Dental erosion due to GERD in patients with developmental disabilities: case theory.

Gastroesophageal reflux disease (GERD) is a common finding among individuals in our society. Unfortunately, the condition is even more prevalent in individuals with developmental disabilities. There are significant comorbidities that can affect the upper gastrointestinal tract. Erosion of tooth surfaces may be the first comorbidity that is detected in individuals unable to express physical discomfort associated with GERD. The dentist should be aware of these findings and able to refer the patient for medical management. In addition, an awareness of preventive regimens and restorative options is essential in maintaining a healthy dentition for these individuals.

Treatment needs and adverse events related to dental treatment under general anesthesia for individuals with autism.

Individuals with autism can be quite challenging to treat in a routine dental-office setting, especially when extensive dental treatment and disruptive behavioral issues exist. Individuals with autism may also be at higher risk for oral disease. Frequently, general anesthesia is the only method to facilitate completion of the needed dental treatment. General anesthesia is not without complications, and unique occurrences are a necessary consideration for special-needs populations. In addition, behavior challenges may occur which can be disruptive to hospital staff. This article describes treatment needs and determines adverse events during the perioperative period for individuals with autism who have had general anesthesia for comprehensive dental treatment in the hospital.

Controlling reduction in the preparation of porcelain laminate veneers.

For a clinician to deliver porcelain veneers with optimum esthetics, tooth preparation should be considered during the planning phase. Precise preparation requires depth-cutting burs and reduction indices as essential tools. A well-designed preparation will allow the laboratory technician to create ideal tooth contours with lifelike esthetics.

Controversial issues in treating the dental patient with autism.

BACKGROUND: The author conducted a literature review to investigate concerns that parents of a child with an autism spectrum disorder may have when oral health care is provided to the child. TYPES OF STUDIES REVIEWED: The author conducted a search of PubMed using the terms "mercury," "fluoride," "nitrous oxide," "antibiotics," "gluten," "casein," "acetaminophen" and "dentistry" each with the term "autism." He identified controlled studies and literature reviews in both medical and alternative medical literature that were related to areas of importance to oral health care workers. The use of mercury, fluoride, nitrous oxide, antibiotic agents and acetaminophen all are sources of controversy between dentistry and the parents of children who have autism. RESULTS: The author found that patients who have autism frequently also have allergies, immune system problems, gastrointestinal disturbances and seizures. Dental health care workers must be aware of these comorbid conditions so they can provide optimal care to the children with autism spectrum disorders. The author found two distinct theories as to what causes autism: one that focuses on genetic causes, and one that focuses on the impact of the environment. He found that the interpretation of these theories might affect parents' concerns about various dental treatments. CLINICAL IMPLICATIONS: Dentists treating patients who have autism may need to provide more than standard patient care, as the use of time-tested dental treatment and prevention modalities may be questioned or refused by parents.

Comprehensive dental treatment of a patient with Huntington's disease: literature review and case report.

Huntington's disease is an inherited neurodegenerative disorder for which there is no cure. Because of the physical impairment and medication side effects, these patients can experience extensive oral disease. A patient presented to the dental clinic with complaints of oral pain and an inability to chew due to extensive caries and periodontal disease. General anesthesia was required to treat his oral problem due to the patient's disease-associated uncontrolled movements, psychological status, and extensive oral disease. As varying anesthesia techniques have been recommended for patients with Huntington's disease, medical consultation was important to restore this individual's oral health.

Stress, burnout, anxiety and depression among dentists.

BACKGROUND: Dentists encounter numerous sources of professional stress, beginning in dental school. This stress can have a negative impact on their personal and professional lives. CONCLUSIONS: Dentists are prone to professional burnout, anxiety disorders and clinical depression, owing to the nature of clinical practice and the personality traits common among those who decide to pursue careers in dentistry. Fortunately, treatment modalities and prevention strategies can help dentists conquer and avoid these disorders. PRACTICE IMPLICATIONS: To enjoy satisfying professional and personal lives, dentists must be aware of the importance of maintaining good physical and mental health. A large part of effective practice management is understanding the implications of stress.

Diabetes mellitus: an updated overview of medical management and dental implications.

Diabetes mellitus (DM) is a major worldwide public health concern. In the United States, 18.2 million people (approximately 6.3% of the population) currently suffer from DM; of those, nearly one-third are undiagnosed. The incidence of DM in the U.S. is expected to double by the year 2010 due to general aging among the population and the epidemic of obesity in the western world. Dental providers must be aware of the rapid changes concerning management of individuals with DM and must understand the significant impact DM has on dental treatment.

The use of low-molecular-weight heparins in outpatient oral surgery for patients receiving anticoagulation therapy.

BACKGROUND: When planning oral surgery, dentists occasionally will have patients who first need to have their anticoagulation regimen altered. To minimize the side effects and not adversely affect the patient's health, therapeutic anticoagulation should be interrupted for as short a time as possible. Low-molecular-weight heparins, or LMWHs, recently have emerged as an alternative in the management of patients whose anticoagulant status should not be modified for lengthy periods. CASE DESCRIPTION: A 72-year-old man, who had a history of deep venous thrombosis, needed to have 19 teeth extracted and an alveoloplasty performed. An LMWH was substituted for warfarin a few days before surgery, and it was withheld from the patient for only a few hours the day of the surgery. CLINICAL IMPLICATIONS: LMWHs are administered on an outpatient basis and do not require hospitalization, as does unfractionated heparin. As a result, they are more cost-effective and offer greater convenience than heparin therapy. Depending on the procedure and the degree to which patients are medically compromised, dentists may not feel comfortable treating patients who continuously receive anticoagulation therapy. As a result, patients' physicians may prescribe LMWH injections to be administered by patients, family members or caregivers to more safely manage the patients' care during oral surgery. As part of the health care team, dentists must be familiar with LMWH and its use to help guide patients safely through treatment.