ABSTRACT
A patient taking warfarin presented to the Oral Medicine Clinic at Liverpool University Dental Hospital, having been prescribed metronidazole and miconazole by his general dental practitioner (GDP) for his oral mucosal problem. He subsequently developed bruising on his torso following mild trauma. Having read the drug information leaflet provided with his metronidazole and miconazole, he noted the potential drug interactions between these and warfarin. He therefore stopped his warfarin. The details of this case are outlined, and the potential for significant drug interactions with warfarin are highlighted. The need for dental practitioners to be vigilant concerning drug interactions is emphasized, together with the importance of CPD in relation to drug prescribing. CPD/CLINICAL RELEVANCE: This case report, which is of relevance to all dental practitioners, highlights the importance of up-to-date medical and drug histories and the continuing awareness of potential drug interactions. In this case, patient intervention after checking drug information leaflets prevented serious consequences. The importance and potentially serious consequences of significant drug interactions needs to be understood.
Subject(s)
Anti-Infective Agents/adverse effects , Anticoagulants/adverse effects , Antifungal Agents/adverse effects , Metronidazole/adverse effects , Miconazole/adverse effects , Warfarin/adverse effects , Aged , Contusions/etiology , Drug Synergism , Gingivitis/drug therapy , Humans , International Normalized Ratio , Lichen Planus, Oral/drug therapy , MaleABSTRACT
Disfigurement after operations for oral and oropharyngeal cancer is an important issue. Our aim was to review the casenotes of patients who reported distress in the appearance domain of the University of Washington Quality of Life Scale (UWQOL) and to find out what help they were given. Of 278 patients with previously untreated oral and oropharyngeal squamous cell carcinoma treated between 1995 and 1999, 114 (41%) were concerned about their appearance. Factors that correlated with these concerns included tumours more than 2cm in size, T2 or worse stage, free tissue reconstruction, segmental mandibular resection, and neck dissection. In only 7 of the 114 was there any mention of the patient's appearance in the clinic notes, of whom 4 were given help (2 scar revisions and 2 oral rehabilitations). This study suggests that patients' concerns about disfigurement are poorly recognised in routine clinical practice and supports the principle of using the UWQOL scale to discuss problems of appearance with patients.
Subject(s)
Carcinoma, Squamous Cell/surgery , Face/anatomy & histology , Mouth Neoplasms/surgery , Oropharyngeal Neoplasms/surgery , Quality of Life , Adaptation, Psychological , Adult , Aged , Body Image , Carcinoma, Squamous Cell/psychology , Chi-Square Distribution , Female , Humans , Male , Middle Aged , Mouth Neoplasms/psychology , Oropharyngeal Neoplasms/psychology , Patient Satisfaction , Plastic Surgery Procedures/statistics & numerical data , Social Adjustment , Surveys and QuestionnairesABSTRACT
BACKGROUND: The University of Washington Quality of Life Scale is the only validated head-and-neck-specific questionnaire that invites patients to write comments in the form of freetext. Freetext allows the questionnaire to record issues raised by the patient. METHOD: Two hundred seventy-eight consecutive patients treated between 1995 and 1999 by primary surgery for oral and oropharyngeal squamous cell carcinoma completed the UWQOL. Freetext from these patients was independently assessed by the authors. RESULTS: Comments were made by 61% of patients at some time. Completion was independent of clinicodemographic characteristics. Comments were predominantly head and neck (39%) and medical (35%). In 55% of cases, the overall tone was negative. Around a quarter of issues was not part of a validated health-related quality-of-life questionnaire. CONCLUSIONS: Freetext gives the multidisciplinary team a better insight into the concerns of the patient and can be used to promote a holistic approach.
