the significant role, or lack thereof, of each factor.

Dental erosion is a prevalent condition that occurs worldwide. It is the result of exposure of the enamel and dentin to nonbacterial acids of extrinsic and intrinsic origin, whereby mineral loss occurs from the surface of the tooth. The most frequently affected areas are the palatal surface of maxillary incisors and the occlusal surface of the mandibular first molars in adolescents. Characteristic early signs of dental erosion include smooth and flat facets on facial or palatal surfaces, and shallow and localized dimpling on occlusal surfaces. Early intervention is key to effectively preventing erosive tooth wear. Effective prevention of dental erosion includes measures that can avoid or reduce direct contact with acids, increase acid resistance of dental hard tissues and minimize toothbrushing abrasion.

The initiation and progression of periodontal disease requires the presence of bacterial accumulations. Once periodontal disease exists, its progression depends on the host response. In order to treat periodontal disease, the biofilm must be disrupted and all hard and soft deposits removed from the tooth surfaces. In order to thoroughly remove deposits and debris without removing excessive tooth structure, instruments must be selected that are suitable for the intended site and technique. The selected debridement method should offer predictable results independent of operator skill level; be efficient to perform clinically, well tolerated by patients and cost effective; and have a low potential for adverse side effects.

Parafunctional activities associated with the stomatagnathic system include lip and cheek chewing, fingernail biting, and teeth clenching. Bruxism can be classified as awake or sleep bruxism. Patients with sleep bruxism are three to four times more likely to experience jaw pain and limitation of movement than people who do not experience sleep bruxism. Signs and symptoms of bruxism and parafunctional activity include hypertrophied masseter and temporalis muscles, myocitis of these same muscles, morning jaw stiffness, and sensitivity in a tooth or teeth. Additionally, migraine is associated with parafunctional activity. Dental professionals are responsible for diagnosing and managing parafunction. Patients can be managed with oral appliances of various designs.

Periodontal disease is more prevalent and more severe in smokers than in nonsmokers. The host response in smokers is altered by a number of factors including increased gingival crevicular fluid, adhesion molecules and genetics. In addition, smokers are poor healers compared to nonsmokers and their response to periodontal therapy can be compromised which can result in continued progression of periodontal disease, or the need for more treatment.

The most frequently administered drugs in dentistry are local anesthetics. These provide relief from pain during procedures, leaving inconvenient residual numbness that takes some time to wear off following completion of dental procedures. Recently, a new drug has been approved for acceleration of the reversal of soft-tissue local anesthesia in patients age 6 and older. This new drug adds a new dimension to the pain management armamentarium of dentists.

Modern-day mouthguards and oral applications have been used since the early 20th century. They are currently in use for protection against athletic injuries; the treatment of TMJ, bruxism and sleep apnea; and athletic performance enhancement. The American Dental Association and the American Academy of Pediatric Dentistry both recommend the use of protective mouthguards to help prevent sport-related injury. The treatment of burxism was, in fact, the first use of modern mouthguards and was followed by customized designs for protection of the oral structures and to treat specific conditions. More recently there has been a resurgence of interest in athletic performance mouthguards, which have been found in a number of studies to improve reaction time, muscle strength and sensory functions. The purpose of a mouthguard dictates the materials and designs most suitable for optimal results.

Inflammatory diseases share many common traits, including the ability to produce pro-inflammatory messengers called cytokines that travel throughout the body. Cytokines play an important role in physiologic regulation of many biological activities, but in inflammatory diseases, they are produced at levels that can have pathological consequences. In diabetes, cytokines can cause β-cell death and insulin resistance. In periodontal disease, the same cytokines are responsible for collagen destruction and alveolar bone loss. Because inflammatory diseases share a common biological denominator, they can often influence the progression of other inflammatory diseases.

Twenty-six million people in the United States are living with chronic kidney disease (CKD). As the baby boomer generation continues to mature, medical procedures extending life improve, and with pharmacology advances, this number will increase. With an increased number of patients living with CKD seeking dental treatment, will the dental healthcare provider be prepared to provide treatment to patients living with renal disease-induced anemia, and with secondary hyperparathyroidism and its effects on bone metabolism and the cardiovascular system? Many providers are familiar with providing palliative treatment for xerostomia, but how do you recommend palliative treatment for someone who is on strict fluid and dietary restrictions, such as patients living with end stage renal disease? Diabetes and hypertension are the two greatest causes of kidney disease. Dental providers should be knowledgeable about the different stages of renal disease and different treatments associated with this condition, and be prepared to address oral complications of renal disease. The dental healthcare provider must become more familiar with the impact of periodontal disease on renal disease, specific medical challenges and become proficient in collaborating with medical healthcare providers to provide dental treatment to these patients.

Dental professionals commonly review health histories listing medications that identify patients with a diagnosis of acid reflux. It is important that dental professionals identify patients with acid reflux and recommend appropriate dental therapies to protect the long-term health and dentition. Acid reflux is associated with a demineralization action resulting in dental enamel erosion. Dental therapy if required, and oral hygiene advice. Dental professionals are also in a position to identify untreated patients with acid reflux and should refer these patients to a physician.