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Medicine

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 ...

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What is the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (CNCP)?

Canadian medical regulatory authorities undertook guideline development in response to: Physicians and other stakeholders seeking guidance regarding safe and effective use of opioids  A growing concern about opioid misuse creating patient and public safety issues, and  The lack of systematically developed national guidelines on opioid use for CNCP. Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain: Executive Summary and Background (PDF) Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain: Recommendations for Practice (PDF) Summary of the Recommendations Cluster 1: Deciding to Initiate Opioid Therapy R01 Before initiating opioid therapy, ensure comprehensive documentation of the patient’s pain ...

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Follow-up: Anti-infectives pediatric dosage

This is a follow-up post to the Refresher: Why use anti-infectives? A number of dentists inquired about the pediatric doses for the anti-infectives mentioned in the post. Sources of information: Lexicomp and e-Therapeutics.ca Amoxicillin Children ≤3 months: Oral: 20-30 mg/kg/day divided every 12 hours Children >3 months and <40 kg: Oral: 20-100 mg/kg/day in divided doses every 8-12 hours Children >3 months and ≥40 kg: Refer to adult dosing. Children ≥12 years: Oral: Extended-release tablet: 775 mg once daily Amoxicillin and Clavulanate Susceptible infections: Infants <3 months: Oral: 30 mg/kg/day divided every 12 hours using the 125 mg/5 mL suspension Mild-to-moderate ...

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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 ...

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Primary failure of tooth eruption: what is the etiology, diagnosis, and treatment?

This summary is based on the article published in the Dental and Medical Problems journal: Primary Failure of Tooth Eruption – Etiology, Diagnosis and Treatment (Issue 50 (3) 2013) Context  Primary failure of eruption (PFE) is a rare condition that involves impeded eruption of teeth despite the lack of an identified local or general causative factor. Since molar teeth are mainly concerned, a typical clinical image presents extensive lateral open bite. A characteristic radiological feature depicts large radiolucent fields around embedded tooth germs. Research performed in recent years has provided evidence that a defect of the eruption mechanism on a genetic background is responsible for ...

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Refresher: Why use local anesthetics?

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 Potential Interactions with Epinephrine or Levonordefrin: Adding epinephrine or levonordefrin to the local anesthetic formulation improves the depth and duration of the local anesthetic block. However, exercise caution if a patient has a history of significant cardiovascular disease or is concomitantly taking any of the following drugs: Nonselective beta-blockers such as nadolol, pindolol, propranolol, sotalol or timolol (may result in increased blood pressure). Tricyclic antidepressants (may result in increased blood pressure and cardiac dysrhythmias). In these cases, use the ...

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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 ...

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Refresher: Why use anti-infectives?

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 when using antibiotics: Use only when there is an indication. Use only when the risk-benefit ratio is favourable. They are not a substitute for establishing adequate drainage. Choose an effective agent with the narrowest spectrum of activity. Prescribe a therapeutic dose. Consider a loading dose. Prescribe at an appropriate frequency. Prescribe for an appropriate duration. Choose the drug with the fewest side effects. Consider laboratory culture and sensitivity tests to target specific ...

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