Falls: considerations for the dental surgeon

Medication-related osteonecrosis of the external auditory canal - A rapid review of the literature and relevance to special care dentists

AIMS

There is growing evidence that anti-resorptive and anti-angiogenic medications can cause medication-related osteonecrosis of the external auditory canal (MROEAC). It is possible that patients taking risk medications may also suffer from concomitant medication -related osteonecrosis of the jaw (MRONJ) or temporomandibular joint (TMJ) involvement. The aim of this paper is to conduct a rapid review of the literature on MROEAC, and, its relevance to special care dentists.

METHODS AND RESULTS

A rapid review of the literature was carried out using PubMed, Science Direct and Google Scholar to identify papers relating to MROEAC. The grey literature and non-English papers were also consulted. Overall, 19 papers were identified from 2005 until December 2022.

CONCLUSIONS

Patients at risk of MRONJ may also be at risk of MROEAC and present to special care dentists. Dental/orofacial disease may cause signs and symptoms suggestive of MROEAC. It should be considered as a potential cause of orofacial pain in special care patients. MROEAC can have a significant impact on a patient's dental treatment, including access, the provision of sedation, communication difficulties, and consent issues.

Ultrasound-guided peripheral intravenous cannulation for patients requiring dental surgery under intravenous dental sedation

Dental surgeons regularly provide intravenous dental sedation and oral/transmucosal sedation, which involves cannulation. Cannulation is an essential skill that dental surgeons should be competent to perform, but certain patient groups may be difficult to cannulate. Ultrasound-guided peripheral intravenous cannulation is an evidence-based technique already used in radiology, emergency medicine, and anaesthesia. Ultrasound-guided peripheral intravenous cannulation has been shown to reduce complications and significantly increase the success of cannulation in patients with difficult intravenous access (DIVA); it may also be preferable in certain special care patient groups. The application of ultrasound-guided peripheral intravenous cannulation should be considered for patients with DIVA who require intravenous dental sedation or other common procedures in dental surgery that involve cannulation.

Oral Health Disorders in Parkinson's Disease: More than Meets the Eye

Despite clinical evidence of poor oral health and hygiene in Parkinson’s disease (PD) patients, the mouth is often overlooked by both patients and the medical community, who generally focus on motor or psychiatric disorders considered more burdensome. Yet, oral health is in a two-way relationship with overall health—a weakened status triggering a decline in the quality of life. Here, we aim at giving a comprehensive overview of oral health disorders in PD, while identifying their etiologies and consequences. The physical (abnormal posture, muscle tone, tremor, and dyskinesia), behavioral (cognitive and neuropsychiatric disorders), and iatrogenic patterns associated with PD have an overall detrimental effect on patients’ oral health, putting them at risk for other disorders (infections, aspiration, pain, malnutrition), reducing their quality of life and increasing their isolation (anxiety, depression, communication issues). Interdisciplinary cooperation for prevention, management and follow-up strategies need to be implemented at an early stage to maintain and improve patients’ overall comfort and condition. Recommendations for practice, including (non-)pharmacological management strategies are discussed, with an emphasis on the neurologists’ role. Of interest, the oral cavity may become a valuable tool for diagnosis and prognosis in the near future (biomarkers). This overlooked but critical issue requires further attention and interdisciplinary research.