Bruxism may lead to changes or damage to the oral and perioral tissues. Bruxism may occur during sleep or when awake. Many patients will not require active management; however, for some, intervention is required. Control of bruxism may be difficult, if not impossible, but the need exists for preservation of the dentition and quality of life. A prediction of risk to the tissues for the planning of interventions is difficult and relies upon evidence of past damage and assessment of future risks. Treatment options may need to be imaginative and rescuable. This series of papers will review the aetiology of bruxism, its impacts and treatment strategies for persistent bruxers who are at risk of, or suffering, tissue damage.

Bruxism is a term that encompasses a range of presentations of rhythmic and repetitive muscular activity. For many, this is not a significant problem but for some, this behaviour leads to substantial impact and tissue damage that can be significant, compromising function and quality of life. This paper will review management methods for reconstructing the damaged dentition.

Bruxism is a term that encompasses a range of presentations of rhythmic and repetitive muscular activity. For many, this is not a significant problem but for some, the behaviour leads to significant problems and extensive tissue damage. This is different to temporomandibular disorders. This paper will review methods of managing cases where bruxism is destructive, or potentially destructive, before needing to resort to full reconstruction.

The landmark March 2015 Supreme Court Montgomery judgement 1 has precipitated any number of doomsday-esque expositions in both the medical 2,3,4 and dental 5,6,7 press with respect to its purported impact on the day-today delivery of clinical care. This paper intends to stimulate discussion among colleagues and to -hopefully -encourage reflection upon our present practise. Its content and opinions may challenge contemporary protocols to a perhaps uncomfortable degree but the author considers the time to be right for such views to be aired.At present, consenting procedures for mandibular third molar removal would generally be expected to focus upon discussion of the risks of inferior dental and lingual nerve injury. That these risks exist is a given; they have been reported upon almost ad infinitum. There is a substantial back catalogue of available publications, many basically duplicating previous studies, yet it appears that little substantive progress in quantifying the legitimate risks to patients has been made over the decades. In the view of the author, such studies have minimal merit. Their methodology is frequently flawed, their comparisons are inappropriate and their interpretations misleading. In reality, these compare apples with pears and yet somehow purport to cultivate prize tomatoes. The opinion of the author is that contemporaneous concepts used in disclosure of the risks of nerve injury during mandibular third molar surgery are fundamentally unsound and indeed, potentially misleading. Moreover, ill-founded anxieties and misconceptions in relation to these risks can give rise to defensive and potentially inappropriate treatment recommendations by clinicians and misguided choices by patients.The author contends that the research previously used is erroneous and misleading.This research has been superseded by modern imaging techniques and change in interpretation is now required to fulfil the requirements of the Montgomery judgement.It is incumbent on practitioners to provide real and accurate information to patients for valid consent. Present processes fail to do this, which calls into question the validity of the consent process in many cases.