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Medically Compromised Patients

What are some of the immunological diseases encountered in dental practice?

This summary is based on the article published in the British Dental Journal: General medicine and surgery for dental practitioners: part 5. Immunological disease and dental practice (August 2014) M. Greenwood, J. G. Meechan and C. Stroud   Context At some stage in clinical practice all dental practitioners will encounter patients with disorders of the immune system. It is therefore important that dental practitioners are aware of the potential implications for safe practice. Purpose of the Paper Provides an overview of clinical immunology and how it interfaces with dentistry. Highlights signs of possible immunodeficiency. Discusses oral conditions that may be ...

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Diagnosis and Treatment of the BRONJ Case

Revisit the Case Presentation and Clinical Evaluation This case is presented by:  Dr. Eric T. Stoopler, D.M.D., FDS RCSEd, FDS RCSEng Dr. Juan M. Bugueno, D.D.S. Dr. Kevin Sweeney, D.D.S. Dr. David C. Stanton, D.M.D., M.D., F.A.C.S  We would like to thank all our dentists who submitted their responses to the diagnosis and treatment challenge. Case Diagnosis The Clinical diagnosis was bisphosphonate-related osteonecrosis of the maxilla. Treatment The patient’s oncologist discontinued the ZA therapy. The patient was evaluated by an oral and maxillofacial surgeon who recommended surgical debridement of the affected areas and the patient underwent the procedure five months after cessation ...

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What are the immediate and long-term considerations for the GP dentist providing dental care to children who have undergone cancer therapy or bone marrow transplantation?”

This question was submitted by a general dentist: What are the immediate and long term considerations for the GP dentist providing dental care to children who have undergone cancer therapy or bone marrow transplantation?” Dr. Carol Janik and Caroline Fulop provided this initial response.  The focus of this article is to provide practitioners with guidance on the clinical considerations for pediatric patients who have undergone cancer therapy or bone marrow transplantation. For more information on patients who have been diagnosed and are planned to initiate treatment or those patients currently undergoing therapy please consider referral to a hospital pediatric dentist and ...

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What’s your diagnosis of this case?

This case is presented by:  Dr. Eric T. Stoopler, D.M.D., FDS RCSEd, FDS RCSEng Dr. Juan M. Bugueno, D.D.S. Dr. Kevin Sweeney, D.D.S. Dr. David C. Stanton, D.M.D., M.D., F.A.C.S  Click here to view the BRONJ Case Diagnosis and Treatment Case Presentation A 64-year-old Caucasian female presented for evaluation of symptomatic exposed bone of a two-year duration post extraction of maxillary teeth with immediate placement of four dental implants. Medical history: Is at stage IV breast adenocarcinoma treated with surgery and trastuzumab. Received intravenous zoledronic acid (ZA) 4 mg monthly for approximately two years for metastatic bone disease. Underwent dental surgery ...

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“Failure to Erupt Syndrome”: Myth or Reality?

This question was submitted by a general dentist: Three siblings have been diagnosed with “failure to erupt syndrome.” The oldest had removal surgery and implants. How rare is this syndrome and how common for all three to have it?  Dr. Ian McConnachie, pediatric dentist at Woodroffe Pediatric Dentistry, provided the following initial and quick response. I am unaware of any condition called “Failure to Erupt Syndrome.” There is a small list of conditions where one finds a failure of at least several teeth to erupt. The one we all remember from our dental student days is cleidocranial dysplasia and the slide of ...

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How would you treat this case?

This case was submitted by a team of dental faculty members in the Oral Medicine and Pathology departments of the University of Pennsylvania School of Dental Medicine.  Alicia M. Houston, D.D.S. (Resident – Department of Oral Medicine) Faizan Alawi, D.D.S. (Associate Professor of Pathology – Department of Pathology) Eric T. Stoopler, D.M.D., FDS, RCSEd, FDS RCSEng  (Associate Professor of Oral Medicine) Case was edited by Dr. Suham Alexander, Oasis Clinical Editor  Case Presentation Findings Extraoral – NSF Intraoral – 2x2cm ulceration at R posterior lateral border of the tongue with indurated borders No herpes simplex virus found in direct fluorescent ...

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What are the effects of radiotherapy on dental hard tissue?

This summary is based on the article published in the journal of Clinical Oral Investigation: The effect of radiotherapy on dental hard tissue. A systematic review (January 2014) H. F. J. Lieshout & C. P. Bots Context Decay of teeth, erosion and disintegration of hard dental tissue are clinically often seen side effects after radiotherapy for tumours in the head and neck region. Purpose of the Review To investigate if these side effects are due to structural changes in dental hard tissues, the current literature was searched. It can influence the quality of life gravely. Results Tooth destruction occurs often and soon after irradiation. There ...

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What is the epidemiology of oral health conditions in older people?

This summary is based on the article published in Gerodontology: Epidemiology of oral health conditions in older people (February 2014) William Murray Thomson Context The main conditions of interest when considering the epidemiology of oral diseases among older people are tooth loss, dental caries, periodontitis, dry mouth and oral pre-cancer/cancer, along with oralhealth-related quality of life (OHRQoL). Purpose of the Article This article presents an overview of what is known about the epidemiology of each of the main conditions of interest among older populations. Key Points Although complete tooth loss is declining, incremental tooth loss continues and is an important determinant of poor OHRQoL. Dental ...

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