Orally dissolving buprenorphine for opioid use disorder linked to caries.

BACKGROUND: Buprenorphine is under scrutiny because of the development of xerostomia and caries. The purpose of this article was to inform dental care professionals about the oral effects of buprenorphine and to increase knowledge and awareness of medication-assisted treatment in the management of opioid use disorder (OUD). CASE DESCRIPTION: In 2022, the US Food and Drug Administration issued a warning about xerostomia and caries associated with the use of transmucosal (sublingual and buccal formulations) buprenorphine. Dental health care professionals should instruct patients taking buprenorphine on how to prevent these dental issues by means of rinsing with water and swallowing once the drug has been completely dissolved, followed by toothbrushing at least 1 hour after taking the drug. In addition, a fluoride supplement should be prescribed. PRACTICAL IMPLICATIONS: It is imperative for dentists to recognize buprenorphine as medication-assisted treatment and to recognize a patient as having an OUD. While taking buprenorphine, the patient should have more frequent oral health care appointments, including home care instructions and caries risk assessment to monitor for caries and xerostomia so that treatment, if indicated, could be initiated as soon as possible. In addition, the dentist's role in OUD is to make sure patients follow the treatment recommendations and use the buprenorphine and to not have them discontinue because of potential caries risk.

Abuse potential of gabapentin in dentistry.

Gabapentin is an anticonvulsant drug widely prescribed for various ailments, including orofacial pain. It was once thought to have no potential for abuse; however, the last decade has seen a dramatic rise in the nonmedical use of gabapentin, particularly among opioid-dependent patients. Gabapentin is sedating and interacts with other sedating medications such as opioids, which can lead to impairment and accidents and may raise the risk of overdose. Dentists must be aware of the potential for abuse of gabapentin and weigh its benefits against its risks when prescribing the drug.

Periodontal Management of a Patient Undergoing Liver Transplantation.

This case report describes the periodontal management of a patient with end-stage liver disease undergoing liver transplantation. In the first part of this article, all medical and dental findings are reported to elaborate adequate diagnoses. A patient-specific treatment plan was structured given the challenging periodontal and systemic scenarios. The second part describes the periodontal therapy delivered in close interaction with the referring physicians. Last, the article reviews current principles and protocols in managing these patients.

Epithelial and Fibrous Hyperplasia: An Oral Manifestation of Tuberous Sclerosis Complex. A Case Study.

The authors present a case study of a 13-year-old female with a past medical history of tuberous sclerosis complex (TSC), an autosomal dominant disorder. It usually presents with a triad of epilepsy, mental deficiency and facial angiofibromas that are often distributed around the nose, cheek and chin, and are frequently shaped like butterfly wings. In addition, oral manifestations include gingival enlargement and developmental enamel pitting on the facial aspect of the anterior permanent dentition in 50% to 100% of patients. The patient's chief complaint was gingival enlargement and gingival bleeding. The histology of the excised gingival tissue revealed epithelial and fibrous hyperplasia, consistent with TSC.

An Evaluation of Antibiotic Use in Periodontal and Implant Practices.

In past decades, warnings about overprescription and misuse of antibiotics- which are now considered to be responsible for antimicrobial resistance, allergies, ineffectiveness, and suprainfections-have been made to both medical and dental clinicians. To help assess the antibiotic prescribing habits of dentists, a survey was created and emailed through the Survey Monkey tool to 102 randomly selected board-certified periodontists. Each was asked to answer multiple-choice questions regarding their use of an antibiotic protocol in 10 specific periodontal or implant-related clinical circumstances. This group of practitioners and the 10 clinical circumstances were chosen to limit the wide variety of clinical conditions treated by dentists and to narrow the scope of variables when antibiotics are considered. All 102 participants returned the questionnaire, and 96% to 100% of respondents reported that they had treated 8 of the 10 circumstances, with 89.9% and 80.8% having treated the other two conditions listed in the survey; this allowed subsequent questioning of the respondents on their antibiotic prescribing protocols. Although the validity of antibiotics for dental procedures may be questioned based on present information, as many as 50% or more of the dentists answering the survey prescribed antibiotics. The prescription, initiation, and duration of antibiotics varied considerably in many of the 10 specific circumstances, including treatment of acute and chronic periodontitis, sinus or ridge augmentation, and immediate or delayed implant placement. Based on the results of the survey, it was obvious that definitive guidelines and protocols are needed as well as expanded postgraduate training regarding antibiotic use.

Septic arthritis of the shoulder in a dental patient: a case report and review.

Septic arthritis of the glenohumoral joint is rare following dental procedures, comprising approximately 3% of all joint infections. Septic arthritis following bacteremia from dental procedures is uncommon and generally occurs in prosthetic joints. Predisposing causes may include immunocompromising diseases such as diabetes, HIV infection, renal failure and intravenous drug abuse. We report a rare case of unilateral glenohumoral joint septic arthritis in a 60-year-old male patient (without a prosthetic joint) secondary to a dental procedure. The insidious nature of the presentation is highlighted. Septic arthritis infections, though rare, require a high level of clinical suspicion. Vague symptoms of shoulder pain may mask the initial diagnosis, as was the case in our patient. Incision and drainage via surgical intervention are often required, followed by parenteral antibiotics.

Septic arthritis of the shoulder in a dental patient.

Septic arthritis of the glenohumoral joint is rare following dental procedures, comprising approximately 3% of all joint infections. Septic arthritis following bacteremia from dental procedures is uncommon and generally occurs in prosthetic joints. Predisposing causes may include immunocompromising diseases such as diabetes, HIV infection, renal failure and intravenous drug abuse. We report a rare case of unilateral glenohumoral joint septic arthritis in a 60-year-old male patient (without a prosthetic joint) secondary to a dental procedure. The insidious nature of the presentation is highlighted. Septic arthritis infections, though rare, require a high level of clinical suspicion. Vague symptoms of shoulder pain may mask the initial diagnosis, as was the case in our patient. Incision and drainage via surgical intervention are often required, followed by parenteral antibiotics.

Medical and dental standardization for solid organ transplant recipients.

Communication between the organ transplant team and dentist is important in formulating individualized care plans to reduce the incidence of pre- and post-transplant complications. Periodontal diseases and other oral infections may present serious risks that could compromise the success of a solid organ transplant. This article reviews why dentistry is an important component of total transplant care while the patient is on the waiting list for a transplant and after the transplantation. Recommendations regarding the care of the organ transplant patient are given.

Bleeding on probing: what does it mean?

A major part of the comprehensive periodontal examination involves the assessment and recording of bleeding on probing (BOP). Many factors can influence bleeding, including medications, systemic diseases, and smoking. A review of classic and current literature is presented, discussing the role of BOP as a clinical parameter in periodontics.

Doxycycline-induced dizziness in a dental patient.

Many dentists are unaware of the documented adverse drug reaction of doxycycline-induced dizziness. Because doxycycline is frequently prescribed in dentistry, it is important for dentists and patients to be aware of this significant adverse reaction to prevent medical complications. A clinical case is reported in which a patient developed dizziness after taking doxycycline that was prescribed following periodontal surgery. The dizziness resolved when the doxycycline was stopped. Patients and dentists should be educated to recognize the signs and symptoms of doxycycline's adverse reactions.

Head and neck cancer in two American presidents: Case reports.

Two former U.S. presidents, Ulysses S. Grant and Grover Cleveland, were diagnosed with head and neck cancer in 1884 and 1893, respectively. A historical review of the risk factors, diagnoses, and treatments is examined and compared with modern-day interpretations. A comparison was made using the original diagnoses with today's equivalent diagnosis. Different treatment outcomes at the time of the original diagnoses relative to today's treatment are reviewed. Clinicians must be familiar with risk factors, signs, symptoms, diagnosis, and treatment of head and neck cancer.

Doxycycline-induced dizziness in dental patient. Case report.

Many dentists are unaware of the documented adverse drug reaction of doxycycline: induced dizziness. Because doxycycline is frequently prescribed in dentistry, it is important for dentists and patients to be aware of this significant adverse reaction to prevent medical complications. A clinical case is reported in which a patient developed dizziness after taking doxycycline that was prescribed following periodontal surgery. The dizziness resolved when the doxycycline was stopped. Patients and dentists should be educated to recognize the signs and symptoms of doxycycline's adverse reactions.

Recognition and treatment of migraine patient in dental practice.

Migraine headache is a common, disabling clinical problem afflicting millions of Americans. Many dental problems are related to headaches and many conditions can cause orofacial pain and headaches, which complicates a definitive diagnosis. Temporomandibular joint disorders, toothache, jaw and sinus pain often coexist with headaches. A toothache of nonodontogenic origin may require a team of dentists and physicians to diagnosis and manage. It is important for the dentist to recognize and understand the management of common headaches, such as migraine, and be able to differentiate between a nonodontogenic headache and a "real" toothache.

Implementation of the American Society of Anesthesiologists Physical Status classification system in periodontal practice.

The American Society of Anesthesiologists Physical Status (ASA-PS) classification is a preoperative rating given to each patient by an anesthesia provider with the sole purpose of assessing the physical state of the patient before anesthesia is administered. It was designed originally as a standardized way for dentists and physicians to convey information about the patient's overall health status and allow outcomes to be stratified by a global assessment of their severity of illness. However, in practice, the ASA-PS classification is often misused as a measure of operative risk, which is the basis of much criticism. Modification of periodontal treatment may be necessary in certain medically complex patients. The ASA-PS classification serves an integral part of risk assessment in determining how a patient should be managed by the periodontist. It should be incorporated into all periodontal practices. Medical assessment of patients has become an essential part of dentistry, as even the most common medical problems may require modifications to routine periodontal care. Periodontists must assess and manage patients for underlying medical conditions and are required to provide dental care to a diversity of medically complex patients. Today many patients in a periodontal practice have multiple medical conditions and are taking many medications. It is more difficult to manage these types of patients, and proper assessment of their physical status is an important part of clinical practice. The ASA-PS classification system is a valuable assessment tool that subjectively categorizes patients into subgroups by preoperative physical fitness prior to administering anesthesia.

A comprehensive analysis of Babe Ruth's head and neck cancer.

BACKGROUND: This article discusses the nasopharyngeal carcinoma (NPC) of American baseball icon Babe Ruth, as well as the diagnosis and treatment of NPC. CASE DESCRIPTION: NPC is a tumor originating from the epithelium of the nasopharynx. It is the leading form of cancer in certain well-defined populations in areas such as southern China, Southeast Asia, the Arctic, North Africa and the Middle East; it is relatively rare in the United States. Despite the fact that Babe Ruth's family was of German descent and NPC is not prevalent in Germany, reports regarding Ruth's autopsy demonstrate that his head and neck cancer was NPC. CLINICAL IMPLICATIONS: Dentists play a pivotal role in the recognition of oral signs and symptoms and in the diagnosis of NPC, as well as the subsequent oral care of patients during and after treatment.

Recognizing doxycycline-induced esophageal ulcers in dental practice: a case report and review.

BACKGROUND: Doxycycline-induced esophageal ulcer is a documented adverse drug reaction. Unfortunately, many health care professionals are not familiar with this particular drug reaction. Because doxycycline frequently is prescribed in the clinical practice of periodontics, it is important for dentists to be aware of this potential drug reaction. METHODS: The authors describe the case of a patient who was taking doxycycline after undergoing periodontal surgery and experienced a complication. The diagnosis revealed that the patient had developed an esophageal ulcer as a result of taking the doxycycline. RESULTS: The patient's esophageal ulcer resolved with the aid of dietary changes and a prescription of rabeprazole, a proton pump inhibitor. CONCLUSIONS: and CLINICAL IMPLICATIONS: The etiology of doxycycline-induced esophageal ulceration is complex, and proper diagnosis is essential for its resolution. Dentists should be aware of the potential for this adverse drug reaction.

Reevaluation of initial therapy. When is the appropriate time?

The concept of periodontal reevaluation of initial therapy needs to be revisited. From interviewing selective periodontists and reviewing the literature, it is apparent that the time period to perform a reevaluation is an ambiguous topic. This seems to be a dichotomy because today everything in dental medicine and medicine is evidence based. When reviewing selective literature sources, it was found that either a time period for reevaluation was given that was different in almost every publication, or a time period was not given but the subject of reevaluation was addressed. The objective of this commentary is to define reevaluation and to determine the best time interval after initial therapy to perform a reevaluation based on classic and current literature. Some questions that need to be addressed are the following: 1. Does too short of a time frame for reevaluation lead to the over treatment of patients? 2. Is there a danger in reevaluating over too long of a time frame that will lead to disease progression and the return of pathogenic microbial flora? This would mean unnecessary periodontal break-down could be occurring without appropriate further treatment. Many concerns need to be addressed, including when the appropriate time period is to measure the effects of initial therapy. After this time period, the stability of the periodontium should be evaluated rather than the effects of therapy.

Reevaluation of initial therapy: when is the appropriate time?

The concept of periodontal reevaluation of initial therapy needs to be revisited. From interviewing selective periodontists and reviewing the literature, it is apparent that the time period to perform a reevaluation is an ambiguous topic. This seems to be a dichotomy because today everything in dental medicine and medicine is evidence based. When reviewing selective literature sources, it was found that either a time period for reevaluation was given that was different in almost every publication, or a time period was not given but the subject of reevaluation was addressed. The objective of this commentary is to define reevaluation and to determine the best time interval after initial therapy to perform a reevaluation based on classic and current literature. Some questions that need to be addressed are the following: 1) Does too short of a time frame for reevaluation lead to the overtreatment of patients? 2) Is there a danger in reevaluating over too long of a time frame that will lead to disease progression and the return of pathogenic microbial flora? This would mean unnecessary periodontal breakdown could be occurring without appropriate further treatment. Many concerns need to be addressed, including when the appropriate time period is to measure the effects of initial therapy. After this time period, the stability of the periodontium should be evaluated rather than the effects of therapy.