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When undertaking dental extractions in modern dental practice, two of the complications that have the potential to cause most apprehension for clinicians are the risks of osteonecrosis of the jaws and uncontrollable haemorrhage. This is especially the case when treating older patients because of the increased likelihood of co-morbidities and accompanying polypharmacy which can predispose patients to these problems. Specific medications of concern to practitioners in relation to osteonecrosis risk are antiangiogenic and antiresorptive drugs. Patients taking dual antiplatelet therapy and direct oral anticoagulants require consideration in relation to bleeding risk. With these medications coming increasingly to the forefront over recent years, guidance has been developed by organisations such as the Scottish Dental Clinical Effectiveness Programme (SDCEP). Appropriate use of these guideline should ensure that patients felt to be at particular risk of these complications can frequently be safely managed in primary care. This article aims to provide advice on recognising patients at risk, and to discuss how to utilise key messages within published guidelines when making treatment decisions. The overall intent is to help primary care clinicians who are likely to encounter these patients more and more.

Peptoids (oligo N-substituted glycines) are peptide analogues, which can be designed to mimic host antimicrobial peptides, with the advantage that they are resistant to proteolytic degradation. Few studies on the antimicrobial efficacy of peptoids have focused on Gram negative anaerobic microbes associated with clinical infections, which are commonly recalcitrant to antibiotic treatment. We therefore studied the cytotoxicity and antibiofilm activity of a family of peptoids against the Gram negative obligate anaerobe Fusobacterium nucleatum, which is associated with infections in the oral cavity. Two peptoids, peptoid 4 (NaeNpheNphe)4 and peptoid 9 (NahNspeNspe)3 were shown to be efficacious against F. nucleatum biofilms at a concentration of 1 μM. At this concentration, peptoids 4 and 9 were not cytotoxic to human erythrocytes or primary human gingival fibroblast cells. Peptoids 4 and 9 therefore have merit as future therapeutics for the treatment of oral infections.

This case report explores the challenging multidisciplinary management of a gentleman over the course of 28 years. It begins with resection of a maxillary ameloblastoma, describes an 18-year period of elusive discomfort, culminating in an exophytic lesion associated with a retained Gore-Tex membrane. Retained foreign bodies can cause a multitude of complications including chronic infection, discomfort and reactive tissue growth. Imaging for foreign bodies may have a low diagnostic yield and surgical exploration should be considered when conventional methods fail to provide a diagnosis. The case concludes with successful prosthodontic rehabilitation, lessons with barrier membranes and foreign body management.

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