The prevalence and severity of tooth wear is increasing in industrialised nations. Yet, there is no high-level evidence to support or refute any therapeutic intervention. In the absence of such evidence, many currently prevailing management strategies for tooth wear may be failing in their duty of care to first and foremost improve the oral health of patients with this disease. This paper promotes biologically sound approaches to the management of tooth wear on the basis of current best evidence of the aetiology and clinical features of this disease. The relative risks and benefits of the varying approaches to managing tooth wear are discussed with reference to long-term follow-up studies. Using reference to ethical standards such as “The Daughter Test”, this paper presents case reports of patients with moderate-to-severe levels of tooth wear managed in line with these biologically sound principles.

The term ‘crown lengthening surgery’ refers to a variety of techniques which aim to expose a greater amount of tooth structure around a tooth or group of teeth. The decision to treat and which technique to use will depend upon: the underlying aetiology; a thorough history and examination; results of any supporting investigations and a clear understanding of the intended outcome of treatment. This paper aims to provide an overview of crown lengthening surgery and is illustrated with clinical cases.

Despite morbidity factors that include pain and complications with healing, there is currently little available guidance regarding optimal pre-and post-operative protocols for dental implant placement. While the first paper of this two-part series discussed the management of post-operative pain, the second instalment reviews pre- and post-operative means of managing early complications associated with dental implant placement.

Although dental implant placements have high success rates and a low incidence of morbidity, post-operative pain and complications with the healing process have been reported. There is little guidance available regarding optimal pre- and post-operative management of dental implant placement. This first paper discusses the mechanisms of pain associated with dental implant placement and offers guidance to clinicians on optimal pre- and post-operative pain management regimes. The second paper aims to discuss pre- and post-operative means of reducing the risk of early healing complications.

Aim: To investigate the relationship between generic and condition specific (CS) quality of life (QoL), general psychological wellbeing and personality in patients with tooth wear. Materials and Methods: Ethical approval was granted (REC:10/H0709/21). Patients 18-70 years with tooth wear completed the Oral Impacts on Daily Performances (OIDP) quality of life questionnaire, the NEO-FFI Personality questionnaire, and the General Health Questionnaire-12 (GHQ). Tooth wear was measured with the Basic Erosive Wear Examination (BEWE).Results: 102 subjects were recruited. Increased BEWE scores were correlated with older age, and worse generic, and CS related QoL. Increased Neuroticism was correlated to increased generic and CS-OIDP scores; generic and CS eating scores; CS smiling score and CS carrying out major work scores. Increased GHQ scores were positively correlated with increased generic and CS-OIDP scores; generic and CS-eating scores; CS-speaking scores; generic and CScleaning scores; generic relaxing scores, generic and CS-smiling scores and generic emotional state score (p=<0.05). Multivariable linear regression analyses showed thatincreasedNeuroticism and decreased GHQ both had an independent effect on generic and CS-OIDP scores when adjusted for tooth wear severity (p<0.05). Conclusion: Quality of life perception is complex, and was not only affected by worsening levels of tooth wear.