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Supporting Your Practice

What is an extrusion and how is it treated?

This post is an adaptation of the Extrusion article found in the Dental Trauma Guide Extrusion Partial displacement of the tooth out of its socket An injury to the tooth characterized by partial or total separation of the periodontal ligament resulting in loosening and displacement of the tooth. The alveolar socket bone is intact in an extrusion injury as opposed to a lateral luxation injury. In addition to axial displacement, the tooth will usually have an element of protrusion or retrusion. In severe extrusion injuries the retrusion/protrusion element can be very pronounced. In some cases it can be more pronounced ...

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What is the current state of second- and third-line therapy for patients with type 2 diabetes?

This summary is based on comprehensive Optimal Therapy Reports on the topic prepared by Canadian Agency for Drugs and Technologies in Health (CADTH): Second- and Third-Line Therapy for Patients with Type 2 Diabetes Report Summary (PDF) Full Report (PDF) The Canadian Agency for Drugs and Technologies in Health (CADTH) has released a series of Optimal Therapy Reports on the prescribing and use of second-line therapy for patients with type 2 diabetes inadequately controlled on metformin, and a therapeutic review of third-line therapy for patients with type 2 diabetes inadequately controlled with metformin and a sulfonylurea combination therapy. CADTH has also released intervention tools to support the uptake ...

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Is your patient on benzodiazepines?

This Post is adapted from the Canadian Pharmacists Association (CPhA) Drug Monograph: Benzodiazepines Benzodiazepines Product Summary Information   Indications   Contraindications Patients with known hypersensitivity to this class of drugs or to any component of the product in question. Patients with myasthenia gravis and acute angle-closure glaucoma, but they may be used in patients receiving appropriate therapy for open-angle glaucoma. Warnings Not recommended for use in patients with a major depressive disorder or psychosis in which anxiety is not a prominent feature. Should be used with extreme caution in patients with severe pulmonary insufficiency or sleep apnea, especially the elderly ...

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Is your patient undergoing treatment with biphosphonates?

This Post is adapted from the Canadian Pharmacists Association (CPhA) Drug Monograph: Biphosphonates Product Summary Pharmacology Bisphosphonates (previously called diphosphonates) are stable analogues of pyrophosphate. After binding to bone surfaces, they slow the formation of hydroxyapatite crystals and delay their aggregation into large clusters. They also interfere with the resorptive action and promote apoptosis (programmed cell death) of osteoclasts, resulting in decreased depth and rate of formation of new bone remodeling units. Lifelong accumulation of remodeling deficits begins shortly after bone growth stops and is thought to be the underlying mechanism of age-related bone loss. By inhibiting this process, bisphosphonates ...

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How do you manage pain due to food impaction?

This Urgent care Scenario (USC) is presented by the JCDA Oasis Team in collaboration with Dr. Samer Nuwwareh. The USC is also available through the Oasis Help system Food impaction is the forceful wedging of food into the periodontium by occlusal forces. It may occur as a consequence of gingival tissue recession or disease, caries, severe attrition, plunger cusp, or inappropriate interproximal contact and clearance.     Resources Gastaldo JF, Cury PR, Sendyk WR. Effect of the vertical and horizontal distances between adjacent implants and between a tooth and an implant on the incidence of interproximal papilla. J Periodontol. 2004;75(9):1242-6. Hancock EB, Mayo ...

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What is subluxation and how is it treated?

This post is an adaptation of the Subluxation article found in the Dental Trauma Guide Description An injury to the tooth supporting structures resulting in increased mobility, but without displacement of the tooth. Bleeding from the gingival sulcus confirms the diagnosis. Diagnosis An injury to the tooth supporting structures resulting in increased mobility, but without displacement of the tooth. Bleeding from the gingival sulcus confirms the diagnosis Visual signs: Not displaced Percussion test: Tender to touch or tapping Mobility test: Increased mobility Pulp sensibility test: Sensibility testing may be negative initially indicating transient pulpal damage. Monitor pulpal response until a ...

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How to improve patient safety?

This summary of evidence is based on the Annals of Internal Medicine Supplement (Ann Intern Med. 2013;158:365-368) and on the report by the Agency for Healthcare Research and Quality: Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices Annals of Internal Medicine Supplement Full Report (PDF) Structured Abstract Study Objective To review important patient safety practices for evidence of effectiveness, implementation, and adoption. Data Sources Searches of multiple computerized databases, gray literature, and the judgments of a 20-member panel of patient safety stakeholders. Results From an initial list of over 100 patient safety practices, ...

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Should the transmission (gears) inside prophy heads and slow speed hand pieces be sterilized between patients?

This question was submitted by a general dentist: “Should the transmission (gears) inside prophy heads and slow speed hand pieces be sterilized between patients? I find to my surprise that assistants and hygienists leave these on the angle nose cones.” A quick initial response is provided by Dr. Nita Mazurat, Associate Professor in the Faculty of Dentistry at the University of Manitoba, representing the Organization for Safety, Asepsis and Prevention (OSAP) 1. Should all hand pieces be sterilized following patient use? The recommendations from the Center for Disease Control (CDC) “Guidelines for Infection Control in Dental Health-Care Settings – 2003” is “to ...

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