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Supporting Your Practice

Which medications are most effective for moderate to severe post-operative dental pain?

The following question was posted by a practising dentist: There is quite a bit of variation in the office with respect to drugs dentists like to prescribe for post-operative pain. Which pain medications are the most effective for moderate to severe pain and have the least number of side effects? Dr. Mark Donaldson from the University of Montana and the Oregon Health & Sciences University provided this initial response: The goal should be: “the most effective dose for the shortest period of time.”  We want to get our patients out of pain as quickly as possible. Two good recent articles come to ...

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What are the advantages and disadvantages of self-adhesive resin cements for crown & bridge cementation?

This question was submitted to us by a practising dentist: What are the pros and cons of self-adhesive resin cements (i.e.: RelyX, Unicem 2) and resin modified glass ionomers (i.e.: FujiCEM 2) in crown and bridge cementation? Are they equally reliable? Dr. Omar El-Mowafy, Head of Restorative Dentistry at the University of Toronto provided this initial response: Advantages of self-adhesive resin cements 1. Eliminate the need for etching tooth structure or application of primer/bonding agent; and as a result, dramatically reduce the potential for post-operative sensitivity . 2. Dual-cured: excess cement can be briefly light-cured for ease of use. When used with a ...

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What factors should I consider when purchasing appointment-confirmation software for my office?

This question came our way from a practising dentist in response to a recent “Plugged In” article in the JCDA: I am seriously considering adding some software which allows communication with patients by email to confirm appointments. What are the pros and cons of the different systems available to me? What specifications should I insist on in the systems I evaluate? Dr. Jeff Glaizel of Toronto who authors our “Plugged In” column provided this initial response. When evaluating a specific communication technology solution for your office there are 2 main areas to look at: 1. Does the workflow fit into ...

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How do I manage vital, irreversibly inflamed teeth with unstoppable bleeding?

This urgent care scenario is presented by the JCDAOasis Team in consultation with Dr. Brian Jafine. Peer-reviewed content that appeared in the JCDA OASIS “point of care” searchable database at www.jcdaoasis.ca  Presentation Population Patients with recent dental restorations (amalgams, resins, crowns) or trauma Medically-compromised patients Signs Large/deep restorations and crowns (broken down, leaking, open margins) Continuous bleeding after several attempts to dry, close, or fill the root canal spaces Symptoms Pain severity: the patient may experience some pain Investigation Thoroughly assess the patient’s medical history: inquire about diabetes mellitus, bleeding disorders, hypertension, history of radiation therapy, etc. Perform an oral examination: ...

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What is the QT-Prolonging effect of Epinephrine on Patients Taking SSRIs?

The following question was submitted by a practicing dentist: What may happen with patients who have a prolonged QT due to their SSRI or Prozac medication when they are administered a local anesthetics-containing epinephrine? The following response is provided by Dr. Joonyoung Ji, resident in the Department of Dental Anesthesia at the University of Toronto Main take-away message Epinephrine, stress, and using more than one psychotropic increases the QT interval. The majority of patients have significant medical co-morbidities in reported cases of arrhythmia associated with psychotropics. Therefore, limiting the use of epinephrine to under 40 mcg or no more than 2 cartridges of ...

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Recurrent Herpes Simplex: What Are the Possible Interventions?

This short consult is presented by Dr. Eric Stoopler, DMD; Dr. Arthur Kuperstein, DDS; and Dr. Thomas Sollecito, DMD Peer-reviewed content that appeared in the JCDA OASIS “point of care” searchable database at www.jcdaoasis.ca and in the sixth edition of the print JCDA. Primary and recurrent infection with herpes simplex virus (HSV-1 and HSV-2) can cause oral and/or genital lesions, although the majority of oral infections are caused by HSV-1. Symptomatic vesicles/ulcers of the oral mucosal tissues generally follow the onset of systemic symptoms and are often accompanied by significant erythema of the gingival tissues (i.e., “primary herpetic gingivostomatitis”). Treatment of primary HSV infections ...

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How can I promote esthetic papilla formation between adjacent implant-supported restorations on upper anterior teeth?

The following verbatim question was submitted by a practising dentist: My patient had implants to replace 11 and 21. I have placed contoured healing abutments and temporary crowns with the contact 4-5 mm above the bone (2 mm gingiva and 2 mm space). These have been in place 4 months and although the papilla has filled in between the laterals, the tissues are still flat between the 11 and 21 despite the fact that a periodontist placed the implants doing a graft to “bulk up”   the tissue. The patient is not overly concerned; however, you can see the area when he smiles, so ...

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Case Follow-up: To Implant or Not To Implant: What Role Does Imaging Play?

This case is presented by the University of Toronto, Department of Oral Radiology Residents: Edwin Chang, Sherif El Saraj, Catherine Nolet-Levesque, Daniel Turgeon, Niloufar Amintavakoli, and Trish Lukat.  Pre-operative images provided courtesy of Dr. Milan Madhavji of Canaray | Specialists in Oral Radiology. You can view the original case here. Case Follow-Up Four implants were placed in the anterior mandible. Following implant surgery, the patient experienced persistent pain in the implant area and two of the implants failed in the immediate post-operative period. Over the course of the following year, the pain progressively worsened in the anterior mandible and the patient was subsequently ...

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