Rare diseases with oral components: care course and quality of life

AIM

To describe links between the care course of individuals suffering from rare diseases and socio-behavioural risk factors and to ascertain the impact of dental conditions on the quality of life.

DESIGN

A cross-sectional comparative study involving self-reported questionnaire was performed. Care course was evaluated using predisposing, enabling and needs factors. The impacts of dental conditions on quality of life were measured with the OHIP 14 questionnaire. Proportions were compared by Chi-square test. Logistic regression for multivariate analysis assessed statistical association between variables.

RESULTS

Responses were received from 355 subjects (mean age 36.9 years, 67.6% females). Thirty-three rare diseases were recorded. Respondents were classified as group A, individuals suffering from rare diseases with a dental component (n=207, 58.3%), and group B, without dental component. Group A reported earlier diagnosis, more positive attitude toward dentists, functional limitation and higher prosthetic treatment needs. Only 17.4% of subjects having fewer than 20 teeth wear prosthetics. A higher percentage of individuals claiming pain, physical disability, psychological discomfort and social disability, was found among group B (p<0.001). Logistic regression analysis retained two impact factors: psychological disability (Exp(B)=8.66; 95% CI 1.86-40.34) and social wellbeing (Exp(B)=0.06; 95% CI 0.02-0.215).

CONCLUSION

Rare diseases with a dental component benefited from earlier identification of symptoms. Dentists could contribute to patients' quality of life by helping in early diagnosis, reducing functional limitation and improving social wellbeing.

Antibiotic prophylaxis: a literature review

Antibiotic prophylaxis has been a matter of great interest and has been discussed by researchers and clinicians over the years. Changes and recommendations have been made in order to clarify protocol and make it safer for patients. Various organizations such as the American Heart Association, American Academy of Oral Surgeons, American Dental Association, and American Academy of Oral Medicine have played vital roles in formulating guidelines for antibiotic prophylaxis. These recommendations for prevention of infective endocarditis have been based on clinical experiences and research as well as expert opinion. This paper summarizes the most recent guidelines for general readers so that informed decisions may be made that are in the interest of patients and practitioners.

An innovative HIV training program for dental hygiene students

Patients with HIV/AIDS deserve to be treated with compassion and receive comprehensive care by their dentist and dental hygienists. Previous studies have shown that many dental and dental hygiene students had negative attitudes towards treating such individuals. This article addresses the effectiveness of a program that trains dental hygiene students in the issues of treating this population. All pre-doctoral students at the Loma Linda University School of Dentistry are required to receive this training. Dental hygiene students complete a pre-session survey during their first year and a post-session survey as they complete the training during their second year. The survey questionnaire was administered during the period of 2003 to 2009, during which 197 students completed responses to the post-session survey. Five questions in the survey address self-evaluation of knowledge, attitudes, confidence in the efficacy of Universal Precautions and Post-Exposure Prophylaxis (PEP) following blood borne exposures. This study reports on 5 overlapping 2 year testing cycles and shows significant shifts in all 5 areas surveyed. The most significant gains were in "Familiarity with PEP" and "Confidence in the Efficacy of PEP." These data support the usefulness of an HIV program in preparing future dental hygienists to deliver appropriate care to persons living with HIV/AIDS.

New antiplatelet and anticoagulant drugs. Considerations for dental patient management

A recent occurrence in dental practice is the noting of new "blood thinners" when the clinician is reviewing a patient's medical history and medications. "Doc, I take Pradaxa or Effient or Xarelto" etc. After many years of the widespread use of aspirin and Coumadin there has appeared a new generation of medications focused on reducing thromboembolic events in patients at risk. This trend has been driven by a need for drugs providing better drug efficacy based on patient biologic processing of the medications and the frequency and cost factors associated with the monitoring the degree of anticoagulation. Guidelines for assessing bleeding risk and managing patients on these new medications in dental practice are not yet defined and are empirically based on medical practitioner experience. This paper will review these new medications and will discuss current considerations for dental patient care. (Note that not all new antiplatelet and anticoagulant medications will be reviewed in this paper.)

Dental treatment for high-risk patients with refractory heart failure: a retrospective observational comparison study

OBJECTIVE

Heart failure affects large population groups. The understanding of the etiology, pathophysiology, and treatment of heart failure has changed considerably within the last few years. The changes have significant implications for the medical management of the disease, as well as on the ability to provide proper dental treatment for these patients.

METHOD AND MATERIALS

A retrospective observational study of the outcome following dental treatment of 54 patients was performed: 32 with refractory heart failure stage D (study group) and 22 patients at risk for heart failure stages A to C (control group). Dental management of these patients concentrated on the prevention of iatrogenic, dental setting- induced, and precipitating factors of heart failure. To prevent deterioration of patients' medical condition, a comprehensive, tailored treatment including adequate anxiolysis, close monitoring, profound dental anesthesia, and close follow-up was used. A previously described three-step gradual level protocol (at home, waiting room, and dental chair) was adopted.

RESULTS

All the planned dental procedures were successfully completed. Six patients experienced respiratory distress during treatment, and five patients demonstrated arrhythmias during dental treatment. Only minute differences were found between the groups regarding blood pressure and heart rate.

CONCLUSION

Use of the suggested protocol facilitated the completion of planned dental treatments for all patients. Thus, providing essential dental treatment for severe heart failure patients with special attention to their medical problems and the use of medications and supporting means to prevent health-compromising situations is recommended.

Lefort 1 osteotomy in a beta-thalassemia major patient--a case report

Maxillary setback of patients with protruded maxilla is a complex procedure. This complexity is aggravated when combined with thalassemia. The Aim of this case report was to treat a beta-thalassemia major girl with severe maxillary protrusion. A 16 year-old beta-thalassemia major girl presented with excessive maxilla, incompetent lips and an everted upper lip was referred for treatment. She had her spleen removed at the age of 9 and her blood transfusion was stopped 3 month before referral. After leveling and aligning with 018 standard edgewise system the patient was sent for Lefort 1 osteotomy. Segmental osteotomy was denied due to excessive bleeding in the procedure. The results showed that the thalassemic patient was effectively treated with presurgical orthodontics, Lefort 1 osteotomy followed by post surgical orthodontics. Very satisfactory esthetic results were obtained in the patient after 4.5 years of active treatment.

Harlequin ichthyosis: a case report

Harlequin Ichthyosis (HI) is a very rare subtype of a group of hereditary disorders that have in common the accumulation and shedding of significant amounts of hyperkeratotic epidermis. HI has a very specific clinical presentation that includes eclabium, fish mouth appearance, mouth breathing and xerostomia. The addition of a very high caloric demand to the clinical features place these affected individuals at extremely high risk for developing rampant dental decay. This case report discusses a two-year-old boy with HI that presents with severe early childhood caries. The specific accommodations that were made to accomplish required dental work under general anesthesia are presented. A case is made for the inclusion of dentists in the management of these cases once a diagnosis is made.

Juvenile idiopathic arthritis: review of the literature and case report

Juvenile idiopathic arthritis (JIA), previously known as juvenile chronic arthritis or juvenile rheumatoid arthritis, is a chronic disease of childhood with a spectrum of joint involvement and associated systemic involvement. The cause of JIA is poorly understood, and no drugs can cure the disease currently. Pediatric dentists should be familiar with the symptoms, complications, and oral manifestations of JIA to help manage the disease and provide quality care to these patients. The purpose of this case report is to review the condition and to describe the case of an adolescent with polyarticular juvenile rheumatoid arthritis, focusing on specific recommendations for dental management.

Pre- and postdoctoral dental education compared to practice patterns in special care dentistry

There has been limited research into the impact of predoctoral experiences and postdoctoral general dentistry residencies on the practice patterns of dentists in the care of patients with special or complex needs. This study was undertaken to determine if educational experiences with special populations had a relationship to practice patterns after graduation or residency. University of the Pacific alumni who graduated between 1997 and 2007 were surveyed regarding their pre- and postdoctoral dental education and their practice patterns for the care of patients categorized as medically compromised, frail elders, and developmentally disabled. Definitions for each patient category were provided. Alumni were asked about their practice setting and postdoctoral education. Thirty-one percent (n=526) of those surveyed responded. Regression analyses showed respondents not in private practice were more likely to have completed a postdoctoral general dentistry program (Advanced Education in General Dentistry or General Practice Residency) after dental school compared to respondents in private practice (p<0.001). Across all age groups, respondents not in private practice treated significantly more patients with developmental disabilities than those in private practice (p<0.001). Respondents not in private practice treated more medically compromised patients younger than age sixty-five compared to respondents in private practice (p<0.01). Interestingly, those in private practice treated significantly more patients over sixty-five who were also classified as medically compromised (p<0.05). Pacific alumni who completed postdoctoral training in general dentistry were found to practice more often in non-private practice settings. Alumni in non-private practice settings reported treating a higher percentage of medically compromised patients below age sixty-five than their counterparts in a typical private practice. The pre- and postdoctoral experiences of treating special needs populations appear to have a relationship to graduates' practice setting and patient population.

Dental treatment in Angelman syndrome patients. 8 case reports

AIM

Angelman syndrome is a rare neurogenetic disorder resulting in delayed neuropsychological development, intellectual disability, speech impairment, movement or balance disorder and a behavioural uniqueness. It is caused by deletion of maternal chromosome 15q11-13. The syndrome has oral manifestations such as diastemas, tongue thrusting, sucking/swallowing disorder, mandibular prognathism, and wide mouth. The dental literature on the syndrome is scarce.

CASE REPORT

We report our approach to dental procedures in Angelman syndrome patients, and the relationship between the dental staff and the patient and his family. The purpose of this paper is to highlight the possibility of dental treatment in general anaesthesia, due to the lack of cooperation of some of these patients.

The impact of obesity on prosthodontic treatment

Obesity has become a worldwide epidemic and an increasing public health concern that has a negative impact on both overall systemic and oral health. At the same time, the need for prosthodontic treatment has increased and has been projected to be more in demand in the future. It has also been predicted that the need to provide prosthodontic treatment to an increasing number of obese patients may become routine. However, delivering prosthodontic treatment to obese patients may be a challenge due to their anatomy, physiology, and physical characteristics. It is important to recognize the potential comorbidities and assist patients in seeking necessary help. It may be necessary to modify hardware, equipment, techniques, treatment positions, and/or prosthodontic protocols to ensure that these patients receive the proper care and avoid unforeseen complications. An obese patient with a compromised medical history and complex dental status may be managed best by a multidisciplinary team approach.

General anesthesia time for pediatric dental cases

PURPOSE

The purpose of this study was to describe the use of operating room (OR) time for pediatric dental procedures performed under general anesthesia (GA) at a regional children's hospital over a 2-year period.

METHODS

A cross-sectional review of a pediatric dental GA records was performed at Seattle Children's Hospital. Data were collected for 709 0- to 21-year-old patients from January 2008 to December 2009. Demographic data, dental and anesthesia operator types, and procedures were recorded. Utilization of OR time was analyzed.

RESULTS

The mean age of patients was 7.1 years (±4.2 SD), and 58% were male. Distribution by American Society of Anesthesiology (ASA) classifications were: ASA I 226 (32%); ASA II 316 (45%); ASA III 167 (24%). Cases finished earlier than the scheduled time by an average of 14 minutes (±28). Overrun time was significantly associated with: patient age (P=.01); ASA classification (P=.006); treatment type (P<.001); number of teeth treated (P<.001); and dentist operator type (P=.005).

CONCLUSIONS

Overall, 73% of dental procedures under GA finished early or on time. Significant variables included patient age, medical status, treatment type and extent, and dentist operator type. Assessing factors that impact the time needed in GA may enhance efficiency for pediatric dental procedures.

Case report: Noonan-like multiple central giant cell granuloma syndrome

The purpose of this report was to: summarize the care of a child between the ages of 12 to 16 years old born with Noonan-like central giant cell syndrome and unrelated common variable immune deficiency; provide information on the dental management of patients with Noonan's syndrome; and present a brief discussion of the recent associated genetic findings. A review of the common features of Noonan syndrome and Noonan-like central giant cell syndrome is also provided.