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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. ...

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Tips on assessing patients with orofacial pain and temporomandibular disorders

This summary is based on the article published in the Dental Clinics of North America: Clinical assessment of patients with orofacial pain and temporomandibular disorders (October 2013) Key points Accurate diagnosis of chronic pain disorders of the mouth, jaws, and face is frequently complex because there are multiple structures localized in 1 small anatomic region that can be a source of painful sensations. Pain can originate from multiple structures including teeth, sinus, eye, nerves, blood vessels, temporomandibular joint, and masticatory muscle sources.  It is common for patients with chronic orofacial pain to consult multiple clinicians and receive an incorrect diagnosis and receive ineffective treatment ...

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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 ...

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Deep Coma and Dentistry: Could a Montreal Researcher’s Finding Help Save Lives?

Dr. Florin Amzica of the University of Montreal faculty of dentistry recently published in PLoS ONE an article on never before reported cerebral activity in people with a flat electroencephalogram (EGG). Dr. Amzica is an associate professor and the head of the laboratory on sleep neurophysiology and altered state of consciousness at the University of Montreal. His research interests include the understanding and management of dentistry-related sleep disorders. The JCDA Oasis team spoke with Dr. Amzica to find out more about his groundbreaking finding. Here are the study key points. Research highlights Brain activity extends beyond deep coma associated with ...

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What are the drug therapies for patients with bipolar disorders?

This summary is based on the guidelines published by the Canadian Medical Association (CMA): Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013 (February 2013) Access the article (PDF) The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications. The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, ...

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Refresher: Why use Analgesics?

This summary is based on the Clinical Info provided by the Canadian Pharmacists Association: Drugs in Dentistry (December 2012) By Dr. Dan Haas, DDS, PhD, FRCDC Consider the following points in the use of analgesics: Eliminate the source of pain, if possible. Individualize regimens. Optimize dose and frequency before switching. Maximize the nonopioid before adding the opioid. Consider a loading dose and/or a preoperative dose for nonsteroidal anti-inflammatory drugs (NSAIDs). Avoid chronic use of any analgesic. Reduce the dose in older individuals. Be aware of the contraindications and cautions for NSAIDs, including ASA (see also individual product monographs and CPhA monographs as ...

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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 ...

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What are some of the clinical approaches to oral mucosal disorders?

This summary is based on the Preface article published in the Dental Clinics of North America: Clinical Approaches to Oral Mucosal Disorders (October 2013) Dr. P. Sollicito, DMD, FDS, RCSEd Dr. Eric Stoopler, DMD, FDS, RCSEd Oral health and disease are intimately related to general health status. Clinicians understand that the oral cavity does not exist in isolation, but as an integral component of the human body. The oral cavity and peri-oral region consist of various tissues that are not unlike other organ systems, including mucous membranes, nerves, ligaments, and bone. The oral cavity is perhaps more intricate than other areas because, in addition ...

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