ABSTRACT
Preparing the patient for painless dentistry must take into account the total patient. In addition to the physical need for anesthetic, the patient has an emotional need for a dentist who responds compassionately to anxiety. By combining the emotional and physical techniques, a dentist can provide patients with the greatest practice-builder the profession has-painless dentistry.
Subject(s)
Anesthesia, Dental/psychology , Anesthesia, Local/psychology , Dental Anxiety/prevention & control , Pain/prevention & control , Anesthesia, Dental/methods , Anesthesia, Local/methods , Dentist-Patient Relations , Humans , Pain/psychology , Preanesthetic MedicationABSTRACT
A patient with Wilson's disease on long-term penicillamine therapy was seen for evaluation and management of chronic persistent debilitating stomatitis, which was subsequently determined to be cytologically and histologically consistent with pemphigus vulgaris. A brief review of the pertinent literature disclosed that the dermatologic lesions of pemphigus secondary to penicillamine are alleviated by discontinuation of penicillamine and institution of prednisone therapy. Our patient's primarily oral lesions did not resolve with this recommended alteration in therapy, since penicillamine could be discontinued only briefly in the interest of maintaining acceptable serum copper levels and because of the paucity of available alternative copper-chelating agents. Eventually the patient was placed on tetraethylene tetramine (TETA), an experimental copper-chelating agent, and betamethasone (Celestone). This has provided a satisfactory reduction in serum copper levels and resolution of the oral lesions.
