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1 Chapter 1-1Figure 1.1.1 Patient with spastic cerebral palsy and preserved intellectual ...Figure 1.1.2 Extensive caries upper central incisors.Figure 1.1.3 (a) Severe malocclusion with anterior open bite. (b) Sialorrhoe...Figure 1.1.4 Patients who present in wheelchairs may have treatment provided...Figure 1.1.5 (a) Spastic cerebral palsy. (b) Hand deformity calls for adapti...

2 Chapter 1-2Figure 1.2.1 Patient with uncontrolled epilepsy wearing a protective headgea...Figure 1.2.2 Severe displacement of the maxillary central incisors following...Figure 1.2.3 (a) Tooth extraction and removal of maxillary bone fragments. (...Figure 1.2.4 (a) Sequelae of repeated facial injuries secondary to epileptic...Figure 1.2.5 Severe gingival hyperplasia in a patient on phenytoin.Figure 1.2.6 Electroencephalogram (EEG) showing epileptiform activity.Figure 1.2.7 Magnetic resonance imaging (MRI) can identify structural change...

3 Chapter 1-3Figure 1.3.1 Facial myopathy with severe open mouth.Figure 1.3.2 Anterior open bite.Figure 1.3.3 Lateral cephalogram showing a dolichocephalic growth pattern (r...Figure 1.3.4 (a) Facial myopathy (hypotonia, dolichocephaly and open mouth)....Figure 1.3.5 Diagnostic muscle biopsy showing random variation in fibre size...Figure 1.3.6 Orthopaedic surgery to improve scoliosis.

4 Chapter 2-1Figure 2.1.1 Dentition: generalised plaque, calculus and gingival inflammati...Figure 2.1.2 Maxilla: caries in teeth #54, #53, #65, stained fissures in #16...Figure 2.1.3 Mandible: caries in teeth #75, #84 and #85; calculus on the lin...Figure 2.1.4 Right and left bitewing radiographs: mixed dentition; caries in...

5 Chapter 2-2Figure 2.2.1 Oral examination was carried out with the help of pictograms.Figure 2.2.2 (a) Fracture of the incisal edge of the crown of tooth #11. (b)...Figure 2.2.3 Desensitisation with visual support may be helpful.Figure 2.2.4 A visual timer may improve co‐operation.Figure 2.2.5 (a) Fascination by an inanimate object. (b) Ritualistic behavio...

6 Chapter 2-3Figure 2.3.1 (a) Irregular palate, with erythema of the denture bearing muco...Figure 2.3.2 Cone beam computed tomography showing a bone defect in the uppe...Figure 2.3.3 (a–d) Prosthodontic rehabilitation with a new upper dental pros...Figure 2.3.4 (a) Lip fissures. (b) Dental agenesis, microdontia and macroglo...Figure 2.3.5 Orthodontic therapy can be successfully performed in selected p...

7 Chapter 3-1Figure 3.1.1 Thickened upper labial frenulum.Figure 3.1.2 Cone beam computed tomography showing a considerable isolated c...Figure 3.1.3 Orthodontic treatment for a patient with visual impairment.Figure 3.1.4 Braille is a useful communication tool mainly for complete blin...Figure 3.1.5 When the blind patient uses a guide dog, avoid interfering with...

8 Chapter 3-2Figure 3.2.1 Bimaxillary compression resulting in a narrow, pointed/ogival a...Figure 3.2.2 Sign language can be used to enhance communication.Figure 3.2.3 Orthodontic treatment for a patient with craniofacial dysostosi...Figure 3.2.4 An audiogram shows the quietest sounds a patient can just hear....Figure 3.2.5 Cochlear implants in a child with congenital deafness.

9 Chapter 4-1Figure 4.1.1 Orthopantomogram showing multiple caries and alveolar bone loss...Figure 4.1.2 Primary tuberculosis manifesting as a non‐healing, tender ulcer...Figure 4.1.3 Positive Mantoux test (also known as tuberculin PPD test for pu...Figure 4.1.4 Chest x‐ray showing cavitary lesions typically associated with ...

10 Chapter 4-2Figure 4.2.1 Oral HPV‐associated papillomatosis in AIDS.Figure 4.2.2 (a–c) Lesions closely associated with HIV infection: oral candi...Figure 4.2.3 Exfoliative cheilitis as an adverse oral effect of proteinase i...Figure 4.2.4 Infection control in the dental clinic.Figure 4.2.5 Pneumonia by Pneumocystis carinii as an AIDS‐defining condition...

11 Chapter 4-3Figure 4.3.1 Orthopantomogram demonstrating unrestorable caries in #26.Figure 4.3.2 Erosive lichen planus in an HCV‐infected patient.Figure 4.3.3 Jaundice related to liver dysfunction.

12 Chapter 5-1Figure 5.1.1 Panoramic radiography showing caries and a prior filling in too...Figure 5.1.2 (a–c) Severe periodontal disease in a 37‐year‐old male with dia...Figure 5.1.3 Xerostomia – depapillated, smooth dry dorsum of the tongue.Figure 5.1.4 Continuous glucose monitoring system.

13 Chapter 5-2Figure 5.2.1 Orthopantomogram: neglected mouth with unrestorable caries in t...Figure 5.2.2 Macroglossia in a patient with hypothyroidism.Figure 5.2.3 Goitre (enlarged thyroid gland).Figure 5.2.4 Grey‐scale ultrasound and colour Doppler sonogram showing multi...

14 Chapter 5-3Figure 5.3.1 Mild goitre (anterior and lateral view).Figure 5.3.2 Pitted hypoplastic enamel and staining present on buccal surfac...Figure 5.3.3 Generalised moderate to severe tooth surface loss on the palata...Figure 5.3.4 Orthopantomogram demonstrating patchy medullary radiolucency su...Figure 5.3.5 Long cone periapical radiograph demonstrating periapical radiol...

15 Chapter 6-1Figure 6.1.1 Orthopantomogram demonstrating a neglected mouth with multiple ...Figure 6.1.2 Postoperative bleeding after dental extraction in liver cirrhos...Figure 6.1.3 Grey‐scale ultrasound and colour Doppler sonogram showing a liv...

16 Chapter 6-2Figure 6.2.1 Orthopantomogram demonstrating multiple carious teeth, missing ...Figure 6.2.2 Brown tumour associated with secondary hyperparathyroidism in a...Figure 6.2.3 Autosomal‐dominant polycystic kidney disease (ADPKD) may lead t...Figure 6.2.4 A haemodialysis system including a blood circuit (with the vasc...

17 Chapter 7-1Figure 7.1.1 Orthopantomogram findings suggestive of osteoporosis as well as...Figure 7.1.2 Granular jawbone and severe cortex erosion in a female patient ...Figure 7.1.3 Right‐sided femoral neck fracture (most are due to osteoporosis...Figure 7.1.4 The gold‐standard method to assess bone mineral density (BMD) i...

18 Chapter 7-2Figure 7.2.1 Enlargement of the left maxillary area.Figure 7.2.2 Hypercementosis associated with Paget disease.

19 Chapter 7-3Figure 7.3.1 Orthopantomogram showing conserved structure of the condylar pr...Figure 7.3.2 Condylar process of a rheumatoid arthritis patient showing flat...Figure 7.3.3 Methotrexate‐induced oral ulcer.Figure 7.3.4 Stiff fingers and swollen joints in rheumatoid arthritis.

20 Chapter 8-1Figure 8.1.1 Orthopantomogram demonstrating severe vertical bone loss in mes...Figure 8.1.2 Angiotensin‐converting enzyme inhibitor (enalapril)‐induced fac...Figure 8.1.3 (a,b) Calcium channel blocker (nifedipine)‐induced gingival hyp...Figure 8.1.4 Ambulatory blood pressure monitoring record over a 24‐hour peri...

21 Chapter 8-2Figure 8.2.1 Periapical dental radiograph showing chronic periapical periodo...Figure 8.2.2 Gingival hyperplasia caused by nifedipine (a calcium channel bl...Figure 8.2.3 Nicorandil (a potassium channel opener)‐induced oral ulcer.Figure 8.2.4 Patient with unstable angina treated in a hospital setting with...Figure 8.2.5 Stress echocardiography and Doppler echocardiography are establ...

22 Chapter 8-3Figure 8.3.1 Orthopantomogram demonstrating loss of multiple teeth and deter...Figure 8.3.2 Oral lichenoid drug reaction triggered by a beta‐blocker (nevib...Figure 8.3.3 Myocardial perfusion single‐photon emission computed tomography...

23 Chapter 8-4Figure 8.4.1 Orthopantomogram showing severe maxillary atrophy and radiograp...Figure 8.4.2 Heart pacemaker (VVI) on chest x‐ray.Figure 8.4.3 Implantable cardioverter‐defibrillator with 1 lead and 2 shock ...

24 Chapter 8-5Figure 8.5.1 Periapical radiograph showing radiolucent lesion related to #36...Figure 8.5.2 Exploratory surgery confirmed the radiological suggestion of ra...Figure 8.5.3 Mechanical mitral valve prostheses.Figure 8.5.4 Biological aortic valve prostheses.

25 Chapter 8-6Figure 8.6.1 Orthopantomogram showing carotid stent.Figure 8.6.2 Invasive coronary angiography remains the standard for the dete...

26 Chapter 9-1Figure 9.1.1 Orthopantomogram of a patient with chronic obstructive pulmonar...Figure 9.1.2 Inhaling smoke is a chronic work hazard for street hawkers.Figure 9.1.3 Spirometry is the standard respiratory function test for case d...Figure 9.1.4 Chest x‐ray of an elderly man with chronic obstructive pulmonar...

27 Chapter 9-2Figure 9.2.1 Lignosus rhinocerus.Figure 9.2.2 Mandibular dentition: rampant caries and multiple retained root...Figure 9.2.3 (a) Characteristic facial features of asthma. (b) Mouth‐breathi...Figure 9.2.4 Spirometry is the recommended test to confirm asthma (see also ...

28 Chapter 10-1Figure 10.1.1 Orthopantomogram showing extensive caries.Figure 10.1.2 Spontaneous gingival bleeding.Figure 10.1.3 Persistent bleeding from hyperplastic pulpitis (pulp polyp).Figure 10.1.4 Infraorbital haematoma following infiltrative local anaesthesi...

29 Chapter 10-2Figure 10.2.1 Multiple other decayed and defective heavily restored teeth.Figure 10.2.2 (a) Periapical radiograph upper right quadrant showing fractur...

30 Chapter 10-3Figure 10.3.1 Periapical radiograph of the #14 demonstrating extensive bone ...Figure 10.3.2 International normalised ratio (INR) testing in the dental cli...Figure 10.3.3 (a,b) Prolonged bleeding and bruising (haematoma) after dental...Figure 10.3.4 Prolonged bleeding after dental extractions; haemostatic pack ...

31 Chapter 10-4Figure 10.4.1 Periapical radiograph showing root canal treatment in tooth #2...Figure 10.4.2 Exploratory surgery showing radicular fracture. Consequently, ...Figure 10.4.3 Bruising (haematoma) following dental extractions.

32 Chapter 10-5Figure 10.5.1 (a,b) Long cone periapical radiographs of lower anterior teeth...Figure 10.5.2 Ecchymoses associated with dental implant surgery.Figure 10.5.3 Most common types of antiplatelet drugs.

33 Chapter 11-1Figure 11.1.1 Lateral view of the face showing malar prominence and anterior...Figure 11.1.2 Mixed dentition with generalised crowding and pale gingivae.Figure 11.1.3 Orthopantomogram demonstrating mixed dentition, thin mandibula...Figure 11.1.4 (a,b) Facial features: frontal bossing, ‘chipmunk face’, class...

34 Chapter 11-2Figure 11.2.1 Lower lip trauma lesion.Figure 11.2.2 Fractured crowns #11 and #21, extruded tooth # 21, localised i...Figure 11.2.3 Upper right and left periapical and upper occlusal radiographs...Figure 11.2.4 Lower lip radiograph: no foreign body/tooth fragments.Figure 11.2.5 Splinting of teeth #11–23 with wire and composite splint.

35 Chapter 11-3Figure 11.3.1 Panoramic radiography showing tooth resorption of the mandibul...Figure 11.3.2 (a,b) Recurrent oral ulceration in cyclic neutropenia.Figure 11.3.3 Severe periodontal disease and early tooth loss related to chr...Figure 11.3.4 Aggressive periodontitis in a teenager with DiGeorge syndrome ...

36 Chapter 11-4Figure 11.4.1 (a) Dentition: inflamed, hyperplastic, bleeding gingivae; toot...Figure 11.4.2 Spontaneous blood‐filled bullae (angina bullosa haemorrhagica)...

37 Chapter 11-5Figure 11.5.1 Generalised dental plaque, calculus and staining.Figure 11.5.2 (a,b) Right and left bitewing radiographs demonstrating extens...Figure 11.5.3 Infiltration of gingival tissue with leukaemia cells in a pati...Figure 11.5.4 Formation of blood cells (haematopoiesis).

38 Chapter 11-6Figure 11.6.1 Extrusion of the lower right second molar and gingival ulcer w...Figure 11.6.2 Orthopantomogram showing #47 radiolucent periapical lesion wit...Figure 11.6.3 Radionuclide bone imaging showing mandibular invasion.Figure 11.6.4 Mediastinal bulk defined from chest radiograph in Hodgkin lymp...Figure 11.6.5 (a.b) Positron emission tomography/computed tomography (PET/CT...

39 Chapter 11-7Figure 11.7.1 Back brace for support.Figure 11.7.2 Mucosa – healing ulcer in the vestibule close to #26.Figure 11.7.3 Floor of mouth – minimal saliva pooling; caries #44, #45 and #...Figure 11.7.4 Periapical radiograph demonstrating caries in #44, #45 and #46...Figure 11.7.5 Cone beam computed tomography images showing a changed bone de...Figure 11.7.6 (a,b) Graft‐versus‐host disease.

40 Chapter 12-1Figure 12.1.1 Malar rash (butterfly rash).Figure 12.1.2 Orthopantomogram demonstrating generalised bone loss, retained...Figure 12.1.3 Delayed wound healing and bacterial infection following tooth ...

41 Chapter 12-2Figure 12.2.1 Long cone periapical radiograph #36 demonstrating associated p...Figure 12.2.2 Acute mucositis secondary to the administration of 5‐fluoroura...Figure 12.2.3 A child wearing a hood due to alopecia.Figure 12.2.4 Chest radiograph showing a left single‐lumen central venous ca...

42 Chapter 12-3Figure 12.3.1 Anterior view of the dentition showing generalised hard and so...Figure 12.3.2 (a,b) Bite‐wing radiographs showing horizontal bone loss, subg...Figure 12.3.3 Sirolimus‐induced oral ulceration.Figure 12.3.4 Cyclosporine‐induced gingival hyperplasia.Figure 12.3.5 Cutaneous chronic graft‐versus‐host disease following kidney t...

43 Chapter 13-1Figure 13.1.1 Orthopantomogram showing segmental mandibulectomy reconstructe...Figure 13.1.2 Surgical sequelae of a lower jaw carcinoma. Reconstruction of ...Figure 13.1.3 The mobility of the residual tongue determines the functional ...Figure 13.1.4 Lymphoscintigraphy for sentinel lymph node detection in patien...

44 Chapter 13-2Figure 13.2.1 Periapical radiograph showing extensive cervical caries #33 an...Figure 13.2.2 Hyposalivation and thick and sticky saliva are common acute co...Figure 13.2.3 Rampant caries (‘radiation caries’) is a delayed complication ...Figure 13.2.4 Clinical findings highly suggestive of osteoradionecrosis in a...

45 Chapter 13-3Figure 13.3.1 (a–c) Implant‐supported prosthetic rehabilitation after surgic...Figure 13.3.2 (a,b) Oral health status in a patient with nasopharyngeal carc...Figure 13.3.3 (a,b) Maintenance care is mandatory for the long‐term success ...

46 Chapter 14-1Figure 14.1.1 Anterior dentition: marginal gingivitis; #11 chipped incisal e...Figure 14.1.2 Palatal aspect of the upper anterior teeth: palatal erosion an...Figure 14.1.3 (a,b) Food packing posteriorly.Figure 14.1.4 Co‐operation during radiological examination diminishes with a...

47 Chapter 14-2Figure 14.2.1 Excessive drooling (sialorrhoea, hypersalivation).Figure 14.2.2 Haematoma on the right side of the forehead due to a fall.Figure 14.2.3 (a,b) Partially edentate, plaque‐induced gingivitis, moderate ...Figure 14.2.4 Long cone periapical radiograph demonstrating extensive caries...Figure 14.2.5 Advanced Parkinson disease showing mask‐like appearance, tremo...

48 Chapter 14-3Figure 14.3.1 Partially edentate, extensive caries #13 and #23.Figure 14.3.2 Upper right maxillary quadrant with extensive soft deposits an...Figure 14.3.3 Long cone periapical radiograph of the upper right quadrant de...Figure 14.3.4 Multiple sclerosis presenting with sustained contracture and m...

49 Chapter 14-4Figure 14.4.1 Xerostomia, frothy saliva, tongue biting.Figure 14.4.2 Heavily restored #17 and #18; food trapping interdentally.Figure 14.4.3 Long cone periapical radiograph; 1 mm space between #17 and #1...Figure 14.4.4 Fasciculations of the tongue.

50 Chapter 14-5Figure 14.5.1 Partially edentate; plaque‐induced gingivitis; root caries fro...Figure 14.5.2 Retained roots #17 and #15; root caries #24.Figure 14.5.3 Xerostomia and healing ulcer left lateral border of the tongue...Figure 14.5.4 Orthopantomogram demonstrating extensive interdental decay in ...Figure 14.5.5 Acute ischaemic stroke (cerebellar infarction) confirmed by co...

51 Chapter 15-1Figure 15.1.1 Scalloped tongue due to bruxism/tongue biting.Figure 15.1.2 Poor oral health with associated gingivitis.Figure 15.1.3 Lower incisors: calculus and lingual recession.Figure 15.1.4 Multiple restorations; #25 caries; #24 disto‐occlusal defectiv...Figure 15.1.5 The Modified Dental Anxiety Scale (MDAS).

52 Chapter 15-2Figure 15.2.1 Partially edentate, deep overbite, multiple carious teeth.Figure 15.2.2 Maxillary dentition: retained roots #17, #24 and #27; palatine...Figure 15.2.3 Mandibular dentition: retained root #41; caries in #34, #32, #...Figure 15.2.4 Full‐mouth periapical radiographs demonstrating multiple retai...

53 Chapter 15-3Figure 15.3.1 Anterior dentition – gingival recession, xerostomia.Figure 15.3.2 Maxillary dentition – retained root #14, extensive subgingival...Figure 15.3.3 Orthopantomogram showing generalised bone loss, #46 perio‐endo...Figure 15.3.4 Dental prosthesis heavily stained due to compulsive smoking an...Figure 15.3.5 Tardive oral dyskinesia.

54 Chapter 15-4Figure 15.4.1 (a) Anterior dentition demonstrating gaps in the lateral incis...Figure 15.4.2 (a) Upper partial denture in situ. (b) Fractured upper partial...Figure 15.4.3 Orthopantomogram demonstrating multiple carious teeth and gene...

55 Chapter 15-5Figure 15.5.1 Angular cheilitis, dry lips/mouth, fissured tongue.Figure 15.5.2 Partially edentate, xerostomia, gingival recession, poor oral ...Figure 15.5.3 Lack of posterior occlusal support on the right side.Figure 15.5.4 Full‐mouth periapical radiographs.

56 Chapter 16-1Figure 16.1.1 Sudden lip swelling during dental treatment may become a medic...Figure 16.1.2 Oral manifestations of allergic reactions (types I–IV).Figure 16.1.3 Patch test to study hypersensitivity to dental materials.Figure 16.1.4 Hypersensitivity reaction to amoxicillin‐clavulanate in an HIV...

57 Chapter 16-2Figure 16.2.1 An area > 1 cm of exposed bone on the right lingual surface of...Figure 16.2.2 Spontaneous bone exposure following periodontal treatment, sug...Figure 16.2.3 Detail of an orthopantomogram showing bone sequestration in th...Figure 16.2.4 Cone beam computed tomography demonstrating the extent of medi...

58 Chapter 16-3Figure 16.3.1 Gingival hyperplasia and bleeding gums.Figure 16.3.2 Pregnancy‐related mild gingivitis.Figure 16.3.3 Pyogenic granuloma (gravidarum).

59 Chapter 16-4Figure 16.4.1 Shoulder obstruction during attempt to undertake an orthopanto...Figure 16.4.2 Orthopantomogram demonstrating caries on the distal aspect of ...Figure 16.4.3 Dental chair unable to reposition.Figure 16.4.4 Bariatric bench.Figure 16.4.5 Wheelchair platform.

60 Chapter 16-5Figure 16.5.1 Orthopantomogram demonstrating metal mesh on the left orbital ...Figure 16.5.2 (a,b) Silver diamine fluoride may be beneficial for patients w...Figure 16.5.3 Homeless man sleeps in a public space.

61 Chapter 16-6Figure 16.6.1 (a,b) Xerostomia with collection of debris/secretions on the p...Figure 16.6.2 (a,b) Supine panoramic radiography device.Figure 16.6.3 Using damp gauze wrapped round a gloved finger to gently moist...Figure 16.6.4 Portable dental unit.Figure 16.6.5 Phases of care when approaching death.

A Practical Approach to Special Care in Dentistry

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