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Author Archives: JCDA Oasis

Are You Concerned About Mandibular Blocks In Patients Taking Anticoagulants?

This question was submitted to us by a general dentist: Are you concerned about mandibular blocks and possible injury to blood vessels (Inferior Alveolar Artery/Vein) in patients continuing anti-coagulant therapy (Warfarin)? Potential Hematomas? Management? Dr. Jason Goodchild provided this quick initial response: For patients on anticoagulant therapy, a careful review of the medical history including consultation with the patient’s physician is warranted.  This consultation should include information on the patient’s INR (International Normalized Ratio).  Ideally, a recent INR (with 24-48 hrs) is needed in order to ascertain the patient’s bleeding risk during surgery.   The literature is consistent on this issue: If the patient’s ...

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Can An Avulsed Permanent Incisor Be Immediately Replanted?

This Urgent Care Scenario (USC) is presented by the JCDA Oasis Team in collaboration with Dr. Mike Casas from the Department of Pediatric Dentistry at the University of Toronto. It is also available through JCDA Oasis Mobile The immediate replantation of an avulsed permanent incisor is to be performed on suitable avulsed incisors with extra-alveolar time of less than 5 minutes (to avoid reduced predictability of periodontal healing). Dentists who have the occasion of performing immediate replantation likely witnessed the traumatic injury or arrived at the scene immediately after the injury that produced the avulsion. Presentation Missing incisor tooth after ...

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How Do I Manage Oroantral Communication? Key Points

This Urgent Care Scenario (USC) is presented by the JCDA Oasis Team in collaboration with Dr. Archie Morrison and is also available through the JCDA Oasis Mobile Oroantral Communication (Oroantral Fistula) Oroantral Communication (OAC) is an abnormal communication between the maxillary sinus and the oral cavity. It may be the result of different pathological processes and often occurs following an extraction. Other causes for OAC include: infection, inflammatory conditions, neoplasm, Paget’s disease, iatrogenic injury, and trauma.  Presentation Population Individuals who recently underwent maxillary posterior tooth extractions. Individuals presenting for extraction of a long-standing lone posterior maxillary molar. Individuals presenting with ...

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How safe is gingivectomy in the disto-lingual area without the risk of traumatising/severing the lingual nerve?

This question was submitted by a general dentist: 15-year old patient with partially erupted 37, 47. Deep pockets 6 mm, small residual pericoronal flap and slight inflammation. How safe is it to do gingivectomy (laser/electrocautery) in this disto-lingual area without the risk of traumatising/severing the lingual nerve? Dr. Gordon Schwartz from GumDocs provided this quick initial answer:  1. Evaluate the position of the wisdom teeth as that might be the underlying cause. 2. Make sure to stay in the area of keratinized tissue. 3. As long as one stays towards the occlusal, it should be safe. 4. Our experience is primarily with scalpels (we ...

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How Do I Manage A Patient Who Is On Anticoagulants?

We are very pleased to present this series of videos by Dr. Mark Donaldson, Director of Pharmacy Services at the Kalispell Regional Medical Center and faculty member at the University of Montana and the Oregon Health & Sciences University There is no such thing as medical clearance. In fact, the dentist retains the primary responsibility for the procedures carried out for the immediate management of many untoward complications. While it is always prudent to get a consult with a medical practitioner, such as the patient’s primary prescriber or cardiologist, at the end of the day, the onus is on the dentist ...

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Do You Know Your Ibuprofen?

 This Prescription Drug Consult is presented by the JCDA Oasis Team. It is also available in JCDA Oasis Mobile Ibuprofen  Addaprin [OTC]; Advil® [OTC]; Caldolor®; I-Prin [OTC]; Ibu®; Midol® Cramps & Body Aches [OTC]; Motrin® Infants’ [OTC]; NeoProfen Presentation Ibuprofen is a Non-Steroidal Anti-Inflammatory Drug (NSAID) which could be administered orally and through I.V. Ibuprofen is prescribed for inflammatory diseases, analgesia, dysmenorrhea, and as an antipyretic. Dosage Analgesic Children: < 4-10 mg/kg/dose every 6-8 hrs. Adults: 200-400 mg/dose every 4-6 hrs (maximum daily dose: 1.2 g, unless directed by physician). Analgesic, antipyretic: (Consult physician if treatment for > 10 days is required) Children 6 months to 11 years: Use of weight to select ...

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How Effective Is the Neuromuscular Occlusion Approach in diagnosing and treating TMD?

This summary is based on the Rapid Response Report developed by the Canadian Agency for Drugs and Technologies in Health:  Neuromuscular Occlusion Concept-based Diagnosis and Treatment of Tempromandibular Joint Disorders: A Review of the Clinical Evidence  Full Report (PDF) Key Messages Diagnosing TMD: The use of electromyograms (EMG) is not supported by evidence. There is insufficient evidence to determine the diagnostic value of kinesiography. Treating TMD: Electrical stimulation is not supported by evidence. The efficacy of occlusal splints is uncertain. Context Temporomandibular disorder (TMD) is a group of clinical problems involving the chewing muscles, the temporomandibular joint (TMJ), and related structures. Symptoms may ...

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How Can I Treat A Patient With Previous Myocardial Infarction (MI)?

This medical Condition Consult is presented by the JCDA Oasis Team. The consult is also available through the JCDA Oasis Mobile Myocardial infarction (MI) is a consequence of obstruction in the coronary artery blood supply to the heart, resulting in death of the myocardium. Predisposing risk factors include atherosclerosis (thickening of arterial wall caused by the accumulation of lipid plaques), obesity, smoking, hyperlipidemia, family history of MI, and undue stress.   LA/Vasoconstrictors Drug Interactions Use vasoconstrictors with caution, due to increased risk for adverse outcomes1. Increased risk of cardiac arrhythmias in patients taking digitalis (e.g., digoxin).2. Increased risk of a ...

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