A severe reaction to carbamazepine: consequences for patient monitoring.

Carbamazepine is a drug commonly prescribed by medical and dental practitioners for the treatment of trigeminal neuralgia. Although included in the Dental Practitioners' Formulary, general dental practitioners (GDPs) rarely prescribe this medication. Those GDPs who do prescribe carbamazepine may need to liaise with the patient's medical practitioner for haematological monitoring. However, a significant number of patients attending their GDP are taking carbamazepine prescribed by hospital colleagues or general medical practitioners. Thus a knowledge of potential side-effects and adverse reactions is useful for all practitioners.

A study of maxillofacial injuries in the elderly resulting from falls.

Falls are a major problem for the elderly, both in terms of the injuries sustained and the consequent loss of confidence and independence. Many studies, both prospective and retrospective, have investigated the possible causes and the resulting injuries following falls. However, no specific consideration appears to have been given to maxillofacial injuries. This survey examines the incidence of such injuries, over a three year period, in elderly patients presenting at an Accident and Emergency Department, and reviews the causes. Recognition of old age abuse is an essential aspect of the assessment of injuries in this group of patients.

Canalicular adenoma of the palatal mucosa.

The clinical and histological features of a canalicular adenoma occurring in the palatal mucosa of a 79-year-old male are described. The management of the case-prompt referral to a specialist centre, histological confirmation of complete excision and an uneventful postoperative course-illustrates the correct procedures for what may be regarded as a cure of this neoplastic disease.

A study of the availability of emergency dental services in Birmingham.

The study reported here was undertaken to ascertain the efficiency and adequacy of the Emergency Dental Services in Birmingham. Even after the inception of the new contract in 1990, too many registered patients appeared to be attending the Birmingham hospitals or contacting their doctors for dental treatment which could and should have been provided by their own dentist. Overall, the results showed that the service provided by Birmingham dentists before 10.30 p.m. is more than adequate, and that most dentists are acting in accordance with the FHSA guidelines relating to the new contract.

Glandular odontogenic cysts. Diagnosis and treatment.

Four cases of glandular odontogenic cyst are reported. Review of these and 13 previously reported cases indicates that they present as slowly growing, painless, radiolucent swellings with a predilection for the anterior part of the mandible. An incisional biopsy is essential to establish a definitive preoperative diagnosis. The unpredictable and potentially aggressive nature of these lesions is suggested by their extensive nature, penetration of cortical bone, locally invasive potential, and high incidence of recurrence after conservative treatment. In view of this behavior we suggest en bloc excision and primary reconstruction to ensure cure and reduce the operative morbidity.

Dental prescribing.

Dental surgeons, who are entitled to prescribe drugs to their patients, have a duty to be conversant with the rapid changes occurring in pharmacology and to inform their patients about the proper use of the medicines they are given. This article outlines the sources of information on drugs that are available to dental practitioners, especially the Dental Practitioners' Formulary.

Medical emergencies in dental practice: an update on drugs and the management of acute airway obstruction.

In response to interest from readers the authors provide an update of their 1986 papers on coping with medical emergencies in dental practice. In particular they review drug regimes and the technique of cricothyroidostomy.

Lupus erythematosus--a case of facial swelling.

A case is reported of acute facial swelling following tooth extraction that failed to respond in a normal manner. The patient developed systemic signs and symptoms ultimately revealing the diagnosis of lupus erythematosus. The possibility of soft tissue lesions arising in some forms of lupus is emphasised by this report.

Mandibular reconstruction using split autogenous bone grafts.

A procedure is described for reconstructing the body, angle and ascending ramus of the mandible using split autogenous bone grafts from the iliac crest. These compound grafts have been monitored using clinical, radiological and radio-isotope scanning techniques which demonstrated early revascularisation and consolidation. The healing pattern is similar to that of one-piece cortico-cancellous grafts. Good functional and aesthetic results have been obtained, and two patients are presented to illustrate the procedure and the features of remodelling of the bone grafts.

Button wires in the treatment of mandibular fractures.

Button wiring has been used as an alternative to eyelet wiring in the Department of Oral and Dental Surgery of Birmingham General Hospital since 1977. This clinical update reviews 65 patients with mandibular fractures in which button wires were utilised in their treatment.

A radio-isotope study of the healing of mandibular bone grafts in patients.

Radionucleotide scanning is now accepted as a reliable method of visualising the metabolic activity of the skeletal system. Its application to the maxillo-facial region is reviewed, and its possible role in monitoring the healing of bone grafts is discussed. The radio-isotope 99m technetium-methylene diphosphonate was used to study the revascularisation and healing of large autogenous bone grafts to the mandible in eight patients. The scans demonstrated the dynamic activity in the grafts and showed varying patterns in different types of grafts.

Analgesia following oral surgery: a comparative study of Solpadeine and a soluble form of dextropropoxyphene napsylate and paracetamol.

A study is presented which was designed to compare Solpadeine (paracetamol 500 mg, codeine phosphate 8 mg and caffeine 30 mg) and soluble DNP (dextropropoxyphene napsylate, equivalent to 32.5 mg hydrochloride and paracetamol 325 mg) in the control of pain following wisdom teeth extraction. A higher percentage of patients found Solpadeine more effective and significantly more Solpadeine patients considered their treatment easier to take.