Dental procedures

The patient should avoid salicylates for at least 1 week before any type of major or minor surgery, including dental surgery, because of the possibility of postoperative bleeding. In addition, the patient should not use the salicylates after any type of surgery until complete healing has occurred. The patient may use acetaminophen or an NSAID after surgery or a dental procedure, when relief of mild pain is necessary. 

If surgery or a dental procedure, such as tooth extraction or gum surgery, is anticipated, notify the primary health care provider or dentist. Salicylates may be discontinued 1 week before the procedure because of die possibility of postoperative bleeding. 

Control of superficial bleeding during surgical and dental procedures of the mouth, nose, throat, and skin ... 

Local infiltration anesthesia is die injection of a local anesthetic druginto tissues. This type of anesfliesia may be used for dental procedures, die suturing of small wounds, or making an incision into a small area, such as that required for removing a superficial piece of tissue for biopsy. 

The main goal of vWF treatment is to prevent bleeding with surgery or dental procedures. Clinicians should evaluate patients every 6 to 12 months for the following ... 

The goal of antimicrobial prophylaxis in dental procedures is to prevent endocarditis. According to American Heart Association guidelines, at-risk individuals should receive 2 g of amoxicillin 1 hour prior to the procedure.23 Patients with a (5-lactam allergy may receive clindamycin 600 mg 1 hour prior to the procedure. Interested readers should refer to the American Heart Association guidelines for a complete discussion on risk stratification and recommendations. 

Bone disease is a common manifestation of multiple myeloma. Bisphosphonates should be initiated in symptomatic patients with bone lesions to slow osteopenia and reduce the fracture risk associated with the disease. Pamidronate and zolendronic acid have equivalent efficacy in the management of osteolytic lesions, but because of relative ease of administration, zolendronic acid is used most frequently.43 The use of zolendronic acid decreases pain and bone-related complications and improves quality of life. The suggestion that bisphosphonates have direct antimyeloma activity, based on the ability to inhibit NF-kB signaling, remains controversial. Recent cases of osteonecrosis of the jaw have been a major concern. Risk factors are unclear, but osteonecrosis of the jaw is more common in patients receiving intravenous administration of bisphosphonates and having dental procedures performed. It is recommended that patients... 

Cardiac Conditions Associated with the Highest Risk of Adverse Outcome from Endocarditis for Which Prophylaxis with Dental Procedures Is Recommended... 

Endocarditis prophylaxis is recommended for all dental procedures that involve manipulation of the gingival tissue of the periapical region of teeth or perforation of the oral mucosa. 

Antibiotic regimens for a dental procedure are given in Table 37-10. 

In addition, pain often is used as an excuse for drug-seeking behavior in health care clinics, dental offices, emergency departments in hospitals, and other primary care clinics. I have heard about some people seeking and receiving unnecessary surgical and dental procedures in order to obtain pain medicines. 

Chloroform is used primarily in the production of chlorodifluoromethane (hydrochlorofluorocarbon-22 or HCFC-22) used as a refrigerant for home air conditioners or large supermarket freezers and in the production of fluoropolymers (CMR 1995). Chloroform has also been used as a solvent, a heat transfer medium in fire extinguishers, an intermediate in the preparation of dyes and pesticides, and other applications highlighted below. Its use as an anesthetic has been largely discontinued. It has limited medical uses in some dental procedures and in the administration of drugs for the treatment of some diseases. 

Seltzer S and Bender IB (1965) The dental pulp. Biological considerations in dental procedures, pp. 117-119. Lippincott, Philadelphia PA, USA. 

The presenting complaints of overexposed workers may be toothache and excessive salivation. There may be a dull red appearance of the oral mucosa. One or more teeth may loosen, followed by pain and swelling of the jaw healing may be delayed after dental procedures such as extractions with necrosis of bone, a sequestrum may develop with sinus tract formation. In a series of 10 cases, the shortest period of exposure to phosphorus fume (concentrations not measured) that led to bone necrosis was 10 months (2 cases), and the longest period of exposure was 18 years. ... 

Uses Rx prevent osteoporosis male female, Rx steroid-induced osteoporosis, Paget Dz Action -1- N1 abnormal bone resorption Dose Osteoporosis Rx 10 mg/d PO or 70 mg qwk Fosamax plus D 1 tab qwk Steroid-induced osteoporosis Rx 5 mg/d PO Prevention 5 mg/d PO or 35 mg qwk Paget Dz 40 mg/d PO Caution [C, ] Not OK if CrCl <35 mLAnin, w/ NSAID use Contra Esophageal anomalies, inability to sit/stand upright for 30 min, X Ca Disp Tabs, soln SE GI disturbances, esophageal irritation, HA, pain, jaw osteonecrosis (w/ dental procedures, chemo) Interactions -1- Absorption W7 antacids, Ca supls, Fe, food T risk of upper GI bleed W/ ASA NSAIDs EMS May cause cardiac conduction abnormalities d/t T Ca T risk of jaw fractures esp w/ dental procedures OD May cause hypocalcemia and adverse upper-GI effects milk or antacids can be given to bind alendronate... 

A 25-year old-woman visits your office with red and itchy eczematoid dermatitis. She had a dental procedure earlier in the day, and the dentist administered a local anesthetic. There were no other findings, al-fhough she indicafed fhaf she had a hisfory of allergic reacfions. Which of fhe following drugs is mosf likely involved ... 

D. Epinephrine is by far the most commonly employed vasoconstrictor. Phenylephrine is occasionally used with procaine for dental procedures. Levonordefrin is also used rarely in dental procedures. Dopamine has no vasoconstrictor activity. Cocaine is itself a local anesthetic with some vasoconstrictor properties. However, cocaine, because of its abuse potential and toxicity, is seldom used. Its only use is topical. 

B. Allergic reactions occur only to the ester type of local anesthetics. This is because the metabolism of all ester-linked local anesthetics leads to the formation of PABA, which is known to be allergenic to some individuals. Both cocaine and procaine are esters. However, cocaine is not employed in dental procedures. Therefore, the best choice is procaine. 

Benzodiazepines have the capacity to produce a calming effect and to cause anterograde amnesia, in which the patient cannot recall events that took place for some time after the drug was administered. Benzodiazepine-induced sedation and amnesia are deemed useful in the preparation of patients for anesthesia, surgery, and other frightening or unpleasant medical and dental procedures and diagnostic tests. Midazolam is a frequently used anesthetic benzodiazepine (see Chapter 25). 

A dental examination with appropriate preventive dentistry should be considered prior to treatment with bisphosphonates in patients with concomitant risk factors (e.g., cancer, chemotherapy, corticosteroid use, poor oral hygiene). While on bis-phosphonate treatment, patients with concomitant risk factors should avoid invasive dental procedures if possible. For patients who develop osteonecrosis of the jaw while on bisphosphonate therapy, dental surgery may exacerbate the condition. For patients requiring dental procedures, there are no data available to suggest whether discontinuation of bisphosphonate treatment reduces the risk of osteonecrosis of the jaw. 

Patients taking MAOIs are advised to carry identification cards that indicate that they are taking MAOIs. Before accepting any medication or anesthetic, patients should notify their physicians that they are taking MAOIs. When patients undergo dental procedures, local anesthetics without vasoconstrictors (e.g., epinephrine) must be used. 

It is an oily liquid eugenol derivative and less potent than thiopentone. It is a very short acting intravenous anaesthetic and specially used for very short outpatient operations and dental procedures. 

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