Summary of the new 2010 American Heart Association Guidelines for Basic Life Support (CPR)

Approximately every 5 years, American Heart Association (AHA) experts review emerging scientific evidence and recent clinical experiences and update the AHA guidelines for basic and advanced life support procedures for in-hospital and out-of-hospital victims of life-threatening cardiac events. This article summarizes many of the 2010 changes in those guidelines as they apply to dental healthcare providers (HCP). More detailed information will be available in the near future as these guidelines are fully implemented and instructional materials are released by the AHA. Until they are trained in future AHA or American Red Cross (ARC) basic or advanced cardiac life support (BLS, ACLS) courses in 2011, dentists, dental assistants, dental hygienists, and office staff should continue to rely on the training and information they received in their most recent basic (and/or advanced cardiac) life support training course.

Is your office prepared for an accidental needlestick or other unexpected exposure incident?

Recommendations and mandatory guidelines for preventing and managing needlestick incidents and other accidental exposures to bloodborne pathogens in healthcare facilities have been published by the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC) for more than 2 decades. Over the years, the incidence of official enforcement actions has declined and a complacency about the standards may have evolved in some dental offices. Some practitioners may not have written an occupational exposure incident protocol or made appropriate arrangements for medical laboratory testing and postexposure medical evaluation following an unexpected needlestick or other exposure incident in the office. When an unexpected event occurs, practitioners may become confused regarding the steps to be taken, and may turn to their local dental society or fellow practitioners for guidance. The provided information may or may not be complete, accurate and/or current. Implementation of periodic personnel training to prevent exposure incidents is extremely important and could ultimately save a dental practice thousands of dollars in expenses related to the occurrence of even one exposure incident, as well as save the life and/or career of a dental healthcare provider. This article does not comprehensively detail all infection control and bloodborne pathogen transmission prevention requirements for dental offices. Rather, the article provides suggestions for dental practitioners regarding the step by step management of exposure incidents, and provides resource information for additional steps that can be taken towards prevention, improved office compliance, and improved litigation protection.

Long-acting erythromycins: assessing their role in treating outpatient odontogenic infections

Erythromycins have been part of our armamentarium against selected bacterial infections since they were discovered in 1952 and approved by the Food and Drug Administration (FDA) in 1964. In 1991, two newer, long-acting erythromycin analogues, azythromycin (brand name: Zithromax) and clarithromycin (brand name: Biaxin) were approved by the FDA. They were joined a few years later by a third long-acting form, dirithromycin (brand name: Dynabac).

Stress-related suicide by dentists and other health care workers. Fact or folklore?

BACKGROUND

The media repeatedly portrays dentists and other health professionals as being at risk of committing suicide. While this message often is accepted without question, there are little reliable data available that verifies this alleged risk. The relationship between professional stress and suicide, if any, has not been substantiated or quantified.

TYPES OF STUDIES REVIEWED

The author evaluated the contemporary literature on stress and suicide in health professionals in an effort to verify or refute the widely held belief that dentists and other health care professionals are at higher risk of committing stress-related suicide. The author also surveyed dental schools to determine what efforts were being made to provide students with stress-management skills.

RESULTS

The author found that there is little valid evidence that dentists are more prone to suicide than the general population, although some related data suggest that female dentists may be more vulnerable. Large-scale studies are needed before firmer conclusions can be reached. The author's survey shows that dental students generally receive some education on stress management, but many dental hygiene and graduate students do not. The author makes several recommendations for future research.

CLINICAL IMPLICATIONS

Although some dentists leave the profession by way of suicide or career change at a time when their careers should be the most rewarding, available data on stress and its impact on suicide incidence are inconclusive and flawed. The profession needs to identify the causes of stress-related suicides and provide assistance to those people who are affected by stress.

Evaluating, documenting and following up oral pathological conditions. A suggested protocol

BACKGROUND

Many textbooks and articles are available to assist dentists in examining patients, establishing diagnoses for oral lesions and understanding the techniques of biopsy. There is little guidance in the literature, however, on when and how to follow up lesions that have a low index of clinical suspicion, or for which the pathological diagnosis does not demonstrate any overt signs of malignancy or premalignancy.

TYPES OF STUDIES REVIEWED

The authors reviewed the literature, talked to numerous clinicians and sought legal opinions regarding how a reasonable and prudent dentist should manage patients with clinically evident oral lesions that do not suggest any adverse long-term effects on the health and safety of the patient.

RESULTS

The few guidelines available in the literature, coupled with the observations of the authors and others, allow logical and reasonable interim recommendations to be proposed regarding the frequency of examinations, the timing of invasive procedures and medicolegally prudent documentation guidelines. Future studies are needed to refine these recommendations.

CLINICAL IMPLICATIONS

Some dentists have been sued for alleged failure to monitor patients, document cases or refer patients with oral lesions. The recommendations provided here can help dentists manage these patients, but they should not be construed as being rigid guidelines or legal standards that apply to all clinical situations. In some cases, the judgment and experience of clinicians may indicate the need to deviate from these recommendations. Refinements of these guidelines may emerge on the basis of future studies.

A review of perioperative corticosteroid use in dentoalveolar surgery

OBJECTIVES

Dental surgeons are often advised to use corticosteroids during and after third molar removal and other dentoalveolar surgery to reduce postsurgical edema, but recommendations for use are rarely accompanied by definitive guidance regarding the type of steroid, dosage, or duration of administration. Many regimens in use appear to be based on anecdotal information from articles in the 1960s and 1970s and might be subtherapeutic. Few regimens have been updated with data from more recent studies, and well-designed comparison studies are lacking.

STUDY DESIGN

In this article, the literature from the past 30 years is reviewed, meaningful findings are highlighted, and available data are used as a basis for formulating interim clinical recommendations for corticosteroid use pending the emergence of more evidence-based data. A meta-analysis of data was not performed.

RESULTS

Recent data suggest that perioperative corticosteroid regimens should be administered in higher doses and for longer durations than recommended in the past and should be started before surgery for optimum benefit.

CONCLUSIONS

Based on the literature review, interim recommendations for the use of corticosteroids are proposed, including dosages and regimens that appear rational for oral, intramuscular, or intravenous corticosteroid administration before and after extractions and other dentoalveolar surgery. These largely empiric recommendations might require adjustment when evidence-based data become available in future studies. There is a great need for well-designed clinical research to further evaluate protocols for corticosteroid use.

Parkinson's disease: an update for dentists

One of the diseases that will afflict the growing number of elderly American dental patients is Parkinson's disease, yet few dental articles and textbooks address the condition. This article reviews the clinical and diagnostic features, pathophysiology, management, and dental concerns in patients with Parkinson's disease who undergo dental care.

Readability of published dental educational materials

BACKGROUND

A growing number of adult Americans are functionally illiterate. These people often do not understand educational documents written by health care professionals, especially if English is the reader's second language. This problem has received little attention in dentistry.

METHODS

In this study, the author selected a sampling of 24 patient educational documents from several dental resources and reviewed them for readability, using a computer-based program that assigns a reading level of understanding on the basis of a standard formula known as the Flesch-Kincaid Formula. The author also conducted a subjective review of each document to identify seemingly unnecessary professional jargon and words that were unlikely to be understood by many readers.

RESULTS

Reading levels varied from third to 23rd grade (according to the Flesch-Kincaid Formula), and 41.7 percent of the materials were written at greater than the recommended level for understanding by most patients (mean level: seventh to ninth grade). Many dental specialty publications were written at or near college levels. Many documents had multiple grammatical errors. Seventy-nine words in the reviewed documents were considered to be jargon or potentially obscure to many lay readers.

CONCLUSIONS

More attention needs to be focused on the preparation of written educational materials for dental patients, to make the documents more understandable to the average patient. Guidelines for acceptable writing are available in the medical, nursing and pharmaceutical literature.

Routine prophylactic antibiotic use in diabetic dental patients

There is no scientific evidence in the literature to support the premise that well-controlled, or even moderately well-controlled, nonketotic diabetic patients are prone to infection when undergoing uncomplicated dentoalveolar surgery. Routine administration of prophylactic antibiotics should be considered only in situations where prophylactic antimicrobials would be used for a nondiabetic patient. Poorly controlled diabetics (whether Type I or II), with fasting glucose levels above 250 mg/dL, should be referred for improved control of their blood sugar before non-emergency surgery is performed. If emergency surgery is needed for a poorly controlled patient, then prophylactic antibiotics are prudent, using the accepted principles of such use. Infections in diabetic patients, regardless of their control levels, should be managed aggressively, including possible early referral to oral and maxillofacial surgeons.

The automated external cardiac defibrillator: lifesaving device for medical emergencies

BACKGROUND

More than 350,000 adult Americans die each year of sudden cardiac arrest, or SCA. The event is unpredictable and can occur in patients with no history of cardiac disease or cardiac symptoms. Drugs and cardiopulmonary resuscitation, or CPR, save only a small percentage of victims. The necessary response is rapid application of electrical shock, and the chances of success are reduced 10 percent for every minute of delay.

TYPES OF STUDIES REVIEWED

The author reviewed the literature on resuscitation of people who have undergone SCA, and examined the emerging technology of automated external defibrillators, or AEDs, for correcting cardiac ventricular fibrillation. Included is a review of the controversies surrounding AED waveforms and energy levels.

RESULTS

Automated cardiac defibrillators are becoming readily available because of improved technology and decreasing prices. AEDs are now commonly found in commercial aircraft, gambling casinos, sports arenas and public buildings, and will soon become as readily available as fire extinguishers. The use of AEDs is being taught in standard CPR courses.

CLINICAL IMPLICATIONS

AEDs are being installed in more public locations, including some dental offices. As costs decrease and availability increases, there is significant potential use for AEDs in managing SCAs in dental offices.

Patient understanding of postsurgical instruction forms

An estimated 20 to 48 million adults in the United States are functionally illiterate, and the number is reportedly increasing. The medical, nursing, and pharmaceutical professions have pioneered examination of the issues surrounding the readability of written instructions, but little introspection has been presented in the dental literature on the subject. Written instructions have been shown to be a valuable supplement to verbal instructions, but many forms and brochures are written at too high a grade level for many patients to be able to read and understand them. Materials should be written in a way that makes it possible for patients to understand them even if those patients read at a sixth- to eighth-grade level. This article examines the issues surrounding the writing of patient instructions and makes recommendations for improvements. Future clinical research is proposed.

Eleven myths of dentoalveolar surgery

Through the years, dentists who perform dentoalveolar surgery have perpetuated many myths and other unproven beliefs from one generation to another. Sometimes, these beliefs originated in older textbooks, while others were given birth by mentors sharing anecdotal experiences with their students. Even today, many of these scientifically unsupported statements are perpetuated in surgical textbooks and in continuing education forums and are passed on to students in dental schools. In today's evolving environment of evidence-based medicine and dentistry, these anecdotal observations do not withstand scrutiny. The purpose of this article is to review the more common surgical myths and to test their validity against scientific evidence.