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Medically Compromised Patients

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Local Anesthetics for the Patient Suffering from Methemoglobinemia

Dr. Joonyoung Ji speaks with Dr. John O’Keefe about the risks of administering local anesthetics to patients suffering from methemoglobinemia. Highlights Scenario A patient has a scope performed in a hospital setting and benzocaine was used to numb the area before inserting the scope. Subsequently, the patient developed methemoglobinemia. The patient’s physician has now advised that all “-caine-type” anesthetics must be avoided in this patient for all dental work. Management Context is important to determine why a scope was performed and how the situation that developed was managed. Often, in medical settings the amounts of local anesthetics that are used ...

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A Primer on Maxillary Defects

Dr. John O’Keefe spoke with Dr. Angela Wong and Dr. Ruth Aponte Wesson, maxillofacial prosthodontists, about maxillary defects. Dr. Angela Wong, DMD, MS, FRCD(C) is a Maxillofacial Prosthodontist currently in private practice in Calgary, Alberta. Dr. Ruth Aponte Wesson, DDS, MS, FACP is a Maxillofacial Prosthodontist and Associate Professor at the University of Texas MD Anderson Cancer Center. Highlights Etiology Maxillary defects can present at birth as with cleft lip and palate or they can be acquired during life. Most acquired maxillary defects are caused by cancer, other causes include infection, trauma or other diseases. Oral cancer makes up about 3% ...

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CE Showcase: Dementia – Best Clinical Practices for Health Care Professionals

Ms. Yvonne Poulin, Registered Massage Therapist and Elder Planning Counsellor, spoke with Dr. Chiraz Guessaier about the course she is offering to dental teams about dementia and its relevance to dentistry. The course is titled: Best clinical practices for health care professionals. To contact Yvonne, please email her at: info@dementiacareexpert.com Course website: courses.dementiacareexpert.com Review the Course Syllabus    

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Dentistry and Geriatrics in Ireland

Dr. John O’Keefe spoke with Dr. Anne Twomey, past President of the Irish Dental Association and who recently addressed the Irish Gerontologist’s Society. The society is composed of consultant geriatricians who are strong advocates for multidisciplinary team approaches in caring for patients; however, no dentist had spoken to this organization to date. As such, Dr. Twomey shared her experiences and insights gained from her practice with their members. Highlights Better outcomes for patients can be expected, if dentists are included in patient care early in their overall care plan. Preventive care is very important for elderly patients. There are several ...

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What are some of the implant complications associated with systemic disorders and medications?

This summary is based on information found in Dental Implant Complications: Etiology, Prevention, and Treatment, 2 (Wiley Publishing, 2015) Key messages Patient selection is the critical factor for implant success and survival in any medically complex situation. When medical conditions are managed wisely, most patients have improved overall health with fixed replacements as opposed to removable appliances. Exceptional care must be taken so that any implants placed will be successful and safe for the clinician and the patient. It is essential to routinely review the literature and expect that protocols for patients with systemic diseases or taking medications will be regularly updated as our knowledge of dental implants advances.   Although ...

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Depression and Anti-Depressants with Dr. Aviv Ouanounou

Dr. Aviv Ouanounou comes back to speak about depression and anti-depressant medication and the main considerations in treating patients who are taking anti-depressants. Highlights  Depression is a common disease that affects the elderly and is the 4th highest cause of disability worldwide. The disease can affect not only the individual diagnosed with depression but, also his/her family and friends. Genetics, biochemical imbalances, stress, personality type, certain medications as well previous depressive episodes can predispose one to depression. Signs and symptoms vary from one individual to another but include suicidal thoughts, sadness, low self-esteem, disturbed sleep patterns and irritability. Types of ...

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Treating Patients with Thyroid Disease

Dr. Aviv Ouanounou comes back to speak about how to manage patients who suffer from thyroid disease.  Highlights Dr. Aviv Ouanounou discusses thyroid disease and its dental implications. The thyroid gland produces two important thyroid hormones, T4 (thyroxine) and T3 (triiodothyronine). The thyroid gland has many important functions including: metabolism, growth and development, cardiovascular effects (stroke volume, heart rate etc.), memory, growth and maturation of the epidermis and the central nervous system. Thyroid disease commonly presents as either hypothyroidism or hyperthyroidism and commonly affects women more often than men. Risk factors for thyroid disease include women aged 55+, obesity, radiation ...

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To stop or not to stop anticoagulants in patient prior to dental surgery?

Dr. Jose Lança, from the Faculty of Dentistry and the Faculty of Medicine at the University of Toronto, speaks with Dr. John O’Keefe about the important decisions dentists need to make when treating patients who are on anticoagulants and who need dental surgery: should they, or not, ask the patient to stop taking their anticoagulant medication? Highlights The monitoring of warfarin anticoagulation is aimed at conventional anticoagulation INR of 2.0-3.0 (normal INR:0.9-1.1). Intensive anticoagulation is defined as an INR of 2.5-3.5, and critical values of >4.5-5.0. Do not be quick in discontinuing oral anticoagulants just because the patient might experience ...

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