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Medically Compromised Patients

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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From the trenches: Why use a blood pressure cuff?

This case was submitted by Dr. Ron Kellen Four months ago, I had a walk-in emergency, male patient, age 32, suffering from a “terrible toothache.” His medical questionnaire was clean except for “a bit of blood pressure, but no problem and no medications.” He was husky, maybe 10 pounds overweight, clearly in fear of the ‘dentist experience.’ He pointed to tooth 13, very carious and fractured off at mid crown. The patient indicated that it hurt a lot at the top of the tooth and that he wanted to extract the tooth. Upon examination, I could see other obvious decay ...

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Managing a patient with HIV

This summary is an adaptation of the e-Therapeutics Evaluation published by the Canadian Pharmacists Association (CPhA): Infectious Diseases: HIV Infection Investigations Clinical History Risk behaviours, social support and need for counselling Establish date of infection, if possible, based on a review of past sexual contacts, period of needle sharing, receipt of blood or blood products, availability of a previous negative test or a history of possible seroconversion illness (e.g., mononucleosis-like or severe flu-like illness) shortly after a high-risk exposure General indicators: anorexia, weight loss, fatigue or malaise, lymphadenopathy Symptoms of opportunistic infections, e.g., fever, night sweats, cough, dyspnea, diarrhea, headache ...

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From the trenches: How to “dodge the bullet” and make the right diagnosis?

This case was submitted by Dr. Ron Kellen  This situation occurred about 20 years ago. My office was in a plaza, on the second floor, requiring 26 steps to access it, with no elevator. At about 2 PM on a weekday, a 60-year-old male patient presented in our office as an emergency case with a terrible toothache. He pointed to his broken 35. On his medical questionnaire, he indicated that he had a little bit of high blood pressure and that he sometimes would get out of breath. He was taking medication once a day for blood pressure, but he ...

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