Paul Coulthard

• The University of Manchester

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major health concern and causes substantial morbidity and mortality. It is imperative that the signs of sepsis are identified early in both adult and paediatric patients and appropriately escalated to initiate early treatment and improve prog...

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus which causes COVID-19, is highly contagious. Dentistry is a high-risk profession for occupational virus transmission because of the close proximity of the operator to the patient during treatment and the procedural generation of aerosols. The impact on the provision of dental c...

As routine care was suspended in most countries, one could anticipate progression of undiagnosed and managed oral disease. Patients are usually unaware of the development of oral disease as it is not visible to them and largely asymptomatic, especially in its early stages. The natural progression of conditions such as caries and periodontitis is in...

The removal of wisdom teeth is a common operation, but it can cause short‐ and long‐term side effects. People may have their wisdom teeth removed if they are causing pain or infection, or if they are damaging other teeth or not breaking through the gum properly. Surgery has a risk of complications. One of the most common is dry socket (also known a...

Background: Pathology relating to mandibular wisdom teeth is a frequent presentation to oral and maxillofacial surgeons, and surgical removal of mandibular wisdom teeth is a common operation. The indications for surgical removal of these teeth are alleviation of local pain, swelling and trismus, and also the prevention of spread of infection that...

The aim of this study was to compare the efficacy and safety of the different local anaesthetic agents for the extraction of impacted lower third molars. A network meta-analysis was performed of all published reports of randomized controlled clinical trials assessing efficacy (anaesthetic success and absence of need for supplementary anaesthesia du...

Background: Implants may be placed penetrating the oral mucosa (1-stage procedure) or can be completely buried under the oral mucosa (2-stage procedure) during the healing phase of the bone at the implant surface. With a 2-stage procedure the risk of having unwanted loading onto the implants is minimized, but a second minor surgical intervention i...

Objectives The objectives of the prospective study were to establish the prevalence of distal caries (DC) in the mandibular second molar and to assess the outcomes of these diseased teeth in our population. Further aims were to identify associated risk factors and to design a protocol for prevention. Methods Clinical and radiographic data from 210...

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the effects of hypnosis (with or without conscious sedation or prior to or following general anaesthesia) in reducing anxiety towards dental treatment. © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Aim To discuss the past and present evidence for the coronectomy technique for third molars. Materials and Methods A review of the past and present literature related to the healing of extraction sockets in the presence of root fragments. Results High‐quality research studies surrounding the coronectomy procedure are lacking and it is important t...

Purpose: Validation of platelet-rich plasma (PRP) system and assessing its enhancing effect on the healing of iliac crest grafts before implant placement. Materials and Methods: Patients randomly allocated to test (n = 13) and control (n = 9) groups. Iliac crest grafts were mixed with PRP in the test group. Tetracycline labeling preceded implant pl...

Combination analgesics are effective in acute pain, and a theoretical framework predicts efficacy for combinations. The combination of dexketoprofen and tramadol is untested, but predicted to be highly effective. This was a randomised, double-blind, double-dummy, parallel-group, placebo-controlled, single-dose trial in patients with moderate or sev...

Aim To investigate the current scope of clinical practice and involvement in postgraduate education and training of UK oral surgeons. Materials and methods Electronic survey via ‘ S urvey M onkey ™’ of members of B ritish A ssociation of O ral S urgeons. Results Response rate of 39% (208) with margin of error 5.29% at 95% level of confidence. Fif...

No abstract is available for this article.

Aim: Describe current dental sedation practice for under 19-year-olds in the UK and compare it with the recommendations of NICE guidance 112. Method: Members of the Society for the Advancement of Anaesthesia in Dentistry and members of the Dental Sedation Teachers Group were invited to participate in an online survey. Results: Two hundred and...

Substance misuse is a major health concern in the United Kingdom, as the consequences for individuals are significant and may include multisystem organ damage. It is important for the dentist to know which patients are misusing substances as some pharmacological agents routinely used in dental practice may be contraindicated. The dentist should be...

Plasmablastic lymphoma is an HIV-associated non-Hodgkin's lymphoma that has a known effect on the oral cavity and jaws. A case is presented of oral plasmablastic lymphoma in an apparently medically well 38 year old male. The patient presented with a large mass fungating from the upper left second molar socket, 2 weeks following extraction. The pres...

No abstract is available for this article.

AimTo describe the role of opioids in the management of pain after oral surgery. Materials and methodsA review of the literature describing the pharmacokinetics, benefits and harms of opioids in terms of systematic review evidence, interactions, use in children, pregnancy and breastfeeding. ResultsA 10-mg intramuscular dose of morphine is recognise...

AimTo describe the measurement of pain after oral surgery. Materials and methodsA review of the literature describing the scales used to rate pain intensity, pain assessment by questionnaire, assessment of pain in children and older adults, the third molar pain model and factors affecting the pain experience in the context of managing pain after or...

Background: Sutures (stitches), staples and adhesive tapes have been used for many years as methods of wound closure, but tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables the closure to be meticulous, but the sutures may show tissue reactivity and can require removal. Tissue adhesives offer the...

Aim To describe the role of non‐steroidal anti‐inflammatory drugs ( NSAIDs ) in the management of pain after oral surgery. Materials and methods A review of the literature describing the pharmacokinetics, benefits and harms of NSAIDs in terms of systematic review evidence, interactions, use in children, pregnancy and breastfeeding. Results Twelve...

The purpose of this cross-sectional study was to ascertain whether undergraduate dental students in the United Kingdom and Ireland are receiving formal teaching on recognizing and managing domestic violence (DV) as part of their curricula. A questionnaire was sent to all dental schools in the UK and Ireland in 2007 and again in 2012, requesting inf...

Background: The surgical removal of mandibular wisdom teeth is one of the most common operations undertaken in oral and maxillofacial surgery. The most common indication for surgery is infection about a partially erupted tooth that is impacted against bone or soft tissues. Other indications include unrestorable caries, pulpal and periapical pathol...

AimOral health changes, such as tooth loss can have a profound effect on a patient's quality of life. The partial and fully edentulous condition has negative impacts on ability to chew, speech and appearance. Dental implants support either a fixed or removable prosthesis and can provide a significant benefit to partially or fully edentulous patient...

There has been a significant increase in the volume of referrals from general dentists to hospital oral surgery services over the last decade in England. The referral rate also varies between dentists and the referral systems need to become more sophisticated to understand demand and support needs led commissioning of services.Aim1. Examine receive...

AimTo describe the role of paracetamol (acetaminophen) in the management of pain after oral surgery. Materials and methodsA review of the literature describing the pharmacokinetics, benefits and harms of paracetamol in terms of systematic review evidence, interactions, use in children, pregnancy and breastfeeding. ResultsParacetamol inhibits cycloo...

AimTo describe the scientific basis of the contemporary management of pain after oral surgery. Materials and methodsA review of the literature describing the concepts of pre-emptive and protective analgesia and evidence-based practice in the context of managing pain after oral surgery. ResultsPain is the consequence of the interplay of numerous che...

This paper compares the beneficial and harmful effects of paracetamol, ibuprofen and the novel combination of both in a single tablet for pain relief following the surgical removal of lower wisdom teeth. In this systematic review only randomised controlled double-blinded clinical trials were included. We calculated the proportion of patients with a...

Background: Iatrogenic injury of the inferior alveolar or lingual nerve or both is a known complication of oral and maxillofacial surgery procedures. Injury to these two branches of the mandibular division of the trigeminal nerve may result in altered sensation associated with the ipsilateral lower lip or tongue or both and may include anaesthesia...

Both paracetamol and ibuprofen are commonly used analgesics for the relief of pain following the surgical removal of lower wisdom teeth (third molars). In 2010, a novel analgesic (marketed as Nuromol) containing both paracetamol and ibuprofen in the same tablet was launched in the United Kingdom, this drug has shown promising results to date and we...

To reduce the number of patients experiencing severe postoperative pain by prescribing 10 mg Morphine either as oral solution or by IM injection as an alternative to Tramadol Hydrochloride in an analgesic protocol. Patients who received in-patient oral and maxillofacial surgery under general anaesthesia were included. Complex intervention analgesic...

This article provides an opinion on the NHS NICE guidance on wisdom tooth removal introduced in 2000. Guidelines should support clinical decision-making by providing recommendations based on sound evidence but the wisdom tooth guidelines were published without any research evidence. General dentists and oral surgeons in England and Wales are under...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the beneficial and harmful effects of ibuprofen for pain relief after surgical removal of lower wisdom teeth, compared to placebo, at different doses and administered preoperatively or postoperatively. Primary: To test the null hypothesis of no diff...

Unlabelled: Conscious sedation in dentistry is usually indicated because a patient's anxiety can prohibit the necessary dental treatment being undertaken. It may also be indicated because of unpleasant or lengthy treatment or to prevent exacerbation of a patient's medical or behavioural condition by anxiety. The indicator of sedation need (IOSN) t...

The shift of large volume oral surgery care provision out of secondary care into primary care desired by the National Health Service (NHS) requires a radical address for the provision of inhalational and intravenous sedation commissioning and provision. This paper aims to address some of the issues arising, and provides some suggested resolutions a...

Objective: This systematic review sets out to assess the efficacy and adverse effects of ibuprofen compared to paracetamol (acetaminophen) for analgesia following surgical removal of lower wisdom teeth, at different doses including novel combination drugs containing both analgesics administered post-operatively. Method: Included studies are a...

Objectives: In many people oral health changes, such as tooth loss, affect quality of life. The partial or fully edentulous condition has been shown to negatively affect chewing, speech and appearance. The aim of this study was to assess changes in oral health quality of life following dental implant treatment. Methods: From April 2011 to Augus...

Objective: Tissue adhesives have entered clinical practice as an alternative to more traditional wound closure methods e.g. sutures/staples. Closure of wounds with sutures enables meticulous closure, but they may show tissue reactivity and can require removal. Tissue adhesives offer the advantage of no risk of needlestick injury and no requiremen...

Cemento‐osseous dysplasia is a relatively uncommon condition of the jaws with a variety of presentations. This case report describes an unusual manifestation of cemento‐osseous dysplasia and aims to raise awareness of the condition among clinicians so that the correct diagnosis can be made in order to carry out the appropriate management.

In this article we report on the use of the IOSN as a referral tool in primary care and the need for sedation in the referred patient population (as determined by the IOSN score). Four centres in the North West of England (primary care) accepting referrals for treatment with the aid of sedation participated in this study. A service evaluation. SUBJ...

The role of the BDJ is to inform its readers of ideas, opinions, developments and key issues in dentistry - clinical, practical and scientific - stimulating interest, debate and discussion amongst dentists of all disciplines.

While the control of pain and anxiety is fundamental to the practice of dentistry, the use of conscious sedation in dentistry is very variable among dentists. The need for conscious sedation could be considered by assessing and ranking a combination of information on patient anxiety, medical history and the complexity of the anticipated clinical tr...

This service evaluation assessed the need for sedation in a population of dental attenders (n = 607) in the North West of England. Using the novel IOSN tool, three clinical domains of sedation need were assessed: treatment complexity, medical and behavioural indicators and patient reported anxiety using the Modified Dental Anxiety Scale. The findin...

Untreated postoperative pain is an important ethical and financial issue that can lead to unnecessary suffering and prolonged stays in hospital. Despite the availability of effective analgesics and a growing body of published material that supports their use, postoperative pain remains a problem worldwide. To reduce acute postoperative pain, we int...

Unlabelled: Sutures are routinely used to achieve haemostasis and to approximate soft tissues after extractions, periodontal procedures, implant surgery and soft tissue biopsies. This paper provides the general dental practitioner with the knowledge and understanding of sutures to select the most appropriate for use. Common suturing techniques are...

The possible occurrence of implant failure is a major concern for implantologists and knowledge in such unavoidable fact is clinically essential. Periimplantitis is an inflammatory response in which there is a loss of the bony support of the implant. Diagnosis is based on the clinical signs of infection such as hyperplastic soft tissues, suppuratio...

Background: Domestic violence exists in all communities across the world. Healthcare services have a pivotal role in the identification, assessment and response to domestic violence. As the face is a common target in assault, dentists and oral and maxillofacial surgeons are in a unique position to screen for domestic violence in the context of pre...

Aim: To investigate the post-operative pain experience of patients undergoing oral surgery under day case general anaesthesia. Methods: All ASA I and II patients, aged 16 years and over requiring oral surgery procedures under day case general anaesthetic over a 3 month period were included. Patients were asked to assess their own level of pain usin...

The aim of this randomised, controlled, parallel-group clinical trial was to evaluate the clinical effect of platelet-rich plasma (PRP) on bone graft healing and implant integration in iliac crest grafted maxillae. Twenty-two consenting patients were randomised to PRP (13 patients) and control (9 patients) groups. Both groups received onlays and 16...

Background: It is important to institute an effective supportive therapy to maintain or recover soft tissue health around dental implants. Different maintenance regimens have been suggested, however it is unclear which are the most effective. Objectives: To assess the effects of different interventions for 1) maintaining and 2) recovering soft t...

The aim of the current study was to investigate whether there was a relationship between a history of third molar removal and the prevalence of orofacial pain in a sample of the general population. A survey was conducted in South East Cheshire, United Kingdom (81% participation rate). Information was collected using postal questionnaires (n = 1510)...

Objectives: Platelet-rich plasma (PRP) is believed to enhance bone healing as shown by histomorphometrical methods. However, little is known of its clinical significance especially with the currently conflicting outcomes which signify the need for well designed clinical trials. The aim of this study was to investigate the effect of PRP on the stabi...

Background: Some dental implant failures may be due to bacterial contamination at implant insertion. Infections around biomaterials are difficult to treat, and almost all infected implants have to be removed. In general, antibiotic prophylaxis in surgery is only indicated for patients at risk of infectious endocarditis; with reduced host-response;...

CONFLICT-OF-INTEREST STATEMENT: Marco Esposito is the first author of two of the included studies; however, he was not involved in the quality assessment of these trials. This review is based on a Cochrane systematic review entitled 'Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications' publish...

Background: Sutures, staples and adhesive tapes are the traditional methods of wound closure, whilst tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables meticulous closure, but they may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of no risk of needlestick i...

Sufficient bone quantity is required for dental implant placement. Bone quantity towards the back of the upper jaw may be insufficient for dental implant placement because of the presence of the maxillary sinus, a natural cavity within the bone. This cavity may enlarge following tooth loss. There are a number of techniques, termed sinus lift proced...

Background: Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenera...

To improve the patients postoperative pain experience using protective analgesia for patients undergoing third molar surgery under day case general anaesthesia. Patients were randomly allocated to a protective analgesia (1.6g modified release ibuprofen) or conventional analgesia (400mg conventional ibuprofen) orally 2h preoperatively. Surgical mode...

CONFLICT-OF-INTEREST STATEMENT: Marco Esposito, Pietro Felice and Paul Coulthard are among the authors of four of the included trials, however, they were not involved in the quality assessment of these trials. This review is based on a Cochrane systematic review entitled 'Interventions for replacing missing teeth: augmentation procedures of the max...

This article subscribes to the initial condition of bone quality and its ultimate effect on the success of dental implant treatment. A high success rate for the preservation of the alveolar bone around oral implants is predicated on good bone quality. For implantologists, the classification of bone quality should be based on the key elements requir...

Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodont...

Background: Dental implants require sufficient bone to be adequately stabilised. For some patients implant treatment would not be an option without horizontal or vertical bone augmentation. A variety of materials and surgical techniques are available for bone augmentation. Objectives: To test whether and when augmentation procedures are necessar...

Background: Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regener...

Adrenal crisis is a life threatening condition which can be induced by stress during surgery in patients with adrenal insufficiency. This may be prevented by perioperative administration of high doses of steroids. There is disagreement on whether supplemental perioperative steroids are required and, when administered, on the amount and frequency of...

Some patients may have insufficient bone to place dental implants, but there are many sur­gical techniques to increase the bone volume making implant treatment possible. Short implants appear to be more effective and cause fewer complications than conventional implants placed in resorbed lower jaws augmented with autogenous bone or bone substitutes...

This randomised double-blind placebo-controlled trial was carried out to investigate the effect of a one-week post-operative course of 600 mg of ibuprofen taken four times a day on marginal bone level around dental implants. A total of 61 patients were allocated to the ibuprofen (31 patients) or placebo group (30 patients). Overall, 132 implants we...

To evaluate if a one-stage implant placement procedure is as effective as a two-stage procedure. The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE, were searched and several journals were hand-searched with no language restriction up to January 2009. All randomised controlled trials (RCTs) of osseointegrated dental impla...

Management of pain in dental patients is important. Effective management of pain requires an understanding of basic pain mechanisms and current best clinical evidence. The traditional view that pain could be adequately described as resulting from the activity in a dedicated pathway originating in peripheral nociceptors has changed. Now a more compl...

Objective: To evaluate the effects of the platelet-rich plasma (PRP) on the soft and hard tissue healing of extraction sockets, and on the quality of life of patients. Methods: Twenty-three patients were randomly allocated to either the PRP or the control group (normal management). The Platelet Concentrate Collection System (PCCSTM) was used for...

This review article describes the scientific basis of contemporary management of pain after oral surgery. Management can be challenging but significant improvement can be made to the patient's experience by patient education, staff education and the use of an evidence-based analgesic protocol.

Osseointegration and Dental Implants offers a comprehensive guide to the state of the art of implant dentistry. Based around the proceedings of the Toronto Osseointegration Conference Revisited, it gathers together information on all aspects of implant dentistry and osseointegration, from basic scientific background, such as the biology of osseoint...

Background: Dental implants require sufficient bone to be adequately stabilized. For some patients implant treatment would not be an option without bone augmentation. A variety of materials and surgical techniques are available for bone augmentation. Objectives: General objectives: To test the null hypothesis of no difference in the success, functi...

Background: To minimise the risk of implant failures after their placement, dental implants are kept load-free for 3 to 8 months to establish osseointegration (conventional loading). It would be beneficial if the healing period could be shortened without jeopardising implant success. Nowadays implants are loaded early and even immediately and it w...

Background The aim of this study was to describe New England dental professionals' attitudes and behaviours regarding domestic violence (DV) and to identify barriers faced in intervening to help suspected victims.Methods A cross-sectional survey using a convenience sample of dentists (n = 169) and hygienists (n = 190) attending the 2004 Yankee Dent...

Dental implants can be successful either if placed through the oral mucosa, sticking through the gums (1-stage procedure) or if completely buried under the soft tissues (2-stage procedure) to heal load-free for a few months. However, one additional minor surgical intervention is needed, if a 2-stage procedure is used, to allow the connection of the...

To evaluate the efficacy of 1) immediate (within 1 week), early (between 1 week to 2 months), and conventional (after 2 months) loading of osseointegrated implants, and of 2) immediate occlusal versus non-occlusal loading during the bone healing phase. The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched and s...

Many variations in the surgical technique for the placement of dental implants have been developed since the introduction of implant surgery into clinical practice. These include variations in the timing of implant placement in relation to the tooth removal, and variations in the way the recipient bone site is prepared, amongst others. To test the...

Dental implants require sufficient bone to be adequately stabilised. For some patients implant treatment would not be an option without bone augmentation. A variety of materials and surgical techniques are available for bone augmentation. General objectives: To test the null hypothesis of no difference in the success, function, morbidity and patien...

Missing teeth can sometimes be replaced with dental implants to which a crown, bridge or denture can be attached. Bacteria introduced during placement of implants can lead to infection and sometimes implant failure. It appears that the oral administration of 2 grams of amoxicillin 1 hour before placement of dental implants is effective in reducing...