Subject(s)
Dental Care for Aged , Aged , Aged, 80 and over , Aging/physiology , Dental Care for Chronically Ill , Drug Therapy , Humans , Patient Care PlanningABSTRACT
Many geriatric patients will have cognitive impairment, sometimes temporary and other times progressive. Dentists are challenged to evaluate for the presence of cognitive impairment that can affect the consent process. This review gives an overview of types of cognitive impairments, clues to recognizing these conditions, how they affect the dental consent process, and what makes an effective informed consent. When there is doubt of a patient's capacity to consent, prudence calls for stopping dental treatment and referring the patient for a medical evaluation.
Subject(s)
Cognition Disorders/psychology , Dental Care for Aged , Informed Consent , Aged , Cognition Disorders/diagnosis , Comprehension , Dentist-Patient Relations , Humans , Mental CompetencyABSTRACT
The purpose of this study was to assess headache response of unselected neurology clinic chronic headache patients to TMD stabilization appliance and self-management therapies, and to identify features of patients whose headaches are more likely to improve from these therapies. Twenty chronic headache patients in a nontreatment control period were provided appliance and self-management therapies, evaluated five weeks after therapy, and those who chose to continue using their appliances were evaluated three months later. The mean pretreatment Headache Disability Inventory (HDI) score of 64.5 suggested the headaches were severe. After five weeks, the mean HDI score decreased by 17 percent (p<0.003), headache medication consumption dropped by 18 percent (p<0.0001), and headache symptoms decreased by 19 percent (p<0.002). Comparing the three months with pretreatment follow-up, the fourteen participants who chose to continue using their appliances had a mean HDI score decrease of 23 percent (p<0.003), headache medication consumption drop of 46 percent (p<0.001), and headache symptom decrease of 39 percent (p<0.001). There was no correlation between response and headache type (p=0.722). These results suggest appliance and self-management therapies can be beneficial for many severe headache patients, irrespective of the headache type (tension-type, migraine without aura, and migraine with aura).
Subject(s)
Headache/therapy , Orthodontic Appliances , Temporomandibular Joint Disorders/therapy , Adult , Aged , Aged, 80 and over , Chronic Disease , Female , Headache/complications , Humans , Male , Middle Aged , Temporomandibular Joint Disorders/complications , Treatment OutcomeABSTRACT
A dental patient with post-traumatic stress disorder (PTSD) may present with greater dental and behavioral challenges than most dental patients. The background review of PTSD's initiating factors, diagnostic criteria, and medical management should help practitioners better understand and manage these challenges. Many of the challenges the clinician may encounter and managing recommendations are described. A case report of a PTSD patient complaining of constant bilateral tooth pain of the maxillary and mandibular bicuspids and molars is presented. Recommended techniques for identifying the tooth pain source and contributing factors are provided. The primary contributing factor for the patient's tooth pain was determined to be his severe tooth clenching activity. A maxillary acrylic appliance provided some pain reduction and a subsequent mandibular soft occlusal appliance worn opposing the maxillary appliance provided additional relief.
Subject(s)
Bruxism/complications , Dental Care for Chronically Ill , Stress Disorders, Post-Traumatic/complications , Toothache/etiology , Bruxism/etiology , Bruxism/therapy , Humans , Male , Muscle Contraction , Night Terrors/complications , Night Terrors/etiology , Occlusal Splints , Toothache/therapy , Vietnam , WarfareABSTRACT
BACKGROUND: Hemopoietic stem cell transplantation, or HSCT, is an important tool in modern cancer treatment. Refinement of transplantation techniques and supportive care has resulted in increased posttransplantation survival rates. Dental care is a key supportive element in both pretransplantation and posttransplantation care of this patient population. METHODS: The authors provide an overview of HSCT transplantation, emphasizing the oral complications and required supportive dental care. CONCLUSIONS: It is critical that transplantation candidates undergo dental screenings and be treated adequately before transplantation, that their care be closely managed during the transplantation process, and that they be given dental support as soon as their recovery permits. Dentists should consult with the patient's oncologist or primary health provider to identify the appropriate timing and intensity of dental support. CLINICAL IMPLICATIONS: Because of improved transplantation survival rates, more patients may seek supportive outpatient dental care after transplantation, which requires special management considerations. Dental professionals need to be knowledgeable about modern HSCT.
Subject(s)
Hematopoietic Stem Cell Transplantation , Adult , Dental Care for Chronically Ill , Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/methods , Humans , Mouth Diseases/prevention & controlABSTRACT
Parkinson's disease is an idiopathic, slowly progressive disorder of the central nervous system characterized by resting tremor, muscular rigidity, slow and decreased movement (bradykinesia), and postural instability. In the United States, Parkinson's disease is the fourth most common neurodegenerative disorder in the elderly, affecting an estimated half a million people. Oral health care providers can expect to be called upon to care for patients with this progressively debilitating disease. To provide competent care to patients with Parkinson's disease, clinicians must understand the disease, its treatment, and its impact on the patient's ability to undergo and respond to dental care.
