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Medically Compromised Patients

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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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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Acetaminophen: a new foe?

This summary is based on the article published in the Journal of Endodontics: Acetaminophen: Old Drug, New Issues (May 2015) Anita Aminoshariae, DDS, MS, and Asma Khan, BDS, PhD Context The Food and Drug Administration (FDA) Drug Safety Communication states that ‘‘acetaminophen-containing prescription products are safe and effective when used as directed, though all medications carry some risks’’ (2). During the past decade, acetaminophen has been identified as the leading cause of acute liver failure in the United States, and up to 50% of the cases are caused by an unintentional overdose (3–6). In 2011, confirming acetaminophen as a dose-dependent ...

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Should vasoconstrictors be avoided in any patients with cardiovascular disease?

In patients at major risk of developing perioperative cardiovascular complications, vasoconstrictors should be used only in consultation with the patient’s physician who may recommend that vasoconstrictors be avoided. This high-risk category includes the following conditions: Acute or recent MI (between 7 to 30 days prior); Decompensated heart failure; and Significant arrhythmias (e.g., AV block, ventricular-related arrhythmia). Some studies have shown that very modest quantities of a vasoconstrictor are safe in these high-risk patients when accompanied by oxygen, sedation, nitroglycerin, and adequate pain control.   Source: Dental Secrets, Elsevier, 2015

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Is it safe to treat a patient who has undergone heart transplantation in an outpatient dental office?

Elective dental treatment should be avoided during the first 3 months after heart transplantation. During this period, various systemic complications and infections are common because the patient is receiving an intensive course of immunosuppressive medications. Emergency dental treatment can be provided in consultation with the patient’s physician. If treatment is required during these first 3 months, antibiotic prophylaxis should be administered. Emergency dental treatment should be completed only after consultation with the patient’s cardiologist. In the stable post-transplantation period (usually after 3 months, but the timing is determined in consultation with the physician), heart transplant patients can receive elective dental treatment. The use of prophylactic antibiotics during ...

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