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Medicine

Could Botulinum Toxin A be a treatment for trigeminal neuralgia and temporomandibular joint dysfunction?

This summary is based on the Rapid Response Report developed by the Canadian Agency for Drugs and Technologies in Health: Botulinum Toxin A for the treatment of trigeminal neuralgia and temporomandibular joint dysfunction: a review of the clinical effectiveness Full Report (PDF) CONTEXT Temporomandibular joint dysfunction (TMD) is a musculoskeletal and rheumatologic disorder of the temporomandibular joint, which may result in jaw deformities, malocclusion, inflammation, and compression of the bilaminar tissue, with pain and dysfunction being the most prominent clinical features. Trigeminal neuralgia (TN) is a disorder caused by proximal compression of trigeminal nerve root, which may bring about electric shock-like pain ...

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How safe are benzodiazepines?

This summary is based on the Rapid Response Report developed by the Canadian Agency for Drugs and Technologies in Health: High dose and watchful dosing of benzodiazepines: a review of the safety and guidelines Full Report (PDF)   Key Findings No “watchful dose” for benzodiazepines was identified. Benzodiazepines may be used in higher than 10 mg diazepam-equivalent doses in some circumstances, but data were limited. Context   Benzodiazepines are compounds that enhance the activity of gamma-aminobutyric acid (GABA)-A receptors by increasing the affinity of the receptors for GABA. Therefore, benzodiazepines are prescribed as anxiolytic medications. In Canada, the labeled indications include, the treatment of anxiety disorders, panic disorder, ...

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How Do I manage a patient with asthma?

  This medical Condition Consult is presented by the JCDA Oasis Team Asthma is a chronic inflammatory respiratory disease associated with increased airway hyper-responsiveness. Patients are sensitive to a variety of stimuli (e.g., cold air, salicylates, NSAIDs, cholinergic drugs, beta-adrenergic blocking drugs). No information available to require special precautions.   Prescribe the following with caution, due to likely adverse reactions: 1. NSAIDs, ASA-containing medications: Samter triad syndrome, an association of ASA sensitivity, ASA-induced asthma, nasal polyposis or sinusitis. 2. Barbiturates, narcotics: may precipitate an asthma attack.   Sulfite preservatives A coughing reflex and prolonged supine positioning. Consider semisupine chair position. ...

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Is inadequate osseointegration a concern in radiation-treated patients, if implants are treatment planned?

This question was submitted by a general dentist: Is inadequate osseointegration a concern in patients who have received radiation therapy for a head and neck malignancy if implants are treatment planned? Dr. Jeff Chadwick, at Princess Margaret Hospital, Dental Oncology, Ocular, and Maxillofacial Prosthetics Group, provided a preliminary response to this question Yes, however … As with most questions related to this patient population, the answer is: “it depends.” Careful examination is a vital step in determining which restorative/prosthodontic approach best suits the individual. Examination also mandates a thorough review of their cancer diagnosis as well as the constituents and sequence ...

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What are the risk factors for osteoradionecrosis (ORN), in a xerostomic radiation-treated patient, if extractions are required?

This question was submitted to us by a general dentist: If extractions are required, what are the risk factors for osteoradionecrosis (ORN) in a xerostomic patient with rampant decay two years after the successful treatment of their head and neck cancer (radiation, chemotherapy and surgery)? Dr. Jeff Chadwick, at Princess Margaret Hospital, Dental Oncology, Ocular, and Maxillofacial Prosthetics Group, provided a preliminary response to this question:  With the numerous comorbidities associated with head and neck radiation (oral mucositis, radiodermatitis, dysgeusia, dysphagia/odynophagia, trismus, and xerostomia), arises a critical issue with tooth extraction is the altered biology of the maxilla and mandible due ...

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How and When Is Epinephrine Used As A Vasoconstrictor in Local Anesthetics?

This Prescription Drug Consult is presented by the JCDA Oasis Team and is also available through JCDA Oasis Mobile Epinephrine in LA (Adrenalin®) Presentation Epinephrine is a an alpha-/beta-agonist that is administered as an adjuvant in local anesthetic cartridges. Epinephrine is also used as an emergency drug for treatment of anaphylactic reaction and a vasoconstrictor to decrease systemic absorption of local anesthetics and to increase the duration of anesthetic action. The use of Epinephrine may decrease superficial hemorrhage. Dosage May be used in concentrations of 1:500,000 to 1:50,000. 1:100,000 and 1:200,000 is used most commonly in a typical 1.8 ml local anesthetic dental ...

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Are You Concerned About Mandibular Blocks In Patients Taking Anticoagulants?

This question was submitted to us by a general dentist: Are you concerned about mandibular blocks and possible injury to blood vessels (Inferior Alveolar Artery/Vein) in patients continuing anti-coagulant therapy (Warfarin)? Potential Hematomas? Management? Dr. Jason Goodchild provided this quick initial response: For patients on anticoagulant therapy, a careful review of the medical history including consultation with the patient’s physician is warranted.  This consultation should include information on the patient’s INR (International Normalized Ratio).  Ideally, a recent INR (with 24-48 hrs) is needed in order to ascertain the patient’s bleeding risk during surgery.   The literature is consistent on this issue: If the patient’s ...

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How Do I Manage A Patient Who Is On Anticoagulants?

We are very pleased to present this series of videos by Dr. Mark Donaldson, Director of Pharmacy Services at the Kalispell Regional Medical Center and faculty member at the University of Montana and the Oregon Health & Sciences University There is no such thing as medical clearance. In fact, the dentist retains the primary responsibility for the procedures carried out for the immediate management of many untoward complications. While it is always prudent to get a consult with a medical practitioner, such as the patient’s primary prescriber or cardiologist, at the end of the day, the onus is on the dentist ...

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