Home » Supporting Your Practice » Medicine » Medically Compromised Patients (page 15)

Medically Compromised Patients

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 ...

Read More »

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. ...

Read More »

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 ...

Read More »

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 ...

Read More »

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 ...

Read More »

Managing severe Alzheimer disease: what are the evidence-based guidelines?

This summary is based on the guidelines published by the Canadian Medical Association (CMA): Diagnosis and treatment of dementia: 6. Management of severe Alzheimer disease. The article was retrieved from the CMA Infobase: Clinical Practice Guidelines Database (CPGs) Access the article here (PDF) Context The management of severe Alzheimer disease often presents difficult choices for clinicians and families. The disease is characterized by a need for full-time care and assistance with basic activities of daily living. The authors outline an evidence-based approach for these choices based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. The authors developed evidence-based guidelines using systematic literature searches, ...

Read More »

How do I protect my patient medically, while safely providing the required treatment?

This case was submitted by Dr. Ron Kellen  Case Details Male patient, 55.  Diagnosed with AIDS in 2/2013 – at which time, CD4 count was 50. Now he says his CD4 count is 200. On Methadone (on-off for 10 years now). Ex heroin IV, and oxycontin, Percocet, etc. narcotics. On anti-convulsive for grand mal seizures. No more seizures since started medications. Smokes medical marijuana to increase his appetite. He is very underweight. On effective AIDS cocktail since Feb, 2013  Just finished thrush treatment of Nystatin swish & swallow (from G.P., not AIDS MD).  Still remnants clearly visible He has only ...

Read More »

How would you treat a patient with neuropathic orofacial pain?

This summary is based on the article published in the Journal of the American Dental Association: Dental treatment for patients with neuropathic orofacial pain (September 2013) Clinical Case A 56-year-old woman visited a dental office with acute dental pain in the left mandibular molar area. The treating dentist established a diagnosis of trigeminal neuralgia (TN) related to the left V3 branch, for which the patient was treated with nerve membrane–stabilizing anticonvulsants. The patient’s medical history included mild hypertension, hypothyroidism and intermittent low back pain for which she was being treated adequately by her physician.  The clinical examination revealed the left mandibular permanent first molar (tooth ...

Read More »