SAFE ANESTHETICS
2% Lidocaine, 1:100,000 epinephrine (Xylocaine)
0.5% Bupivacaine with 1:200,000 epinephrine (Marcaine)
4% Septocaine with 1:100,000 and 1,200,000 epinephrine (Articaine)
4% Prilocaine HCL with 1:200,000 epinephrine or without epinephrine (Citanest Forte/Citanest Plain)
3% Mepivacaine (Carbocaine)
2% Mepivacaine (Carbocaine) with 1 :20,000 Levonordefrin (NeoCobefrin)
ANESTHETIC GUIDELINES
Inject LA after the baby has been fed
Stage I hypertensive lactating patient: Use LA with 1:200,000 epinephrine
Avoid epi. in stage II Htn. patient
Defer routine dental treatment in a stage III hypertensive lactating patient
SAFE ANALGESICS
Acetaminophen (Tylenol)
Codeine + Tylenol (Tylenol # 1-3)
Hydrocodone + Tylenol (Vicodin)
Oxycodone + Tylenol (Percocet)
ANALGESIC GUIDELINES
Patient takes pain medication after breast feeding and keep a 2 hour interval with the next feed
Opioids pass through the breast milk: Use lower doses and prescribe Opioids only when absolutely needed
SAFE ANTIBIOTICS
All Penicillins
All Cephalosporins
All Macrolides
Clindamycin
ANTIBIOTIC GUIDELINES
Take antibiotic after breast feeding & keep 2 hour interval with the next feed
Minimize antibiotic use due to risk of altering the baby's intestinal flora and promoting resistant pathogens growth
Read more...
" The Professional Man has no right to be other than a continuous student "
Quote of the day
Sunday, January 9, 2011
Pregnancy and Dentistry - Safe AAA
Pregnancy and Trimesters
Suggested Dental Guidelines
1)Avoid Rx during Organogenesis: Weeks 3-10: Highest risk to the fetus
2)Safest and most comfortable time for dentistry are: The last 2-3 weeks of the first
trimester, the entire second trimester and the first half of the third trimester
3)Give the patient a left lateral position in the latter half of the third trimester
4)Dentistry is not contraindicated in 2nd ½ of 3rd Trimester: It may be uncomfortable
5)DO NOT USE O2 +N2O for stress mgmt as N2O has teratogenic effects
6)Restrict excessive radiographs and take only those needed
7)Full mouth radiographics not contraindicated: Use full body & thyroid lead shield
8)Routine extractions, periodontal Rx, restorations, orthodontic Rx, placement of
removable and fixed prosthodontics and crowns can occur during pregnancy
9)Use minimum amount of epinephrine and minimum number of LA carpules
SAFE ANESTHETICS:
2% Lidocaine (Xylocaine), 1:100,000 epinephrine
4% Prilocaine HCL with 1:200,000 epinephrine (Citanest Forte)
4% Prilocaine HCL without epinephrine (Citanest Plain)
ANAESTHETIC GUIDELINES:
Best to use LAs with less or no epi. in the presence of tachycardia
Use a maximum of 2 carpules
Avoid epi. with mild to mod. Htn
Use 4% Prilocaine HCL without epinephrine (Citanest Plain) after clearance from patient’s obstetrician
SAFE ANALGESICS
Acetaminophen (Tylenol)
Codeine + Tylenol
Hydrocodone + Tylenol (Vicodin)
Oxycodone + Tylenol (Percocet)
ANALGESIC GUIDELINES
Percocet & Vicodin are category B
They are safe when used short-term and in smaller doses
Avoid Vicodin and Percocet just prior (2-4 weeks) to delivery to prevent breathing problems in the newborn
Avoid Aspirin and NSAIDS
SAFE ANTIBIOTICS
All Penicillins
All Cephalosporins
Azithromycin
Clindamycin
ANTIBIOTIC GUIDELINES
Use Pen. VK to treat acute oral infections (symptomatic for less than 3 days)
Use Clindamycin with Penicillin allergy or if the infection has been symptomatic for more than 3 days.
Read more...
First Trimester from 1-14 weeks
Second Trimester from 14-28 weeks
Third Trimester from 28-40 weeks
1)Avoid Rx during Organogenesis: Weeks 3-10: Highest risk to the fetus
2)Safest and most comfortable time for dentistry are: The last 2-3 weeks of the first
trimester, the entire second trimester and the first half of the third trimester
3)Give the patient a left lateral position in the latter half of the third trimester
4)Dentistry is not contraindicated in 2nd ½ of 3rd Trimester: It may be uncomfortable
5)DO NOT USE O2 +N2O for stress mgmt as N2O has teratogenic effects
6)Restrict excessive radiographs and take only those needed
7)Full mouth radiographics not contraindicated: Use full body & thyroid lead shield
8)Routine extractions, periodontal Rx, restorations, orthodontic Rx, placement of
removable and fixed prosthodontics and crowns can occur during pregnancy
9)Use minimum amount of epinephrine and minimum number of LA carpules
SAFE ANESTHETICS:
2% Lidocaine (Xylocaine), 1:100,000 epinephrine
4% Prilocaine HCL with 1:200,000 epinephrine (Citanest Forte)
4% Prilocaine HCL without epinephrine (Citanest Plain)
ANAESTHETIC GUIDELINES:
Best to use LAs with less or no epi. in the presence of tachycardia
Use a maximum of 2 carpules
Avoid epi. with mild to mod. Htn
Use 4% Prilocaine HCL without epinephrine (Citanest Plain) after clearance from patient’s obstetrician
SAFE ANALGESICS
Acetaminophen (Tylenol)
Codeine + Tylenol
Hydrocodone + Tylenol (Vicodin)
Oxycodone + Tylenol (Percocet)
ANALGESIC GUIDELINES
Percocet & Vicodin are category B
They are safe when used short-term and in smaller doses
Avoid Vicodin and Percocet just prior (2-4 weeks) to delivery to prevent breathing problems in the newborn
Avoid Aspirin and NSAIDS
SAFE ANTIBIOTICS
All Penicillins
All Cephalosporins
Azithromycin
Clindamycin
ANTIBIOTIC GUIDELINES
Use Pen. VK to treat acute oral infections (symptomatic for less than 3 days)
Use Clindamycin with Penicillin allergy or if the infection has been symptomatic for more than 3 days.
Read more...
Sunday, September 26, 2010
Sunday, September 12, 2010
Premedication in Dentistry
WHAT TO GIVE:
Amoxicillin
Adults: 2.0 g PO (oral), 1 h before procedure
Children*: 50 mg/kg PO, 1 h before procedure
Non-Penicillin allergic patients unable to take Oral Medications:
Ampicillin:
Adults: 2.0 g IM or IV 30 minutes before the procedure
Children: 50 mg/kg IM or IV 30 minutes before the procedure
Cefazolin or Ceftriaxone:
Adults: 1 g IM or IV 30 minutes before the procedure.
Children: 50 mg/kg IM or IV 30 minutes before the procedure
*Total children’s dose should not exceed adult dose
Clindamycin :
Adults: 600 mg PO (oral), 1 h before the procedure
Children: 20 mg/kg PO 1 h before the procedure
Cephalexin (Keflex)
Adults: 2.0 g oral 1 h before the procedure
Children: 50 mg/kg oral 1 h before the procedure
Azithromycin (Zithromax) or Clarithromycin (Biaxin):
Adults: 500 mg oral 1 h before the procedure
Children: 15 mg/kg oral 1 h before the procedure
**Avoid Cephalosporins with immediate-type hypersensitivity/acute anaphylaxis to Penicillin
To avoid Strep. Viridans resistance to the Premed. antibiotic: Keep an interval of 7 days between successive appointments when using the same antibiotic for premedication
PREMEDICATION AND CO-INFECTION
Co-Infection is treated one of two ways:
I: Use the same antibiotic for premedication and treatment of infection
Example:
Premed: 2.0 g Amox. P.O 1 h prior to treatment
Infection Rx: Then start Amox. 250 / 500 mg 6 hours LATER, prescribing
250 / 500 mg Amox. q.i.d for 5-7 days
NOTE:
Avoid Amoxicillin as premed during appointments for the following 2-3 weeks
II: Use a different antibiotic for premedication and the treatment of infection
Example:
Premed: 2.0 g Amoxicillin PO 1 h prior to treatment
Infection Rx: Then start Clindamycin 150/300mg PO 6 hours AFTER intake of 2.0 g Amoxicillin prescribing Clindamycin 150/300 mg tid x 5- 7 days
NOTE:
No change in the premed. antibiotic needed for subsequent dental visits
WHEN TO GIVE
CONDITIONS THAT REQUIRE PREMEDICATION
I) CARDIAC CONDITIONS
1) Prosthetic heart valves
2) Past history of bacterial endocarditis
3) Unreparied/ Incompletely repaired congenital heart disease
4) Completely repaired congential heart defect with prosthetic material or device for first 6 months after the procedure
5)Cardiac transplant patients who develop heart valve associated problems
II) NON CARDIAC CONDITIONS
a) Hemodialysis
Premedicate patient with Intravenous catheter
AV fistula does not require premedication for invasive dental procedures.However always confirm with patient’s MD prior to dentistry.Occasionally premedication may be needed with a “young” or newly forming fistula if the patient has severe periodontal infection
The patient with an AV graft should always be premedicated prior to dentistry
b)Peritoneal dialysis: Premedication prophylaxis per say is not needed
However in some cases if there is an indwelling catheter premed is required
c)Cirrhosis: Premedicate a cirrhotic patient presenting with ascites to prevent bacterial growth
d)Chemotherapy Vascular Access: Patients with infuse port or Hickman catheter line requires premedication prior to dental treatment
e)Prosthetic Joints: Premedication is needed for the first 2 years for all patients
Premedicate joint prosthesis beyond the first two years with:
Immune deficiency: DM, HIV/AIDS, chemotherapy, radiotherapy or malignancy
Chronic joint diseases caused by RA/osteoarthritis/Lupus arthritis
Patient with multiple joint prosthesis
Past history of joint prosthesis infection
Congenital bleeding disorders: Hemophilias/VWD
Chronic skin disease with open sores due to Psoriasis/eczema: Distant infection
Severe periodontal disease: This is a local source of infection
f) Neutropenia: Moderate neutropenic patient gets premedication prophylaxis for all dental procedures.
Mild neutropenic patient gets premedication prophylaxis for major procedures only
These are based on the Absolute Neutrophil Count (ANC) levels:
i) 0-500 Neutrophils/mm3:
This range identifies severe Neutropenia
Increased/severe risk for life threatening infections exists with this range
ii) 500-1,000 Neutrophils/mm3:
This range identifies moderate Neutropenia
Moderate risk of infection exists with this range
iii) 1000-1,500 Neutrophils/mm3:
This range identifies mild Neutropenia
Mild risk of infection exists with this range
CONDITIONS THAT DO NOT REQUIRE PREMEDICATION
a) Atrial Septal defect/ Ventricular septal defect
b) Hypertrophic cardiomayopathy
c) Mitral Valve prolape with/ without regurgitation
d) Rheumatic Heart Disease
e) Calcified Aortic Stenosis
f) Coronory Artery Bypass Graft
g) Severe anaemia, hyperthyroidism,
h) Pacemakers or defibrillators
i) Mature AV fistulas for hemodialysis
Read more...
Amoxicillin
Adults: 2.0 g PO (oral), 1 h before procedure
Children*: 50 mg/kg PO, 1 h before procedure
Non-Penicillin allergic patients unable to take Oral Medications:
Ampicillin:
Adults: 2.0 g IM or IV 30 minutes before the procedure
Children: 50 mg/kg IM or IV 30 minutes before the procedure
Cefazolin or Ceftriaxone:
Adults: 1 g IM or IV 30 minutes before the procedure.
Children: 50 mg/kg IM or IV 30 minutes before the procedure
*Total children’s dose should not exceed adult dose
Clindamycin :
Adults: 600 mg PO (oral), 1 h before the procedure
Children: 20 mg/kg PO 1 h before the procedure
Cephalexin (Keflex)
Adults: 2.0 g oral 1 h before the procedure
Children: 50 mg/kg oral 1 h before the procedure
Azithromycin (Zithromax) or Clarithromycin (Biaxin):
Adults: 500 mg oral 1 h before the procedure
Children: 15 mg/kg oral 1 h before the procedure
**Avoid Cephalosporins with immediate-type hypersensitivity/acute anaphylaxis to Penicillin
To avoid Strep. Viridans resistance to the Premed. antibiotic: Keep an interval of 7 days between successive appointments when using the same antibiotic for premedication
PREMEDICATION AND CO-INFECTION
Co-Infection is treated one of two ways:
I: Use the same antibiotic for premedication and treatment of infection
Example:
Premed: 2.0 g Amox. P.O 1 h prior to treatment
Infection Rx: Then start Amox. 250 / 500 mg 6 hours LATER, prescribing
250 / 500 mg Amox. q.i.d for 5-7 days
NOTE:
Avoid Amoxicillin as premed during appointments for the following 2-3 weeks
II: Use a different antibiotic for premedication and the treatment of infection
Example:
Premed: 2.0 g Amoxicillin PO 1 h prior to treatment
Infection Rx: Then start Clindamycin 150/300mg PO 6 hours AFTER intake of 2.0 g Amoxicillin prescribing Clindamycin 150/300 mg tid x 5- 7 days
NOTE:
No change in the premed. antibiotic needed for subsequent dental visits
WHEN TO GIVE
CONDITIONS THAT REQUIRE PREMEDICATION
I) CARDIAC CONDITIONS
1) Prosthetic heart valves
2) Past history of bacterial endocarditis
3) Unreparied/ Incompletely repaired congenital heart disease
4) Completely repaired congential heart defect with prosthetic material or device for first 6 months after the procedure
5)Cardiac transplant patients who develop heart valve associated problems
II) NON CARDIAC CONDITIONS
a) Hemodialysis
Premedicate patient with Intravenous catheter
AV fistula does not require premedication for invasive dental procedures.However always confirm with patient’s MD prior to dentistry.Occasionally premedication may be needed with a “young” or newly forming fistula if the patient has severe periodontal infection
The patient with an AV graft should always be premedicated prior to dentistry
b)Peritoneal dialysis: Premedication prophylaxis per say is not needed
However in some cases if there is an indwelling catheter premed is required
c)Cirrhosis: Premedicate a cirrhotic patient presenting with ascites to prevent bacterial growth
d)Chemotherapy Vascular Access: Patients with infuse port or Hickman catheter line requires premedication prior to dental treatment
e)Prosthetic Joints: Premedication is needed for the first 2 years for all patients
Premedicate joint prosthesis beyond the first two years with:
Immune deficiency: DM, HIV/AIDS, chemotherapy, radiotherapy or malignancy
Chronic joint diseases caused by RA/osteoarthritis/Lupus arthritis
Patient with multiple joint prosthesis
Past history of joint prosthesis infection
Congenital bleeding disorders: Hemophilias/VWD
Chronic skin disease with open sores due to Psoriasis/eczema: Distant infection
Severe periodontal disease: This is a local source of infection
f) Neutropenia: Moderate neutropenic patient gets premedication prophylaxis for all dental procedures.
Mild neutropenic patient gets premedication prophylaxis for major procedures only
These are based on the Absolute Neutrophil Count (ANC) levels:
i) 0-500 Neutrophils/mm3:
This range identifies severe Neutropenia
Increased/severe risk for life threatening infections exists with this range
ii) 500-1,000 Neutrophils/mm3:
This range identifies moderate Neutropenia
Moderate risk of infection exists with this range
iii) 1000-1,500 Neutrophils/mm3:
This range identifies mild Neutropenia
Mild risk of infection exists with this range
CONDITIONS THAT DO NOT REQUIRE PREMEDICATION
a) Atrial Septal defect/ Ventricular septal defect
b) Hypertrophic cardiomayopathy
c) Mitral Valve prolape with/ without regurgitation
d) Rheumatic Heart Disease
e) Calcified Aortic Stenosis
f) Coronory Artery Bypass Graft
g) Severe anaemia, hyperthyroidism,
h) Pacemakers or defibrillators
i) Mature AV fistulas for hemodialysis
Premedication in patients already receiving antibiotics.
If a patient is already receiving chronic antibiotic therapy with an antibiotic that is also recommended for IE prophylaxis for a dental procedure, it is prudent to select an antibiotic from a different class rather than to increase the dosage of the current antibiotic. Eg. Patients who take an oral penicillin for secondary prevention of rheumatic fever or for other purposes are likely to have viridans group streptococci in their oral cavity that are relatively resistant to penicillin or amoxicillin. In such cases, the provider should select either clindamycin, azithromycin or clarithromycin for IE prophylaxis for a dental procedure. Because of possible cross-resistance of viridans group streptococci with cephalosporins, this class of antibiotics should be avoided. If possible, it would be preferable to delay a dental procedure until at least 10 days after completion of the antibiotic therapy. This may allow time for the usual oral flora to be re-established.
Read more...
Common Interview questions for Advanced Standing Programs in Dentistry
Being invited for an interview is a good sign because it means you have made it past the initial applicant screenings. Congratulations..!!! The interview is the admission committee's chance to observe how you interact and decide whether you would fit well in their program. They will also use the interview as an opportunity to assess your communication skills, critical thinking abilities, and motivation for the study and practice of dentistry. It is also your chance to evaluate the program they offer to determine how well it suits your needs. For these reasons, the interview is an important opportunity for you to make a good impression.
Read more...
Read more...
Wednesday, September 8, 2010
Antibiotics safe in Liver Disease
SAFE ANTIBIOTICS
Pen VK: Normal dose
Amoxicillin: Normal dose
Augmentin: Normal dose
Keflex: Normal dose
Duricef: Normal dose
Clindamycin: Normal dose with Hepatitis
Clarithromycin: Normal dose with normal kidney function
Metronidazole: Normal dose with mild liver disease
Doxycycline: Normal dose
IV Vancomycin: Normal dose
ANTIBIOTICS WITH ALERTS
Ampicillin: Use caution/avoid
Azithromycin: Avoid
Clindamycin: 50% dose with Cirrhosis
Metronidazole: 50% dose with moderate or severe liver disease
Tetracycline HCL: Avoid
1)Pen VK: No dose alteration needed
2)Amoxicillin: No dose adjustment
3)Azithromycin: Avoid Azithromycin in patients with Liver disease
4)Clindamycin:
a)Hepatitis: Full dose can be used with non-acute, non-fulminant hepatitis
b)Cirrhosis: Decrease Clindamycin total dose by 50%
5)Metronidazole (Flagyl)
a)mild Liver Disease: Prescribe the normal dose
b)moderate & severe Liver Disease: Decrease the total dose by at least 50%
c)Decreased dose of Flagyl used if both liver and kidney are affected: 250 mg q12h
6)Tetracycline HCL: Avoid Tetracycline HCL with Liver Disease
7)Doxycycline: No dose change needed with kidney/live/kidney & liver disease
Read more...
Pen VK: Normal dose
Amoxicillin: Normal dose
Augmentin: Normal dose
Keflex: Normal dose
Duricef: Normal dose
Clindamycin: Normal dose with Hepatitis
Clarithromycin: Normal dose with normal kidney function
Metronidazole: Normal dose with mild liver disease
Doxycycline: Normal dose
IV Vancomycin: Normal dose
ANTIBIOTICS WITH ALERTS
Ampicillin: Use caution/avoid
Azithromycin: Avoid
Clindamycin: 50% dose with Cirrhosis
Metronidazole: 50% dose with moderate or severe liver disease
Tetracycline HCL: Avoid
1)Pen VK: No dose alteration needed
2)Amoxicillin: No dose adjustment
3)Azithromycin: Avoid Azithromycin in patients with Liver disease
4)Clindamycin:
a)Hepatitis: Full dose can be used with non-acute, non-fulminant hepatitis
b)Cirrhosis: Decrease Clindamycin total dose by 50%
5)Metronidazole (Flagyl)
a)mild Liver Disease: Prescribe the normal dose
b)moderate & severe Liver Disease: Decrease the total dose by at least 50%
c)Decreased dose of Flagyl used if both liver and kidney are affected: 250 mg q12h
6)Tetracycline HCL: Avoid Tetracycline HCL with Liver Disease
7)Doxycycline: No dose change needed with kidney/live/kidney & liver disease
Read more...
Antibiotics and Kidney Disease
SAFE ANTIBIOTICS
Clindamycin: No dose change
Azithromycin: No dose change
Doxycycline: No dose change
Metronidazole: Normal dose for Mild/Mod. disease
Vancomycin Pulvules
ANTIBIOTICS WITH ALERTS
Pen VK: Prolong interval
Amoxicillin: Prolong interval
Augmentin: Decrease dose
Ampicillin: Decrease dose
Dicloxacillin: Decrease dose
Keflex: Prolong interval
Duricef: Prolong interval
Clarithromycin: Avoid
Metronidazole: Prolong interval for severe disease
IV Vancomycin: Avoid
1)Pen VK: INTERVAL PROLONGED; DOSE UNCHANGED
a)Serum Creatinine < 2.0 mg/dL or the CrCl is > 50 mL/minute:
Pen VK is dosed normally at 250-500 mg PO q6h
b)S. Creatinine 2.0 mg/dL to Predialysis or CrCl 10-50 mL/minute:
Pen VK is dosed at 250-500 mg q8-12h
c)Patient on Dialysis:
Pen VK is dosed at 250-500 q12-16h
2)Amoxicillin: DOSE UNCHANGED; INTERVAL PROLONGED
a)Serum Creatinine below 3.3 mg/dL or Cr Cl >30 ml/minute:
Dispense the normal dose of Amoxicillin: 250-500 mg PO q8h
b)Serum Creatinine above 3.3 mg/dL to Predialysis or Cr Cl 10-30 ml/minute:
Prolong the interval and dispense: 250-500 mg PO q12h
Avoid using the 875 mg tablet
c)Cr Cl <10 ml/minute or the Dialysis Patient:
Prolong the interval and dispense: 250-500 mg PO q24h
The dose must be administered after dialysis completion
3)Augmentin:
Decrease the total dosage by 50% in the renal compromised patient
4)Azithromycin:
Use full dose of Azithromycin in the Renal compromised patient
Kidney disease: No dose change is needed with Kidney disease or Renal failure
Used with 50% total dose reduction in patient with both Kidney & Liver disease
5)Metronidazole (Flagyl):
Dose adjustment is required only in the presence of renal failure/dialysis
Metronidazole should be dosed at 500 mg PO q12h instead of q8h after the dialysis
6)Tetracycline HCL:
a. Serum Creatinine between 1.25-2.0 mg/dL or CrCl 50-80 mL/minute:
Dose Tetracycline HCL q8-12h
b. Serum Creatinine between 2.0 mg/dL to Pre-dialysis or CrCl 10-50 mL/minute:
Dose Tetracycline HCL q12-24h
c. In the presence of Dialysis or CrCl <10 mL/minute:
Dose Tetracycline HCL q24h
7)Doxycycline:
No dose change needed with kidney/live/kidney & liver disease
Read more...
Clindamycin: No dose change
Azithromycin: No dose change
Doxycycline: No dose change
Metronidazole: Normal dose for Mild/Mod. disease
Vancomycin Pulvules
ANTIBIOTICS WITH ALERTS
Pen VK: Prolong interval
Amoxicillin: Prolong interval
Augmentin: Decrease dose
Ampicillin: Decrease dose
Dicloxacillin: Decrease dose
Keflex: Prolong interval
Duricef: Prolong interval
Clarithromycin: Avoid
Metronidazole: Prolong interval for severe disease
IV Vancomycin: Avoid
1)Pen VK: INTERVAL PROLONGED; DOSE UNCHANGED
a)Serum Creatinine < 2.0 mg/dL or the CrCl is > 50 mL/minute:
Pen VK is dosed normally at 250-500 mg PO q6h
b)S. Creatinine 2.0 mg/dL to Predialysis or CrCl 10-50 mL/minute:
Pen VK is dosed at 250-500 mg q8-12h
c)Patient on Dialysis:
Pen VK is dosed at 250-500 q12-16h
2)Amoxicillin: DOSE UNCHANGED; INTERVAL PROLONGED
a)Serum Creatinine below 3.3 mg/dL or Cr Cl >30 ml/minute:
Dispense the normal dose of Amoxicillin: 250-500 mg PO q8h
b)Serum Creatinine above 3.3 mg/dL to Predialysis or Cr Cl 10-30 ml/minute:
Prolong the interval and dispense: 250-500 mg PO q12h
Avoid using the 875 mg tablet
c)Cr Cl <10 ml/minute or the Dialysis Patient:
Prolong the interval and dispense: 250-500 mg PO q24h
The dose must be administered after dialysis completion
3)Augmentin:
Decrease the total dosage by 50% in the renal compromised patient
4)Azithromycin:
Use full dose of Azithromycin in the Renal compromised patient
Kidney disease: No dose change is needed with Kidney disease or Renal failure
Used with 50% total dose reduction in patient with both Kidney & Liver disease
5)Metronidazole (Flagyl):
Dose adjustment is required only in the presence of renal failure/dialysis
Metronidazole should be dosed at 500 mg PO q12h instead of q8h after the dialysis
6)Tetracycline HCL:
a. Serum Creatinine between 1.25-2.0 mg/dL or CrCl 50-80 mL/minute:
Dose Tetracycline HCL q8-12h
b. Serum Creatinine between 2.0 mg/dL to Pre-dialysis or CrCl 10-50 mL/minute:
Dose Tetracycline HCL q12-24h
c. In the presence of Dialysis or CrCl <10 mL/minute:
Dose Tetracycline HCL q24h
7)Doxycycline:
No dose change needed with kidney/live/kidney & liver disease
Read more...
Monday, September 6, 2010
Allergies in Dentistry
Sulpha Allergy: "Sulfa allergy" is a term used to describe adverse drug reactions to sulfonamides, a group of drugs that includes those with and without antibiotic characteristics.
b) Sulphite/bisulphite Allergy: All dental local anesthetics that contain epinephrine contain metabisulfite which is an antioxidant to prevent breakdown of epi.
Sulfites are added to injectable epinephrine (such as in the Epi-Pen) to prevent browning, which decreases the effectiveness of the drug. However, epinephrine has not been reported to cause adverse reactions in people with sulfite allergy, and should not be withheld in an allergic emergency. Injectable epinephrine may prove life saving in people with sulfite allergy experiencing anaphylaxis.
Read more...
b) Sulphite/bisulphite Allergy: All dental local anesthetics that contain epinephrine contain metabisulfite which is an antioxidant to prevent breakdown of epi.
Sulfites are added to injectable epinephrine (such as in the Epi-Pen) to prevent browning, which decreases the effectiveness of the drug. However, epinephrine has not been reported to cause adverse reactions in people with sulfite allergy, and should not be withheld in an allergic emergency. Injectable epinephrine may prove life saving in people with sulfite allergy experiencing anaphylaxis.
Patients who are allergic to sulpha are not allergic to bisulphites and vice-versa. It is safe to give epi containing local anesthetics with sulpha allergy
c)Penicillin : Allergic to Penicillin means allergy to all members of penicillin family. If its a simple rash type of reaction then we can use cephalosporins but in case of severe anaphylaxis type reaction even cephalosporins are contraindicated. Even for rash type reactions it is advisable not to give cephalosporins because of other choice available at disposal.
d)Codeine : A patient allergic to codeine is usually allergic to morphine due to cross reactivity. Before giving out prescription make sure you not only ask "Are you allergic to codeine/morphine but ask have you taken codeine/morphine before" ?
e)Local Anesthetics: Allery to amide anesthetics is very rare. Allergy to one amide does not contraindicate the use of other amides. There is definite cross reactivity with ester anesthetics ie allergy to one ester anesthetic means allergy to all ester anesthetics
f) Latex Allergy: Children with spina bifida are at extraordinary high risk of latex hypersensitivity.
Screening: Have you experienced hives, wheezing, rashes, coughing, or difficulty in breathing when handling items like balloons and rubber balls?”
“Have you experienced any of these symptoms after contact with medical or dental products like rubber gloves or dental dams?”
“Have you ever worked in a health care setting? In the rubber industry?”
Dental Management: There are two main sources of latex exposure to our patients. The primary source is latex gloves. The practitioner must wear nonlatex gloves for the latex-sensitive patient. The second source is aerosolized latex. Latex proteins adhere to the cornstarch powder added by manufacturers to assist in donning and removal. It is a common misconception that it is the powder to which a person is allergic; rather, it is the protein sticking to the powder.
Each time powdered gloves are used, latex is introduced into the air, where it can remain up to 12 hours.(14) This “latex dust” acts as a sensitizing aeroallergen, and in sensitive people has caused serious, asthmatic life-threatening reactions. Therefore, merely wearing nonlatex gloves while treating an allergic patient may be an inadequate precaution when powdered latex gloves are being used elsewhere in the office.
If there is any question of safety, it is often advisable to have an allergic patient come to your office and simply sit in your waiting room. If there is any risk, it may be prudent to refer the patient to a latex-safe office.
For the latex-allergic patient, the following are recommended:
the patient should be the first patient of the day (low “latex dust”);
no direct contact with latex is allowed;
nonlatex substitutes for patient care must be used: prophy cups, dental dam, N20 mask, etc.;
latex in the room must be ALARA (As Low As Reasonably Achievable);
any latex items that cannot be removed must be covered;
the room should be close to the entrance (in case of emergency);
personnel setting up the room must wear nonlatex gloves;
instruments must be handled only with nonlatex gloves;
lab work must be handled with nonlatex gloves and thoroughly rinsed before placement;
multi-dose glass vials of anesthetic or glass ampules should be used;
if the patient is taking beta blockers, a medical consult must be done (these drugs interfere with the medications needed to resuscitate a patient should an emergency arise);
use nonlatex blood pressure cuffs;
wear minimal perfume and aftershave;
gutta percha has a potential for cross-allergencity (an alternative is Ketac-Endo fill).
Original Author for latex topic By Lawrence D. Duffield, DDS
Journal of the Michigan Dental Association
June 1998 href="http://www.latexallergylinks.org/MDA.html">http://www.latexallergylinks.org/MDA.html
c)Penicillin : Allergic to Penicillin means allergy to all members of penicillin family. If its a simple rash type of reaction then we can use cephalosporins but in case of severe anaphylaxis type reaction even cephalosporins are contraindicated. Even for rash type reactions it is advisable not to give cephalosporins because of other choice available at disposal.
d)Codeine : A patient allergic to codeine is usually allergic to morphine due to cross reactivity. Before giving out prescription make sure you not only ask "Are you allergic to codeine/morphine but ask have you taken codeine/morphine before" ?
e)Local Anesthetics: Allery to amide anesthetics is very rare. Allergy to one amide does not contraindicate the use of other amides. There is definite cross reactivity with ester anesthetics ie allergy to one ester anesthetic means allergy to all ester anesthetics
f) Latex Allergy: Children with spina bifida are at extraordinary high risk of latex hypersensitivity.
Screening: Have you experienced hives, wheezing, rashes, coughing, or difficulty in breathing when handling items like balloons and rubber balls?”
“Have you experienced any of these symptoms after contact with medical or dental products like rubber gloves or dental dams?”
“Have you ever worked in a health care setting? In the rubber industry?”
Dental Management: There are two main sources of latex exposure to our patients. The primary source is latex gloves. The practitioner must wear nonlatex gloves for the latex-sensitive patient. The second source is aerosolized latex. Latex proteins adhere to the cornstarch powder added by manufacturers to assist in donning and removal. It is a common misconception that it is the powder to which a person is allergic; rather, it is the protein sticking to the powder.
Each time powdered gloves are used, latex is introduced into the air, where it can remain up to 12 hours.(14) This “latex dust” acts as a sensitizing aeroallergen, and in sensitive people has caused serious, asthmatic life-threatening reactions. Therefore, merely wearing nonlatex gloves while treating an allergic patient may be an inadequate precaution when powdered latex gloves are being used elsewhere in the office.
If there is any question of safety, it is often advisable to have an allergic patient come to your office and simply sit in your waiting room. If there is any risk, it may be prudent to refer the patient to a latex-safe office.
For the latex-allergic patient, the following are recommended:
the patient should be the first patient of the day (low “latex dust”);
no direct contact with latex is allowed;
nonlatex substitutes for patient care must be used: prophy cups, dental dam, N20 mask, etc.;
latex in the room must be ALARA (As Low As Reasonably Achievable);
any latex items that cannot be removed must be covered;
the room should be close to the entrance (in case of emergency);
personnel setting up the room must wear nonlatex gloves;
instruments must be handled only with nonlatex gloves;
lab work must be handled with nonlatex gloves and thoroughly rinsed before placement;
multi-dose glass vials of anesthetic or glass ampules should be used;
if the patient is taking beta blockers, a medical consult must be done (these drugs interfere with the medications needed to resuscitate a patient should an emergency arise);
use nonlatex blood pressure cuffs;
wear minimal perfume and aftershave;
gutta percha has a potential for cross-allergencity (an alternative is Ketac-Endo fill).
Original Author for latex topic By Lawrence D. Duffield, DDS
Journal of the Michigan Dental Association
June 1998 href="http://www.latexallergylinks.org/MDA.html">http://www.latexallergylinks.org/MDA.html
Read more...
Sunday, July 26, 2009
Impression Materials
EDENTULOUS IMPRESSIONS
ZOE impression paste and impression plaster
ADV Examples of mucostatic impression materials, do not compress the tissue during seating of tray. Ideal material for taking impression of Edentulous structures.
Disadv Are inelastic, cannot be removed past undercuts without fracturing or distorting.
Solution Use very fluid, light body elastomeric impression materials
ELASTOMERIC IMPRESSION MATERIALS
a) Polysulfide, byproduct water. Custom trays recommended for impression making to reduce quantity of material and hence dimensional changes. Lowest viscosity and so one of the least stiff allowing it to be removed from undercut areas with minimum stress
b)Condensation silicone, byproduct ethyl alchohol
c)Additional silicone/ Polyvinyl Siloxanes. No reaction byproduct but reaction between moisture and residual hydride polymers can lead to production of hydrogen gas which can result in pinpoint voids in gypsum if casts are poured soon after removal from mouth. So wait an hour.
Sulphur in latex/vinyl gloves inhibit the setting of this material. Touching the tooth with gloved finger can inhibit the setting of impression material in critical area producing major distortion
d) Polyether
PUTTY refers to high viscosity materials which are highly filled so that less polymer is present and there is less polymerization shrinkage.
IMPRESSION MAKING
Longer the impression material remains in the mouth, less the distortion on removal
I) Multiple Mix technique
a)LIGHT body material- used with syringe and placed directly on hard and soft tissues
b)HEAVY body material- used in tray to support light body material
II) Monophase or Single Viscosity technique : MEDIUM Viscosity materials are used. Single mix is made and part of it is placed in syringe and part on tray. When the medium viscosity material is pushed through the syringe the viscosity decreases (pseudoplastic property). Material in tray retains its medium viscosity and when seated forces the syringed material past critical areas.
III) Putty Wash Technique:
a) Two step technique: Make a preliminary impression with thick putty material in a stock tray using thin polyethylene sheet as a spacer for light body material. This makes a custom tray in which light body material can be used to make a final wash impression. Some light body material can be placed directly onto the preparation.
b)Single step technique: Light body material is syringed in place and unset putty is seated in a tray and then in mouth. Disadv is that the higher viscosity material may displace the lighter material and the critical areas may be reproduced in putty rather than lighter material and the required detail may not be captured in the material.
Both these techniques have distortion as their problem. Inadequate space for light body or distortion of set putty can cause problems.
POURING THE CAST
a) Two or three dies can easily be constructed as these materials are dimensionally stable. Each successive die will be less accurate than the first.
b)The time interval between the impression pours should be less than 30 mins.
c)Polyvinysiloxane materials are hydrophobic which make it difficult to wet the surface by gypsum forming slurry. Use the surfactant spray to form a bubble free cast.
WORKING AND SETTING TIME
Store or Mix the material on cool slab to increase the working time and then the setting time is decreased in mouth at high temp. Working and setting time decrease as viscosity increases.
DIMENSIONAL STABILITY
Polysulfides and Condensation silicones lose reaction byproducts, water and alcohol respectively, so for maximum accuracy, pour these impressions within 30 mins.
Additional silicone and Polyether can be stored from 24 hours to 1 week.
DISINFECTION
Condensation silicones, Polysulfides and Additional silicones can be disinfected with any EPA disinfectant.
Polyethers are suseptible to dimensional changes if immersed for longer than 10 mins due to absorption of water and leaching of water soluble plasticizer.
Long immersion time with Polyvinylsiloxanes may cause the surfactant to leach out rendering the material less hydrophilic and hence difficult to pour.
Rinse and dry the impression after 10 mins of immersion in disinfectant.
EDENTULOUS IMPRESSIONS
ZOE impression paste and impression plaster
ADV Examples of mucostatic impression materials, do not compress the tissue during seating of tray. Ideal material for taking impression of Edentulous structures.
Disadv Are inelastic, cannot be removed past undercuts without fracturing or distorting.
Solution Use very fluid, light body elastomeric impression materials
ELASTOMERIC IMPRESSION MATERIALS
a) Polysulfide, byproduct water. Custom trays recommended for impression making to reduce quantity of material and hence dimensional changes. Lowest viscosity and so one of the least stiff allowing it to be removed from undercut areas with minimum stress
b)Condensation silicone, byproduct ethyl alchohol
c)Additional silicone/ Polyvinyl Siloxanes. No reaction byproduct but reaction between moisture and residual hydride polymers can lead to production of hydrogen gas which can result in pinpoint voids in gypsum if casts are poured soon after removal from mouth. So wait an hour.
Sulphur in latex/vinyl gloves inhibit the setting of this material. Touching the tooth with gloved finger can inhibit the setting of impression material in critical area producing major distortion
d) Polyether
PUTTY refers to high viscosity materials which are highly filled so that less polymer is present and there is less polymerization shrinkage.
IMPRESSION MAKING
Longer the impression material remains in the mouth, less the distortion on removal
I) Multiple Mix technique
a)LIGHT body material- used with syringe and placed directly on hard and soft tissues
b)HEAVY body material- used in tray to support light body material
II) Monophase or Single Viscosity technique : MEDIUM Viscosity materials are used. Single mix is made and part of it is placed in syringe and part on tray. When the medium viscosity material is pushed through the syringe the viscosity decreases (pseudoplastic property). Material in tray retains its medium viscosity and when seated forces the syringed material past critical areas.
III) Putty Wash Technique:
a) Two step technique: Make a preliminary impression with thick putty material in a stock tray using thin polyethylene sheet as a spacer for light body material. This makes a custom tray in which light body material can be used to make a final wash impression. Some light body material can be placed directly onto the preparation.
b)Single step technique: Light body material is syringed in place and unset putty is seated in a tray and then in mouth. Disadv is that the higher viscosity material may displace the lighter material and the critical areas may be reproduced in putty rather than lighter material and the required detail may not be captured in the material.
Both these techniques have distortion as their problem. Inadequate space for light body or distortion of set putty can cause problems.
POURING THE CAST
a) Two or three dies can easily be constructed as these materials are dimensionally stable. Each successive die will be less accurate than the first.
b)The time interval between the impression pours should be less than 30 mins.
c)Polyvinysiloxane materials are hydrophobic which make it difficult to wet the surface by gypsum forming slurry. Use the surfactant spray to form a bubble free cast.
WORKING AND SETTING TIME
Store or Mix the material on cool slab to increase the working time and then the setting time is decreased in mouth at high temp. Working and setting time decrease as viscosity increases.
DIMENSIONAL STABILITY
Polysulfides and Condensation silicones lose reaction byproducts, water and alcohol respectively, so for maximum accuracy, pour these impressions within 30 mins.
Additional silicone and Polyether can be stored from 24 hours to 1 week.
DISINFECTION
Condensation silicones, Polysulfides and Additional silicones can be disinfected with any EPA disinfectant.
Polyethers are suseptible to dimensional changes if immersed for longer than 10 mins due to absorption of water and leaching of water soluble plasticizer.
Long immersion time with Polyvinylsiloxanes may cause the surfactant to leach out rendering the material less hydrophilic and hence difficult to pour.
Rinse and dry the impression after 10 mins of immersion in disinfectant.
Polysulfide (Coe-Flex,Permlastic)
Advantages High tear resistant,Modest Cost
Disadvantages Long working time,Requires custom tray,Odor,Pour within 1 hour,Stains clothes
Vinyl Polysiloxane (Aquasil,Express/Imprint/Imprint II,Extrude,Polysil)
Advantages One material,Easily seen margins,Pour repeatedly,Stable delay pour
Disadvantages Hydrophobic,No flow If sulcus moist,Low tear strength,High cost,Difficult to pour cast
Polyether (Impergum,Permadyne)
Advantages Fast setting,Least hydrophobic,Easily seen margins,Good stability,Delay pour
Disadvantages Stiff, high modulus, Bitter taste, Needs to block undercuts,Absorbs water,Leaches components,High Cost.
Read more...
ZOE impression paste and impression plaster
ADV Examples of mucostatic impression materials, do not compress the tissue during seating of tray. Ideal material for taking impression of Edentulous structures.
Disadv Are inelastic, cannot be removed past undercuts without fracturing or distorting.
Solution Use very fluid, light body elastomeric impression materials
ELASTOMERIC IMPRESSION MATERIALS
a) Polysulfide, byproduct water. Custom trays recommended for impression making to reduce quantity of material and hence dimensional changes. Lowest viscosity and so one of the least stiff allowing it to be removed from undercut areas with minimum stress
b)Condensation silicone, byproduct ethyl alchohol
c)Additional silicone/ Polyvinyl Siloxanes. No reaction byproduct but reaction between moisture and residual hydride polymers can lead to production of hydrogen gas which can result in pinpoint voids in gypsum if casts are poured soon after removal from mouth. So wait an hour.
Sulphur in latex/vinyl gloves inhibit the setting of this material. Touching the tooth with gloved finger can inhibit the setting of impression material in critical area producing major distortion
d) Polyether
PUTTY refers to high viscosity materials which are highly filled so that less polymer is present and there is less polymerization shrinkage.
IMPRESSION MAKING
Longer the impression material remains in the mouth, less the distortion on removal
I) Multiple Mix technique
a)LIGHT body material- used with syringe and placed directly on hard and soft tissues
b)HEAVY body material- used in tray to support light body material
II) Monophase or Single Viscosity technique : MEDIUM Viscosity materials are used. Single mix is made and part of it is placed in syringe and part on tray. When the medium viscosity material is pushed through the syringe the viscosity decreases (pseudoplastic property). Material in tray retains its medium viscosity and when seated forces the syringed material past critical areas.
III) Putty Wash Technique:
a) Two step technique: Make a preliminary impression with thick putty material in a stock tray using thin polyethylene sheet as a spacer for light body material. This makes a custom tray in which light body material can be used to make a final wash impression. Some light body material can be placed directly onto the preparation.
b)Single step technique: Light body material is syringed in place and unset putty is seated in a tray and then in mouth. Disadv is that the higher viscosity material may displace the lighter material and the critical areas may be reproduced in putty rather than lighter material and the required detail may not be captured in the material.
Both these techniques have distortion as their problem. Inadequate space for light body or distortion of set putty can cause problems.
POURING THE CAST
a) Two or three dies can easily be constructed as these materials are dimensionally stable. Each successive die will be less accurate than the first.
b)The time interval between the impression pours should be less than 30 mins.
c)Polyvinysiloxane materials are hydrophobic which make it difficult to wet the surface by gypsum forming slurry. Use the surfactant spray to form a bubble free cast.
WORKING AND SETTING TIME
Store or Mix the material on cool slab to increase the working time and then the setting time is decreased in mouth at high temp. Working and setting time decrease as viscosity increases.
DIMENSIONAL STABILITY
Polysulfides and Condensation silicones lose reaction byproducts, water and alcohol respectively, so for maximum accuracy, pour these impressions within 30 mins.
Additional silicone and Polyether can be stored from 24 hours to 1 week.
DISINFECTION
Condensation silicones, Polysulfides and Additional silicones can be disinfected with any EPA disinfectant.
Polyethers are suseptible to dimensional changes if immersed for longer than 10 mins due to absorption of water and leaching of water soluble plasticizer.
Long immersion time with Polyvinylsiloxanes may cause the surfactant to leach out rendering the material less hydrophilic and hence difficult to pour.
Rinse and dry the impression after 10 mins of immersion in disinfectant.
EDENTULOUS IMPRESSIONS
ZOE impression paste and impression plaster
ADV Examples of mucostatic impression materials, do not compress the tissue during seating of tray. Ideal material for taking impression of Edentulous structures.
Disadv Are inelastic, cannot be removed past undercuts without fracturing or distorting.
Solution Use very fluid, light body elastomeric impression materials
ELASTOMERIC IMPRESSION MATERIALS
a) Polysulfide, byproduct water. Custom trays recommended for impression making to reduce quantity of material and hence dimensional changes. Lowest viscosity and so one of the least stiff allowing it to be removed from undercut areas with minimum stress
b)Condensation silicone, byproduct ethyl alchohol
c)Additional silicone/ Polyvinyl Siloxanes. No reaction byproduct but reaction between moisture and residual hydride polymers can lead to production of hydrogen gas which can result in pinpoint voids in gypsum if casts are poured soon after removal from mouth. So wait an hour.
Sulphur in latex/vinyl gloves inhibit the setting of this material. Touching the tooth with gloved finger can inhibit the setting of impression material in critical area producing major distortion
d) Polyether
PUTTY refers to high viscosity materials which are highly filled so that less polymer is present and there is less polymerization shrinkage.
IMPRESSION MAKING
Longer the impression material remains in the mouth, less the distortion on removal
I) Multiple Mix technique
a)LIGHT body material- used with syringe and placed directly on hard and soft tissues
b)HEAVY body material- used in tray to support light body material
II) Monophase or Single Viscosity technique : MEDIUM Viscosity materials are used. Single mix is made and part of it is placed in syringe and part on tray. When the medium viscosity material is pushed through the syringe the viscosity decreases (pseudoplastic property). Material in tray retains its medium viscosity and when seated forces the syringed material past critical areas.
III) Putty Wash Technique:
a) Two step technique: Make a preliminary impression with thick putty material in a stock tray using thin polyethylene sheet as a spacer for light body material. This makes a custom tray in which light body material can be used to make a final wash impression. Some light body material can be placed directly onto the preparation.
b)Single step technique: Light body material is syringed in place and unset putty is seated in a tray and then in mouth. Disadv is that the higher viscosity material may displace the lighter material and the critical areas may be reproduced in putty rather than lighter material and the required detail may not be captured in the material.
Both these techniques have distortion as their problem. Inadequate space for light body or distortion of set putty can cause problems.
POURING THE CAST
a) Two or three dies can easily be constructed as these materials are dimensionally stable. Each successive die will be less accurate than the first.
b)The time interval between the impression pours should be less than 30 mins.
c)Polyvinysiloxane materials are hydrophobic which make it difficult to wet the surface by gypsum forming slurry. Use the surfactant spray to form a bubble free cast.
WORKING AND SETTING TIME
Store or Mix the material on cool slab to increase the working time and then the setting time is decreased in mouth at high temp. Working and setting time decrease as viscosity increases.
DIMENSIONAL STABILITY
Polysulfides and Condensation silicones lose reaction byproducts, water and alcohol respectively, so for maximum accuracy, pour these impressions within 30 mins.
Additional silicone and Polyether can be stored from 24 hours to 1 week.
DISINFECTION
Condensation silicones, Polysulfides and Additional silicones can be disinfected with any EPA disinfectant.
Polyethers are suseptible to dimensional changes if immersed for longer than 10 mins due to absorption of water and leaching of water soluble plasticizer.
Long immersion time with Polyvinylsiloxanes may cause the surfactant to leach out rendering the material less hydrophilic and hence difficult to pour.
Rinse and dry the impression after 10 mins of immersion in disinfectant.
Polysulfide (Coe-Flex,Permlastic)
Advantages High tear resistant,Modest Cost
Disadvantages Long working time,Requires custom tray,Odor,Pour within 1 hour,Stains clothes
Vinyl Polysiloxane (Aquasil,Express/Imprint/Imprint II,Extrude,Polysil)
Advantages One material,Easily seen margins,Pour repeatedly,Stable delay pour
Disadvantages Hydrophobic,No flow If sulcus moist,Low tear strength,High cost,Difficult to pour cast
Polyether (Impergum,Permadyne)
Advantages Fast setting,Least hydrophobic,Easily seen margins,Good stability,Delay pour
Disadvantages Stiff, high modulus, Bitter taste, Needs to block undercuts,Absorbs water,Leaches components,High Cost.
Read more...
Sunday, September 21, 2008
Fluoride Causes Cavities
Like most drugs, fluoride causes what it purports to cure.
Dentists tell us that drinking “optimal” levels of fluoridated water - 1 part per million or 1 milligram fluoride per liter (quart) - each day, reduces tooth decay without serious side effects. While this dental dogma has never been proven scientifically, research shows, above optimal fluoride levels causes tooth decay and most Americans get more fluoride then they need.
The severe outward sign of fluoride overdose is dental fluorosis - yellow, brown or black stained and/or pitted teeth. Cavities increase in people with severe fluorosis according to a dentistry textbook entitled, “Dentistry, Dental Practice and the Community,” by Burt and Eklund.
This phenomenon has been demonstrated in the United States from National Institute of Dentistry and Craniofacial Research studies in seven communities in northern Illinois. The results of the dental decay examinations, related to fluoride concentrations in drinking water, form a J-shaped curve. With increasing fluoride levels, cavity experience diminishes to a certain point and then starts to rise again, the authors report.
These data suggest that the true relationship between water fluoride levels and dental decay is the J-shaped curve, with the turning point in the J being something between 3 and 4 times the optimal level, they write.
Additionally, protein-calorie malnutrition, iodine deficiency and excessive fluoride increase susceptibility to dental caries, according to the U.S. Surgeon General's first ever Oral Health Report.
The problem is that children already receive above optimum doses of fluoride even without drinking fluoridated water. By 1974 samples of duplicate meals indicated more than ten times as much fluoride as had been found thirty years earlier – and this study didn't factor in fluoride content of snack foods.
Excess fluoride may be contributing to the growing tooth decay problem in the U.S. Even though U.S. children are fluoride saturated from water, air, foods, beverages and dental products, the surgeon general reports that tooth decay is still a major problem and an epidemic in our poor and minority populations. The Centers for Disease Control reports that up to 48% of school children sport dental fluorosis - 4% is severe.
Children from the African country of Uganda have less tooth decay than American children even though most Ugandan children don’t use fluoride toothpaste or even a toothbrush to clean their teeth. In fact, Ugandan children who drink high fluoride water have more tooth decay than their equals in low fluoride districts, according to “Clinical Oral Investigations."
A different paper, presented at a June 2001 meeting of the International Association of Dental Research by Louw, et al, shows the same unexpected results with a different African population. Children drinking 3.0 mg/L water fluoride have more cavities than children drinking .19 and .48 mg/L fluoride.
Americans drink fluoridated water, use fluoridated toothpaste, eat foods and beverages made with fluoridated water, along with fluoride pesticide residues on produce and grains. Fluoride supplements, mouthrinses, treatments, varnishes, and other fluoridated dental products are used profusely in the U.S. And fluoride is a major industrial air pollutant. Fluoride is also a component of many drugs, in teflon and sulfuryl fluoride has replaced methyl bromide as a post-harves fumigant.
The big difference between American and Ugandan children is diet. The basic Ugandan diet is composed of complex carbohydrates, e.g., cooking banana, cassava, potatoes, maize and sorghum eaten at regular meals. About 80% of the children reported no between-meal intake of sugar containing items.
In American, black children have the highest rates and severity of dental fluorosis and have among the highest rates of tooth decay.
Fluoride is neither a nutrient nor essential. Fluorosed teeth contain more fluoride and less calcium than normal teeth, according to A. K. Susheela, Ph.D., Director, Fluorosis Research and Rural Development Foundation, in “A Treatise on Fluorosis.”
Research on about 400,000 Indian children by Teotia and Teotia, indicate that cavities are caused by high fluoride and low dietary calcium intakes, separately and through their interactions.
One would think dentists would be campaigning to have calcium placed in the drinking water but then they might lose the financial support they enjoy from fluoride manufacturers of toothpastes and other dental materials. When dentists endorse fluoride, people buy it.
Dentists report they are seeing more tooth decay among their soda drinking patients despite full fluoride “protection.” Ironically, many soft drinks and juices contain “optimal” fluoride levels because fluoridated tap water is used to make them.
And a study in the Journal of “Contemporary Dental Practice” shows that, among people who drink fluoridated water and use fluoride toothpaste, tooth decay still progresses after snacking on cola, apple juice or sweetened yogurt between meals. However, cavities remineralized (partially reversed) when snacks were whole milk, skim milk, 2% milk, cheddar cheese, plain yogurt and chocolate milk or no snacks at all.
An article in “RDH” (Registered Dental Hygienist) reports, “Dr. Carole Palmer, professor of nutrition and preventive dentistry at Tufts University, says, ‘We’re looking at why these things (nutrition in dentistry) have fallen by the wayside. There was a perception, perhaps, that fluoride had resolved the problem (of caries), but that’s far from the truth. A lack of research and funding in nutrition and oral connections has made it difficult to move forward. But nutritional counseling and diet counseling need to be important components of preventive dental care.’”
Like most things American, fluoride is overblown, over-prescribed, and over-used. Along with the expansion of fast food restaurants and American waistlines, fluoride's expansion into the food supply via the water supply is out of control and may be creating instead of curing tooth decay. It's time to stop water fluoridation. Fluoride can't fix a poor diet
Posted by: SallyStride
http://www.granitebaypt.com/detail/93536.html
Read more...
Dentists tell us that drinking “optimal” levels of fluoridated water - 1 part per million or 1 milligram fluoride per liter (quart) - each day, reduces tooth decay without serious side effects. While this dental dogma has never been proven scientifically, research shows, above optimal fluoride levels causes tooth decay and most Americans get more fluoride then they need.
The severe outward sign of fluoride overdose is dental fluorosis - yellow, brown or black stained and/or pitted teeth. Cavities increase in people with severe fluorosis according to a dentistry textbook entitled, “Dentistry, Dental Practice and the Community,” by Burt and Eklund.
This phenomenon has been demonstrated in the United States from National Institute of Dentistry and Craniofacial Research studies in seven communities in northern Illinois. The results of the dental decay examinations, related to fluoride concentrations in drinking water, form a J-shaped curve. With increasing fluoride levels, cavity experience diminishes to a certain point and then starts to rise again, the authors report.
These data suggest that the true relationship between water fluoride levels and dental decay is the J-shaped curve, with the turning point in the J being something between 3 and 4 times the optimal level, they write.
Additionally, protein-calorie malnutrition, iodine deficiency and excessive fluoride increase susceptibility to dental caries, according to the U.S. Surgeon General's first ever Oral Health Report.
The problem is that children already receive above optimum doses of fluoride even without drinking fluoridated water. By 1974 samples of duplicate meals indicated more than ten times as much fluoride as had been found thirty years earlier – and this study didn't factor in fluoride content of snack foods.
Excess fluoride may be contributing to the growing tooth decay problem in the U.S. Even though U.S. children are fluoride saturated from water, air, foods, beverages and dental products, the surgeon general reports that tooth decay is still a major problem and an epidemic in our poor and minority populations. The Centers for Disease Control reports that up to 48% of school children sport dental fluorosis - 4% is severe.
Children from the African country of Uganda have less tooth decay than American children even though most Ugandan children don’t use fluoride toothpaste or even a toothbrush to clean their teeth. In fact, Ugandan children who drink high fluoride water have more tooth decay than their equals in low fluoride districts, according to “Clinical Oral Investigations."
A different paper, presented at a June 2001 meeting of the International Association of Dental Research by Louw, et al, shows the same unexpected results with a different African population. Children drinking 3.0 mg/L water fluoride have more cavities than children drinking .19 and .48 mg/L fluoride.
Americans drink fluoridated water, use fluoridated toothpaste, eat foods and beverages made with fluoridated water, along with fluoride pesticide residues on produce and grains. Fluoride supplements, mouthrinses, treatments, varnishes, and other fluoridated dental products are used profusely in the U.S. And fluoride is a major industrial air pollutant. Fluoride is also a component of many drugs, in teflon and sulfuryl fluoride has replaced methyl bromide as a post-harves fumigant.
The big difference between American and Ugandan children is diet. The basic Ugandan diet is composed of complex carbohydrates, e.g., cooking banana, cassava, potatoes, maize and sorghum eaten at regular meals. About 80% of the children reported no between-meal intake of sugar containing items.
In American, black children have the highest rates and severity of dental fluorosis and have among the highest rates of tooth decay.
Fluoride is neither a nutrient nor essential. Fluorosed teeth contain more fluoride and less calcium than normal teeth, according to A. K. Susheela, Ph.D., Director, Fluorosis Research and Rural Development Foundation, in “A Treatise on Fluorosis.”
Research on about 400,000 Indian children by Teotia and Teotia, indicate that cavities are caused by high fluoride and low dietary calcium intakes, separately and through their interactions.
One would think dentists would be campaigning to have calcium placed in the drinking water but then they might lose the financial support they enjoy from fluoride manufacturers of toothpastes and other dental materials. When dentists endorse fluoride, people buy it.
Dentists report they are seeing more tooth decay among their soda drinking patients despite full fluoride “protection.” Ironically, many soft drinks and juices contain “optimal” fluoride levels because fluoridated tap water is used to make them.
And a study in the Journal of “Contemporary Dental Practice” shows that, among people who drink fluoridated water and use fluoride toothpaste, tooth decay still progresses after snacking on cola, apple juice or sweetened yogurt between meals. However, cavities remineralized (partially reversed) when snacks were whole milk, skim milk, 2% milk, cheddar cheese, plain yogurt and chocolate milk or no snacks at all.
An article in “RDH” (Registered Dental Hygienist) reports, “Dr. Carole Palmer, professor of nutrition and preventive dentistry at Tufts University, says, ‘We’re looking at why these things (nutrition in dentistry) have fallen by the wayside. There was a perception, perhaps, that fluoride had resolved the problem (of caries), but that’s far from the truth. A lack of research and funding in nutrition and oral connections has made it difficult to move forward. But nutritional counseling and diet counseling need to be important components of preventive dental care.’”
Like most things American, fluoride is overblown, over-prescribed, and over-used. Along with the expansion of fast food restaurants and American waistlines, fluoride's expansion into the food supply via the water supply is out of control and may be creating instead of curing tooth decay. It's time to stop water fluoridation. Fluoride can't fix a poor diet
Posted by: SallyStride
http://www.granitebaypt.com/detail/93536.html
Read more...
Friday, July 25, 2008
Writing a Personal Statement for Dental School
I have personally been through the process of applying to dental schools for an advanced standing program and I know how it feels when it comes to writing a personal statement especially when you have no clue what to write and what exactly they are looking for. When I was in need, somebody helped me and now its my turn to help others. Before I start, the following views are based on the advices/guidance I was given and from my own personal experience in this journey so far but you are the best judge for yourself.
The personal statement is one of the most important aspects of one's application which unfortunately is overlooked by prospective candidates. They are just worried about hitting the deck with scores above 90. A strong and very well written personal statement can make the all the difference. It is your first introduction to the admissions committee that also demonstrates your writing abilities.They are very experienced and they can actually make out a lot about you without actually seeing you just by reading what reflects from it.
A good personal statement should address why or how you became interested in dentistry, your past achievements and your vision of your future goals.You can mention what you can contribute to a given program if you are selected (this is also a potential interview question).
Why you ? Highlight aspects of your life that set you apart from other international dental graduates. Perhaps you have a unique cultural background that
broadens your perspective.Try to emphasize something about yourself that makes you a little different than the “average” applicant (achievements academically, in sports, any research experience, observership or dental assisting experience,any volunteer experience may not only be in dentistry but for any social cause), this will help you to “stand out from the crowd”. Admissions committees will read hundreds of personal statements; you should write in a way that attracts their attention and keeps them interested in what you have to say.
The personal statement should also allude to your professional aspirations. Be as specific as possible without making up goals. If you have a desire to do research,specialize in a particular area, focus on prevention and public health, or become a general practitioner, say what your professional career ideally would entail. You are not locking yourself into a particular career path by doing this. Everyone realizes that goals can change remarkably over the course of time, but being specific gives an idea about how focused you are.Be professional in your choice of words.
It wont be a bad idea to write a general sop which you can send to all the schools.In case you are very particular about some school then you can modify it a little bit to highlight the attributes that particular school is looking for in you. For instance some schools desire the candidates to have leadership qualities. For such schools write something that shows your leadership abilities, if you ever lead a group etc.You may also like to mention why did you come to US or why you selected this school over others.Find out some key points about that particular program and mention them in you sop. This shows that you are really interested in their program and that you actually did your homework.
Represent yourself accurately and positively.Don't be modest about your strengths and avoid mentioning weaker aspects of your application, such as poor TOEFL or NDBE scores.If there happen to be irregularities in your academic record or any other points which might need explanation, you can write about that but keep it brief and try to keep the main focus of your essay on the positive aspects.
Like any other essay a clear introduction, a body and a conclusion are a must. Make sure it is proofread, spell-checked, and grammatically correct.
You can take professional help also. There are agencies that charge you and write a SOP for you but I feel you are the best person to write about yourself. In case someone is writing for you just make sure you know whats written in your sop and review it before going for an interview. They may pick up few questions from it and ask you to elaborate.
Last piece of advice is that please do not make it too long.Be very precise and clear. With hundreds of students applying to these schools each term no one has the time or the patience to read all the junk. A good personal statement according to me is the one which is just about a page long and yet contains all that shows you as a bright and promising candidate. Some schools also mention that the personal statement be written in particular font size. Check for the requirements and modify accordingly.
All the very Best..!!!!
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The personal statement is one of the most important aspects of one's application which unfortunately is overlooked by prospective candidates. They are just worried about hitting the deck with scores above 90. A strong and very well written personal statement can make the all the difference. It is your first introduction to the admissions committee that also demonstrates your writing abilities.They are very experienced and they can actually make out a lot about you without actually seeing you just by reading what reflects from it.
A good personal statement should address why or how you became interested in dentistry, your past achievements and your vision of your future goals.You can mention what you can contribute to a given program if you are selected (this is also a potential interview question).
Why you ? Highlight aspects of your life that set you apart from other international dental graduates. Perhaps you have a unique cultural background that
broadens your perspective.Try to emphasize something about yourself that makes you a little different than the “average” applicant (achievements academically, in sports, any research experience, observership or dental assisting experience,any volunteer experience may not only be in dentistry but for any social cause), this will help you to “stand out from the crowd”. Admissions committees will read hundreds of personal statements; you should write in a way that attracts their attention and keeps them interested in what you have to say.
The personal statement should also allude to your professional aspirations. Be as specific as possible without making up goals. If you have a desire to do research,specialize in a particular area, focus on prevention and public health, or become a general practitioner, say what your professional career ideally would entail. You are not locking yourself into a particular career path by doing this. Everyone realizes that goals can change remarkably over the course of time, but being specific gives an idea about how focused you are.Be professional in your choice of words.
It wont be a bad idea to write a general sop which you can send to all the schools.In case you are very particular about some school then you can modify it a little bit to highlight the attributes that particular school is looking for in you. For instance some schools desire the candidates to have leadership qualities. For such schools write something that shows your leadership abilities, if you ever lead a group etc.You may also like to mention why did you come to US or why you selected this school over others.Find out some key points about that particular program and mention them in you sop. This shows that you are really interested in their program and that you actually did your homework.
Represent yourself accurately and positively.Don't be modest about your strengths and avoid mentioning weaker aspects of your application, such as poor TOEFL or NDBE scores.If there happen to be irregularities in your academic record or any other points which might need explanation, you can write about that but keep it brief and try to keep the main focus of your essay on the positive aspects.
Like any other essay a clear introduction, a body and a conclusion are a must. Make sure it is proofread, spell-checked, and grammatically correct.
You can take professional help also. There are agencies that charge you and write a SOP for you but I feel you are the best person to write about yourself. In case someone is writing for you just make sure you know whats written in your sop and review it before going for an interview. They may pick up few questions from it and ask you to elaborate.
Last piece of advice is that please do not make it too long.Be very precise and clear. With hundreds of students applying to these schools each term no one has the time or the patience to read all the junk. A good personal statement according to me is the one which is just about a page long and yet contains all that shows you as a bright and promising candidate. Some schools also mention that the personal statement be written in particular font size. Check for the requirements and modify accordingly.
All the very Best..!!!!
Read more...
Sunday, July 20, 2008
Drug Promises to Restore Sensation After Dental Visit
By ANDREW POLLACK
Published: May 12, 2008
For those who don’t like to drool, slur their speech or unknowingly bite their tongue after a visit to the dentist, help might be at hand.
A small drug company said it won approval Friday from the Food and Drug Administration to market the first drug meant to undo the effects of local dental anesthesia.
In clinical trials, the drug cut the median time it took for full sensation to return to the lips by about 75 to 85 minutes, or by more than half.
The drug, called OraVerse, was developed by Novalar Pharmaceuticals, a privately held company in San Diego. The company said it would begin selling the drug to dentists late this year for $12.50 an injection.
After a dentist finished a filling or some other procedure, he or she would inject OraVerse into the same spot where the anesthetic had been injected.
Is a drug really needed for what seems like a trivial use? Novalar and some dentists who advise the company said it might be useful for children, who can injure themselves by biting their lip or tongue without knowing it.
“Kids tend to chew on their tongue when it’s numb,” said Dr. Athena Papas, a professor at the Tufts University School of Dental Medicine. The drug, however, is not approved for children younger than 6 or weighing less than 33 pounds.
Dr. Papas, an adviser to Novalar and an investigator in its clinical trials, said she thought the drug would appeal especially to those receiving cosmetic dentistry “who like to look good when they leave the dentist’s office.”
Novalar said its surveys showed great interest in the product among consumers and among dentists, some of whom said they would mark up the price of the drug as a source of profit.
With about 300 million anesthesia injections given by dentists each year, company executives say the drug could easily achieve sales of hundreds of millions of dollars a year.
OraVerse is a formulation of a decades-old drug, phentolamine mesylate, which is used to treat severe episodes of hypertension.
When dentists administer lidocaine or another local anesthetic, they usually combine it with another drug called epinephrine, which acts to constrict the blood vessels. That keeps the blood from carrying away the anesthetic from the mouth too quickly.
OraVerse does the opposite, dilating the blood vessels and speeding up blood flow so the anesthetic can be carried away.
“We aren’t reversing the local anesthesia,” said Dr. Paul A. Moore, chairman of anesthesiology at the University of Pittsburgh School of Dental Medicine, who is an adviser to Novalar. “It is reversing the epinephrine.”
The label for the hypertension drug phentolamine contains warnings about heart attacks and occlusion of blood flow to the brain. Novalar said the label of OraVerse would also contain the warnings, but note that OraVerse is given in a different manner. In the clinical trials there were no serious side effects, Novalar said.
Novalar also said patients did not have pain because the anesthesia wore off more quickly, except for a little extra pain at the injection site. But the trials excluded people who got root canals or tooth extractions. Those patients would be expected to have lingering pain, and should not get Oraverse, Dr. Moore said.
In two trials of 484 patients in total, people were given either OraVerse or a sham injection. (Patients were blindfolded so they could not see the needle and, being numb, supposedly could not tell if the needle penetrated.)
People then tapped their lips every five minutes for five hours, feeling for sensation. Observers measured the symmetry of their smiles, checked for drool and listened to them read sentences.
About 41 percent of patients who got OraVerse reported normal lower lip sensation one hour after getting the drug, compared with 7 percent of those getting the sham injection. About 59 percent of those who got OraVerse had normal sensation in the upper lip after one hour, compared to 12 percent in the control group.
Courtesy "NEW YORK TIMES "
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Published: May 12, 2008
For those who don’t like to drool, slur their speech or unknowingly bite their tongue after a visit to the dentist, help might be at hand.
A small drug company said it won approval Friday from the Food and Drug Administration to market the first drug meant to undo the effects of local dental anesthesia.
In clinical trials, the drug cut the median time it took for full sensation to return to the lips by about 75 to 85 minutes, or by more than half.
The drug, called OraVerse, was developed by Novalar Pharmaceuticals, a privately held company in San Diego. The company said it would begin selling the drug to dentists late this year for $12.50 an injection.
After a dentist finished a filling or some other procedure, he or she would inject OraVerse into the same spot where the anesthetic had been injected.
Is a drug really needed for what seems like a trivial use? Novalar and some dentists who advise the company said it might be useful for children, who can injure themselves by biting their lip or tongue without knowing it.
“Kids tend to chew on their tongue when it’s numb,” said Dr. Athena Papas, a professor at the Tufts University School of Dental Medicine. The drug, however, is not approved for children younger than 6 or weighing less than 33 pounds.
Dr. Papas, an adviser to Novalar and an investigator in its clinical trials, said she thought the drug would appeal especially to those receiving cosmetic dentistry “who like to look good when they leave the dentist’s office.”
Novalar said its surveys showed great interest in the product among consumers and among dentists, some of whom said they would mark up the price of the drug as a source of profit.
With about 300 million anesthesia injections given by dentists each year, company executives say the drug could easily achieve sales of hundreds of millions of dollars a year.
OraVerse is a formulation of a decades-old drug, phentolamine mesylate, which is used to treat severe episodes of hypertension.
When dentists administer lidocaine or another local anesthetic, they usually combine it with another drug called epinephrine, which acts to constrict the blood vessels. That keeps the blood from carrying away the anesthetic from the mouth too quickly.
OraVerse does the opposite, dilating the blood vessels and speeding up blood flow so the anesthetic can be carried away.
“We aren’t reversing the local anesthesia,” said Dr. Paul A. Moore, chairman of anesthesiology at the University of Pittsburgh School of Dental Medicine, who is an adviser to Novalar. “It is reversing the epinephrine.”
The label for the hypertension drug phentolamine contains warnings about heart attacks and occlusion of blood flow to the brain. Novalar said the label of OraVerse would also contain the warnings, but note that OraVerse is given in a different manner. In the clinical trials there were no serious side effects, Novalar said.
Novalar also said patients did not have pain because the anesthesia wore off more quickly, except for a little extra pain at the injection site. But the trials excluded people who got root canals or tooth extractions. Those patients would be expected to have lingering pain, and should not get Oraverse, Dr. Moore said.
In two trials of 484 patients in total, people were given either OraVerse or a sham injection. (Patients were blindfolded so they could not see the needle and, being numb, supposedly could not tell if the needle penetrated.)
People then tapped their lips every five minutes for five hours, feeling for sensation. Observers measured the symmetry of their smiles, checked for drool and listened to them read sentences.
About 41 percent of patients who got OraVerse reported normal lower lip sensation one hour after getting the drug, compared with 7 percent of those getting the sham injection. About 59 percent of those who got OraVerse had normal sensation in the upper lip after one hour, compared to 12 percent in the control group.
Courtesy "NEW YORK TIMES "
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Wednesday, July 16, 2008
Contact Me
Dear Friends if you found something interesting in this blog, please spare a minute to post your valuable comments and suggestions.
For any queries and suggestions, you can contact me at
doctorsumeet@gmail.com
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For any queries and suggestions, you can contact me at
doctorsumeet@gmail.com
Read more...
From the author
I always used to hear about blogs but never knew what a "Blog" actually meant. So out of curiosity I landed into Blogger. I started with great enthusiasm but soon I was found myself short of thing to write about. I published jokes, interesting facts, news; inshort something about everything.
Soon I realized that this is going nowhere. Being a dental student I thought it will be much more interesting and informative if I dedicate my blog entirely to dentistry. The things I learn everyday and then forget, the things I never knew before about dentistry or the misconceptions I had in the field; to keep all that information safe at one place before it becomes part of history again; to tie it to the back of my brain someplace so that I can put them to practice and be a better health care professional.
This is one such effort.....
Read more...
Soon I realized that this is going nowhere. Being a dental student I thought it will be much more interesting and informative if I dedicate my blog entirely to dentistry. The things I learn everyday and then forget, the things I never knew before about dentistry or the misconceptions I had in the field; to keep all that information safe at one place before it becomes part of history again; to tie it to the back of my brain someplace so that I can put them to practice and be a better health care professional.
This is one such effort.....
Read more...
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About This Blog
The sole purpose of writing this blog is to be a continuous learner, to share information and to keep that information safe and easily accessible before it vanishes in pages of history.