Home » Supporting Your Practice » Medicine » Medically Compromised Patients (page 14)

Medically Compromised Patients

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 ...

Read More »

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 ...

Read More »

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 ...

Read More »

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 ...

Read More »

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), ...

Read More »

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 ...

Read More »

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 ...

Read More »

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 ...

Read More »