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Supporting Your Practice

Managing severe Alzheimer disease: what are the evidence-based guidelines?

This summary is based on the guidelines published by the Canadian Medical Association (CMA): Diagnosis and treatment of dementia: 6. Management of severe Alzheimer disease. The article was retrieved from the CMA Infobase: Clinical Practice Guidelines Database (CPGs) Access the article here (PDF) Context The management of severe Alzheimer disease often presents difficult choices for clinicians and families. The disease is characterized by a need for full-time care and assistance with basic activities of daily living. The authors outline an evidence-based approach for these choices based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. The authors developed evidence-based guidelines using systematic literature searches, ...

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How do I protect my patient medically, while safely providing the required treatment?

This case was submitted by Dr. Ron Kellen  Case Details Male patient, 55.  Diagnosed with AIDS in 2/2013 – at which time, CD4 count was 50. Now he says his CD4 count is 200. On Methadone (on-off for 10 years now). Ex heroin IV, and oxycontin, Percocet, etc. narcotics. On anti-convulsive for grand mal seizures. No more seizures since started medications. Smokes medical marijuana to increase his appetite. He is very underweight. On effective AIDS cocktail since Feb, 2013  Just finished thrush treatment of Nystatin swish & swallow (from G.P., not AIDS MD).  Still remnants clearly visible He has only ...

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Do self-etch adhesives cause less postoperative sensitivity than etch-and-rinse adhesives?

This summary is based on the critical appraisal published in the Journal of Esthetic and Restorative Dentistry: Post-op Sensitivity with Direct Composite Restorations (August 2013) Studies Reviewed Total-etch versus Self-etch Adhesive: Effect on Postoperative Sensitivity. Journal of the American Dental Association 2003 (134:1621–9) Postoperative Sensitivity in Class I Composite Resin Restorations in Vivo. Journal of Adhesive Dentistry 2006 (8:53–8) Clinical Evaluation of a Two-step Etch & Rinse and a Two-step Self-etch Adhesive System in Class II Restorations:Two-year Results. Operative Dentistry 2009 (39:656–63) Effect of Glass-ionomer Cement Lining on Postoperative Sensitivity in Occlusal Cavities Restored with Resin Composite—A Randomized Clinical Trial. Operative Dentistry 2009 (34:648–55) Key Messages Much ...

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New CDA Position Statement on Dental Patients with Total Joint Replacement

In June 2013, CDA adopted a new position statement on dental patients with total joint replacement. The Committee on Clinical and Scientific Affairs (CCSA) reviewed clinical evidence, including a thorough systematic review of the literature conducted by the American Dental Association (ADA) and the American Academy of Orthopedic Surgeons (AAOS) which was conducted in 2011. Preamble The issue of whether patients with orthopedic implants, primarily total hip and knee replacements, are prone to implant infection from routine dental procedures via hematogenous seeding of the implant from dental-procedure-related bacteremia has been a controversial topic for dentists, physicians and patients alike. Background ...

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How to manage white spot lesions in fixed orthodontic appliances?

This summary is based on the article published in the Journal of Esthetic and Restorative Dentistry: A contemporary review of white spot lesions in orthodontics (April 2013) Context White spot lesions (WSL) associated with fixed orthodontic appliances are a common adverse effect of orthodontic treatment and represent a significant challenge to achieving esthetic excellence. Purpose The purpose of this article is to review the current evidence regarding diagnosis, risk assessment, prevention, intratreatment management, and post-orthodontic treatment of WSL and to provide clinical recommendations useful for both the orthodontist and the general dentist. Key Messages White spot lesions associated with orthodontic treatment are a ...

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Could Chlorhexidine varnish be effective in preventing root caries?

This summary is based on the Critical Summary published in the Journal of the American Dental Association: Use of chlorhexidine varnish to prevent root caries may benefit some patients (September 2013) Clinical Question The critical summary was in response to the following question: “Does the application of CHX-V reduce the incidence or activity of root caries in adult patients with gingival recession compared with that in adult patients who do not receive CHX-V application?” Key Message Chlorhexidine varnish (CHX-V) may be effective in preventing root caries in the absence of regular professional tooth cleaning and oral hygiene instructions for patients who need special care. Clinical Implications Although ...

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Periodontitis and atherosclerotic cardiovascular disease: what does the consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases say?

This is the summary of the report issued by the Joint European Federation of Periodontology and the American Academy of Periodontology Workshop on Periodontitis and Systemic Diseases: Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases (April 2013)  Context This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (ACVD). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth-supporting apparatus leading to tooth loss; as such, it is a major public health issue. Periodontitis leads to entry of bacteria ...

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Diagnosing periodontal disease: what is the periodontal classification system?

This question was submitted by a general dentist: What are the latest thoughts on periodontal disease and the classification used for its diagnosis? Dr. Sayed Mirbod, representing the Canadian Academy of Periodontology (CAP), provided this initial quick response The benefit of a classification system is to provide a framework to study the etiology, progression and treatment for a disease. The system can also be used by clinicians to organize their patients’ health-care needs. Diagnosing periodontal disease is directly related to the classification system that is used by the clinician and the variations in the definition of periodontal health, gingivitis and periodontitis ...

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