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Medically Compromised Patients

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What are the dental considerations for treating patients suffering from acute adrenal insufficiency?

  Cortisol, a glucocorticoid produced by adrenal cortex is essential for the human body to survive in stressful situations. The deficiency of cortisol in the human body leads to adrenal insufficiency which in turn can compromise the individual’s ability to adapt to a stressful situation, such as a dental appointment. Adrenal insufficiency can manifest as loss of consciousness, a decrease in peripheral vascular resistance, shock, and ventricular asystole leading to death. Based on the underlying pathophysiology, adrenal insufficiency can be classified as primary adrenal insufficiency (Addison’s disease) due to autoimmune adrenalitis, and secondary adrenal insufficiency due to disuse atrophy of ...

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What precautions do I need to take with patients suffering from heart failure or acute pulmonary edema?

  Heart failure is described as the inability of the heart to fill and eject the blood or supply the proper amount of oxygenated blood to meet the metabolic needs of the body. Normal heart functioning is influenced by three basic factors: preload, afterload, and contractility of heart muscles. Preload is basically an end diastolic volume and a decrease in preload will decrease the amount of stroke volume ejected. On the other hand, afterload is defined as resistance to left ventricular ejection. The third factor, contractility, is the inherent property of heart muscle and is regulated by the sympathetic nervous ...

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Dr. Aviv Ouanounou: How important is polypharmacy in the elderly population?

Dr. Aviv Ouanounou discusses the topic of polypharmacy including the causes and ways to reduce this phenomenon in the video below. Video Highlights Polypharmacy is fairly common in the elderly, affecting approximately 1 in 3 elders and is one of the leading causes of death in North American geriatric patients. The term polypharmacy refers to patients who take more than 9 medications than are clinically warranted. As patients take more medications, they incur a corresponding cost increase, a higher probability of prescription errors given the multiple medications, as well as an increased incidence of drug interactions and adverse drug reactions. Polypharmacy can lead ...

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CDA Oasis Conversations: Managing adverse drug reactions in the elderly

Dr. Aviv Ouanounou speaks with Dr. Suham Alexander about adverse drug reactions and their management in the elderly population. Interview Highlights Adverse drug reactions are undesired or unexpected effects which occur in patients at therapeutic dosages. These differ from side-effects of medications which are known ahead of time through clinical trials and have been detailed in drug monographs. Causes of adverse drug reactions Use of multiple medications (polypharmacy). Many medications are not trialed in the elderly therefore, there is no information about reactions or side-effects that may occur in this population. Altered physiology, metabolism and pharmacokinetics in the elderly. Common Adverse ...

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Hepatitis B

What are the guidelines for the management of occupational exposure to hepatitis B virus?

Hepatitis B is an inflammatory disease of the liver caused by Hepatitis B viral infections (HBV). The risk for transmission of HBV is well recognized after exposure to infected blood or body fluids. The most common modes of HBV transmission in a dental office include needle stick injuries and other percutaneous injuries. Exposure prevention remains the key strategy to minimize occupational HBV infections; however, if the exposure occurs a proper post-exposure management is of the utmost importance. HBV Post Exposure Prophylaxis (PEP) recommendations are summarized below: PEP Recommendations If the status of the source person is Hepatitis B Surface Antigen ...

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Case Conference: Diagnosis and management of the white lesion with Dr. Aviv Ouanounou

Dr. Aviv Ouanounou from the University of Toronto comes back to present the diagnosis and management of the white lesion case that we presented in September on oasis Discussions.   View the initial case presentation            Watch the video presentation

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CDA Oasis Conversations: Dr. Archie Morrison speaks about the update to the systematic review on osteonecrosis of the jaw

In this short interview, Dr. Archie Morrison speaks about the update to the 2009 systematic review on osteonecrosis of the jaw.  List of authors and their affiliations (PDF) Highlights of the updated review Spontaneous resolution of ONJ is possible. Early treatment recommendations discouraged surgical intervention, with conservative therapy continuing indefinitely or until there was progression of disease. Others have had reasonable success with surgical management. There is still no comfortable proven treatment algorithm for the various stages of this disease. The International Task Force believes that surgical intervention is required for Stage 3 disease and for those Stage 2 patients that are ...

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Case Conference: How would you manage this case?

This case is presented by Dr. Aviv Ouanounou from the Faculty of Dentistry at the University of Toronto. Watch the Case Presentation   We welcome your input about this topic. You have the option to remain anonymous in leaving your feedback. Please note that all your comments are moderated by the CDA Oasis Team and no comments go live immediately. Your feedback is sent to us in the form of an email which is accessed by the CDA Oasis Team and is not shared by a third party. You can safely leave your name and email allowing us to contact you, ...

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