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Medically Compromised Patients

The Bidirectional Relationship between Periodontitis and Diabetes: How Should Patients Affected by Either or Both These Diseases be Managed?

This summary is based on a series of articles published in the Journal of Clinical Periodontology (2013, 40 Supplement 14)

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How do you manage a child patient with an acute asthma exacerbation?

This post is based on the Canadian Medical Association guidelines for managing the paediatric patient with an acute asthma exacerbation Source: CMA Infobase: Clinical Practice Guidelines Database (CPGs) Access the resource in PDF Context Children with acute asthma exacerbations frequently present to an emergency department with signs of respiratory distress. The most severe episodes are potentially life-threatening. Effective treatment depends on the accurate and rapid assessment of disease severity at presentation. This statement addresses the assessment, management and disposition of pediatric patients with a known diagnosis of asthma who present with an acute asthma exacerbation, especially preschoolers at high risk for persistent asthma. Guidance includes the assessment of asthma severity, ...

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Your Opinion: How would you treat this case?

This case is presented by Dr. Neel Joshi I have a 17-year old female patient who has had viral gastroparesis for the past 4 years.  It’s a chronic condition that causes her to vomit and/or have stomach acids reflux in her mouth multiple times throughout the day. I don’t believe there is an associated eating disorder – she was diagnosed at Sick Kids Hospital. Her teeth have slowly eroded over time – not yet into the pulp or shortened, but I wish there was something I could suggest.  I have made custom Fluoride trays with neutral Fluoride and also have her ...

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What are the pathologic bone alterations in celiac disease?

This summary is basedon the article published in Nutrition: Pathologic bone alterations in celiac disease: Etiology, epidemiology, and treatment (January 2014, Supplement) Context  Low bone mineral density (BMD), osteopenia, and osteoporosis are frequent complications of celiac disease (CD). The etiology of pathologic bone alterations in CD is multifactorial; however, two main mechanisms are involved: intestinal malabsorption and chronic inflammation. A strict gluten-free diet (GFD) is thought to be the only effective treatment for CD; but treating bone complications related to CD remains complex. Purpose of the Review The review attempts to elucidate the bones problems related to CD and to increase awareness of osteoporosis development, considered ...

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What is calcium channel blocker-induced gingival enlargement?

This summary is based on the article published in the Journal of Human Hypertension: Calcium channel blocker-induced gingival enlargement (June 2013) Context Despite the popularity and wide acceptance of the calcium channel blockers (CCBs) by the medical community, their oral impact is rarely recognized or discussed. CCBs, as a group, have been frequently implicated as an etiologic factor for a common oral condition seen among patients seeking dental care: drug-induced gingival enlargement or overgrowth. This enlargement can be localized or generalized, and can range from mild to extremely severe, affecting patient’s appearance and function. Treatment options for these patients include cessation of the offending drug ...

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Are there any approaches to caries prevention and therapy for the elderly?

This summary is based on the article published in Advances in Dental Research: Approaches to Caries Prevention and Therapy in the Elderly (September 2013) Context The population of the world is aging. A greater proportion of older people are retaining increasing numbers of natural teeth. Aging is associated with changes in oral architecture and muscle weakness, making personal oral hygiene more difficult, particularly for the oldest and most frail individuals. Furthermore, there is exposure of root dentin with its higher pH for demineralization in addition to enamel as a substrate for caries. Aging is also associated, for many in the developed world, with taking multiple medications, with the associated ...

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How efficient are Toluidine Blue and Brush Biopsy in diagnosing oral lesions?

This summary is based on the article published in the International Journal of Oral and Maxillofacial Pathology: Efficacy of Toluidine Blue and Brush Biopsy in Oral Lesions (January 2013) Context Oral cancer is a global health problem and its early detection is of prime importance. In vivo stains and brush biopsy have emerged in recent years to aid as clinical diagnostic tools.  Purpose of the Study The study assessed the efficacy and accuracy of Toluidine blue and brush biopsy in comparison to wedge biopsy in patients with oral pre-malignancies and malignant lesions.  Key Messages The combined evaluation of Toluidine blue ...

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Why must you know about your patients’ pharmacological history?

By Drs. Jacob Fitzgerald, Joel Epstein, Mark Donaldson, Karen Fung, Gordon Schwartz, Cameron Jones Classes of medications reported by patients (PDF) There are many reasons why we need to be aware of the medications that our patients are taking. We need to make sure that there are no adverse reactions to these medications with the treatments or drugs that we prescribe. Additionally, we need to have an understanding of the effects these medications on the oral environment. Importantly, knowing exactly what a patient takes can also provide insight into their medical conditions. Some medications have oral side effects upon saliva, mucosa ...

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