Compendium of continuing education in dentistry
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Compend Contin Educ Dent · Nov 2016
ReviewPharmacological Reversal Agents in Dental Practice: Keys to Patient Safety.
Though uncommon, medical emergencies in the dental office are harrowing occurrences that can be the result of adverse drug reactions. Pharmacological antagonists have been developed for administration as reversal agents in emergency situations in which patients may have an untoward effect, typically caused by too much medication. Dental practitioners should be familiar with these agents to keep patients safe and help mitigate drug-induced medical emergencies. ⋯ Outside of emergency situations, the pharmacological antagonist phentolamine has been developed to reverse the effects of the vasoconstrictor in dental local anesthesia preparations when the effects of the agonist medication are no longer required. Such newer reversal agents are being considered for more routine use once the dental procedure is complete. This article is intended to assist dental practitioners who are familiar with pharmacological antagonists to be better able to help mitigate drug-induced medical emergencies should they occur.
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With little room for error and recent reports of abuse and deaths, propofol, a commonly used general anesthetic induction agent, has provoked considerable concern and has stirred debate regarding its classification and how care should be rendered. The drug, when abused, presents a risk for psychological dependence, and studies have indicated an increase in the rate of propofol abuse, particularly among individuals in academic anesthesia programs. ⋯ When determining whether to administer propofol to patients, practitioners should bear in mind certain precluding factors, such as allergies to egg and soy. The narrow margin for error, the lack of a reversal agent, and risk for death make diligent and vigilant care imperative.
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In dentistry, local pain management is a critical component of patient care. When efforts to achieve local anesthesia are unsuccessful, the resulting stress for both the patient and practitioner can be significant. This Forum has reviewed new technologies that are reported to increase the probability of a favorable outcome with local anesthesia. ⋯ However, the potential benefits of the new devices and techniques available in local anesthesia broaden the practitioners' choices. There may not yet be a "magic bullet" in local anesthesia, but the advances reviewed here hold great promise. Our participants seem to agree that predictable local anesthesia will always require a thorough understanding of the broad range of devices, techniques, and drugs available and a commitment by the dentists to use them wisely.
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Compend Contin Educ Dent · Jan 2000
ReviewPreemptive vs preventive analgesia: which approach improves clinical outcomes?
Administering a drug that blocks painful (nociceptive) input from entering the central nervous system before a surgical procedure attenuates the development of changes that manifest as increased pain at later time points. Clinically, this strategy predicts not only less pain during the initial postoperative period, but also lowers the intensity of pain during the days after the procedure. ⋯ The adaptation of this method as a standard clinical practice has been delayed by controversy over whether the pharmacological intervention should be administered before the surgical event (preemptive analgesia), before pain onset (preventive analgesia), or by repeat administration over the expected postoperative course. Evidence reviewed in this article supports all of these approaches for decreasing the development of central sensitization, attenuating postoperative pain, decreasing analgesic consumption, and enhancing recovery.
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Compend Contin Educ Dent · Jul 1998
ReviewCraniofacial pain of myofascial origin: temporomandibular pain & tension-type headache.
Craniofacial pain of myofascial origin is a common chronic disorder. When the pain is unilateral and located periauricularly, masticatory myalgia is likely. ⋯ The possible interrelationship with generalized myofascial disorders are discussed. Practical approaches to history-taking, diagnosis, and treatment are suggested.