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Pharmacology

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To stop or not to stop anticoagulants in patient prior to dental surgery?

Dr. Jose Lança, from the Faculty of Dentistry and the Faculty of Medicine at the University of Toronto, speaks with Dr. John O’Keefe about the important decisions dentists need to make when treating patients who are on anticoagulants and who need dental surgery: should they, or not, ask the patient to stop taking their anticoagulant medication? Highlights The monitoring of warfarin anticoagulation is aimed at conventional anticoagulation INR of 2.0-3.0 (normal INR:0.9-1.1). Intensive anticoagulation is defined as an INR of 2.5-3.5, and critical values of >4.5-5.0. Do not be quick in discontinuing oral anticoagulants just because the patient might experience ...

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Managing Type 2 Diabetes in the Dental Practice

This post was prepared by Drs. Aviv Ouanounou and Suham Alexander    Diabetes occurs in approximately 6-15% of the general population and typically, in those over the age of 45 years. Up to 25-30% of the adult population over 65 years is diagnosed with some form of diabetes. Diabetes is the 6th most common cause of death and can result in blindness, end-stage renal disease, cardiac disorders as well as neuropathies. Type I Diabetes Insulin Dependent Diabetes Mellitus (IDDM) Also, known as Juvenile Diabetes Occurs mostly in young children and teens Affects ~10% of the diabetic population Destruction of beta ...

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Exploring Xerostomia in the Elderly with Dr. Aviv Ouanounou

Dr. Aviv Ouanounou explores with Dr. Suham Alexander the topic of xerostomia in the elderly patient.  Video Highlights Xerostomia or dry mouth is a common condition that occurs in the elderly population. In xerostomia, salivary flow is reduced. Because saliva has several important functions in the oral cavity including but not limited to antimicrobial effects, digestion, swallowing and speech, decreased salivary flow has many important implications. Prevalence in the elderly ranges from 45-50% compared to 10-14% in the general population 3 main causes in the elderly Use of non- and prescription medications Medical conditions such as salivary gland disorders (Sjogren’s syndrome), ...

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Exploring Epilepsy and Epileptic Drugs with Dr. Aviv Ouanounou

Dr. Aviv Ouanounou explores with Dr. Suham Alexander the topic of epilepsy and anti-epileptic drugs and their relevance to dentistry.   Video Highlights Epilepsy is one of the first diseases noted in history and it afflicts ~1% of the population. While most epileptics are well-controlled with medication, there is still a fairly high number of people that have uncontrolled seizures. In this video presentation, Dr. Aviv Ouanounou, discusses the pathophysiology, medications and dental implications of patients with this disease. 3 types of seizures – partial, generalized, status epilepticus Anti-epileptic drugs reduce voltage regulated Ca2+ channels, enhance GABA neurotransmission and interact with glutamate ...

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CDA Oasis Conversation: EpiPen Efficacy & Safety – What Every Dentist Needs to Know with Dr. Mark Donaldson

Dr. Mark Donaldson, Director at VHA, US health care network of not-for-profit hospitals, speaks about the safety and efficacy of the long-used EpiPen. Highlights Epinephrine is one of the most important medications in an emergency kit. It is the reversal agent required for anaphylactoid reactions. EpiPen In most cases, there should be 3 EpiPens or EpiPen, Jr. in the office if treating an adult or pediatric patient, respectively. An ampule of epinephrine has a longer shelf life than an EpiPen. There is a high risk and incidence of auto-injection of health care professionals when attempting to administer the medication to the ...

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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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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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