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Medically Compromised Patients

How do you treat a patient with scleroderma who has periodontal issues – advanced recession, stripping of the attached gingiva from the roots?

This question was submitted by a general dentist: How do you treat a patient with scleroderma who has periodontal issues – advanced recession, stripping of the attached gingiva from the roots? Dr. George Sandor, DDS MD and Dr. Suham Alexander, Oasis Clinical Editor provided this initial response.      Systemic Scleroderma  Systemic scleroderma is a relatively rare condition that affects ~19/1,000,000 adults annually. Women experience the condition 3 times more than men. A vasoconstrictive event known as Raynaud’s phenomenon is often one of the first signs of the disease which is precipitated by emotional distress or exposure to cold. (It should ...

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Is it safe to use vasoconstrictors in patients with sickle-cell disease?

This question was submitted by a general dentist: Is it safe to use vasoconstrictors in patients with sickle-cell disease? Which one is the best choice? Could I perform a painless dental extraction without vasoconstrictors in these cases? Dr. George Sandor, DDS MD and Dr. Suham Alexander, Oasis Clinical Editor provided this initial response. Sickle Cell Anemia  Sickle cell anemia is a genetic disorder of hemoglobin synthesis occurring predominantly in African, Mediterranean and Asian populations. Affected individuals with carrying one allele have the sickle cell trait and may experience some sickling with exercise or in high altitudes due to lower oxygen tensions. ...

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Are there recommended guidelines for reducing the incidence of shingles in a patient that has a history of developing shingles after dental care?

This question was submitted by a general dentist: Are there recommended guidelines for reducing the incidence of shingles in a patient that has a history of developing shingles after dental care? Dr. George Sandor, DDS MD and Dr. Suham Alexander, Oasis Clinical Editor provided this initial response.  Shingles (herpes zoster) is the reactivation of the chicken pox virus (varicella zoster) which typically establishes dormancy in dorsal root or cranial nerve ganglia during childhood. Reactivation usually occurs later in life mainly affecting thoracic and lumbar dermatomes; however, a small proportion of patients present with trigeminal nerve involvement. Herpes zoster may occur spontaneously ...

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How effective are non-pharmacological interventions in the relief of dry mouth?

This summary is based on the review published in the Cochrane database of systematic reviews: Interventions for the management of dry mouth: non-pharmacological interventions (September 2013) Furness S, Bryan G, McMillan R, Birchenough S, Worthington HV     Context Xerostomia is the subjective sensation of dry mouth. Common causes of xerostomia include adverse effects of many commonly prescribed medications, disease (e.g. Sjogren’s Syndrome) and radiotherapy treatment for head and neck cancers. Non-pharmacological techniques such as acupuncture or mild electrostimulation may be used to improve symptoms. Purpose of the Review To assess the effects of non-pharmacological interventions administered to stimulate saliva ...

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Dealing with the most frequent medical emergencies in the dental office

This summary is based on the article published in the British Dental Journal: General medicine and surgery for dental practitioners: part 3. Management of specific medical emergencies in dental practice (August 2014) M. Greenwood and J. G. Meechan Note: The article could contain medication that is not similarly labelled in Canada.      Purpose of the Article The actions needed to manage specific medical emergencies are discussed. Each emergency requires a correct diagnosis to be made for effective and safe management. Contemporar The article: Discusses treatment for specific emergencies and where appropriate the drugs used. Recognises signs and symptoms of relevant ...

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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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