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Medically Compromised Patients

Which are safe drugs for patients suffering from renal failure?

This information is courtesy of Dr. Mark Donaldson Dr. Mark Donaldson is Director of Pharmaceutical Services at the Kalispell Regional Medical Center,  Clinical Professor in the Department of Pharmacy at the University of Montana, and Clinical Associate Professor in the School of Dentistry at the Oregon Health and Sciences University Safe Drugs in Renal Failure (PDF)   Do you have any particular question on this topic? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca You are invited to comment on this post and provide further insights by posting in the comment box which you will find by clicking on ...

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How do you treat an oral infection in a patient with a history of C. Difficile?

This question was submitted by a general dentist: A patient presents with an oral infection for which I would like to consider antibiotics as part of overall care. However, she has a history of C.Difficile infection and there is concern that the antibiotic chosen might reactivate the residual C.Difficile in her gut. What is the best course of action in treating the oral infection? Dr. Dan Haas, DDS, PhD, FRCD(C) Professor and Dean, Arthur Zwingenberger Decanal Chair, Faculty of Dentistry at the University of Toronto Dr. Dan Haas provided the following quick and initial response:  A recent history of Clostridium Difficile-associated colitis ...

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Are local anesthetics still controversial for patients taking oral anticoagulants?

This summary is based on the article published in the British Journal of Oral and Maxillofacial Surgery: Safety of local anaesthesia in dental patients taking oral anticoagulants: is it still controversial? (January 2012) Purpose of the Study To investigate the safety of local infiltration techniques and the inferior alveolar nerve block (IANB) in dental patients taking oral anticoagulants. Main Findings Bleeding as a result of the use of local anaesthesia in patients with therapeutic INR is unlikely, provided that the IANB is done correctly. IANB in patients with INR within therapeutic range is safe. Haemorrhagic complications after local anaesthesia, including the IANB (possibly even other nerve blocks), ...

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Can addictive behaviour be altered? The concept of drug-evoked synaptic plasticity

This summary is based on the article published in the Journal of Neuroscience: Drug-Evoked Synaptic Plasticity Causing Addictive Behavior (November 2013) Context The core element of the addiction process: an initially neutral stimulus becomes attractive when associated with drug consumption, and even after prolonged periods of abstinence this cue may trigger craving and cause the subject to relapse. Therefore, many researchers have argued that the secret to understanding addiction lies in the elucidation of the “memory trace” that links the cue to the compulsive drug use. The implicit underlying hypothesis is that addictive drugs generate an inappropriate learning signal that leads to the encoding of a unique trace, which, when reactivated, has ...

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How can dentists prevent the abuse of prescription opioids?

This summary is based on the article published in the Journal of the American Dental Association: Prevention of prescription opioid abuse: the role of the dentist (July 2011) Full-text article (PDF) Context  Opioids are analgesics that have potential for misuse, abuse or addiction. Up to an estimated 23 percent of prescribed doses are used non-medically. As prescribers of 12 percent of immediate-release (IR) opioids in the United States, dentists can minimize the potential for misuse or abuse. The authors participated in a two-day meeting in March 2010 co-hosted by Tufts Health Care Institute Program on Opioid Risk Management, Boston, and Tufts University School of Dental Medicine, Boston. The ...

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How do you manage a severely disabled and G tube-fed patient?

This question was submitted by a general dentist: Is there a resource with current information on appropriate oral care for severely disabled and G tube-fed population? There are many position papers and guidelines indicating that this population needs care. However, I found only limited information on the actual clinical treatment provided to them and on what the treatment goals should be. These patients often present with gross calculus, limited cooperative ability for professional cleaning, and present with the risk of an aspiration pneumonia. Any attempt to clean the teeth in the office is limited at best, then the question is: what ...

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How accurate, clinically effective, and cost-effective are light-based screening techniques for the early detection of oral cancer?

By Lieutenant-Colonel Jean Pierre Picard Lieutenant-Colonel Jean-Pierre Picard is a Periodontist of the Canadian Armed Forces. He is currently the Deputy Commanding Officer of 1 Dental Unit and the Royal Canadian Dental Corps Periodontics Practice Leader. Lieutenant-Colonel Picard is also an examiner for the National Dental Specialty Examination in Periodontics of the Royal College of Dentists of Canada, the Treasurer of the Canadian Academy of Periodontology (CAP), and the CAP representative to the Canadian Dental Specialties Association. Dentists are, by way of formal education and expertise, the health care providers best equipped to detect abnormalities of the oral cavity and ...

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What are the guidelines for bisphosphonate associated osteonecrosis of the jaw? Canadian Consensus Practice

This summary is based on the the guidelines published by the Canadian Medical Association (CMA): Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw (July 2008) Access the article in PDF More information is also available on BRONJ on Oasis Help Medical Condition BRONJ Urgent Care Scenario BRONJ Context Following publication of the first reports of osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates in 2003, a call for national multidisciplinary guidelines based upon a systematic review of the current evidence was made by the Canadian Association of Oral and Maxillofacial Surgeons (CAOMS) in association with national and international societies concerned with ONJ. ...

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