Cold agglutinin disease and its implications for dental treatment

Cold agglutinin disease (CAD) is a rare variant of autoimmune hemolytic anemia, characterized by the destruction of red blood cells by autoantibodies following exposure to cold temperatures. This case is of a 75‐year‐old male who presented to a dedicated hematology dental clinic. The dental management over a 3‐year period is described, whereby the patient had extraction and periodontal disease management with considerations for medical, social and dental risk assessments and treatment modifications. The principles are applicable to patients with other hematological disorders.     

The oral implications of Hodgkin's disease

Hodgkin's disease is a cancer involving the lymphatics. While the yearly total of new cases is only approximately 7,500, the disease is very curable with modern radiotherapy and/or combination chemotherapy. This represents an increasing number of survivors who require dental treatment. Unfortunately, the treatment for Hodgkin's results in significant, permanent complications that persist for the duration of the patient's life. These complications can include xerostomia, radiation-induced caries, the risk of osteoradionecrosis in irradiated bone, and systemic complications such as a reduced immune response to microorganisms. These patients can and do undergo all types of dental treatment safely as long as the practitioner recognizes the risks involved and takes appropriate precautions.     

Valvular heart disease and heart failure: dental management considerations

Approximately 5 million people are diagnosed with valvular heart disease in the United States each year. Many of these will present to the general dentist for routine dental care. The dentist must then understand the implications of this disease process to treat these patients safely and effectively. Of course patients with pathologic valve disease are managed in close consultation with their physicians. Even so, a dentist with knowledge of the disease process, as well as its diagnosis and treatment, has greater confidence when treating these patients. This article summarizes issues related to valvular heart disease and heart failure and provides guidance to dentists treating patients with such conditions.     

Numb chin syndrome: dental treatment implications

Numb chin syndrome (NCS) is characterized by facial numbness and lip paresthesia along the distribution of the mental branch of the trigeminal nerve. Most cases of this syndrome that are not dental in origin are usually associated with malignant tumors or diffuse metastatic disease. This case report emphasizes the necessity for the dentist, when confronted with such a case, to gather all diagnostic information before providing dental treatment.     

Ischemic heart disease: dental management considerations

Ischemic heart disease (IHD) is a common problem. Thus, most dental professionals who treat adults see patients with IHD on a daily basis. Fortunately, most patients are either too young to have clinical stigmata of IHD or have the disease well controlled. However, for those patients prone to angina or a myocardial infarction, dental care providers must be prepared to recognize and manage the risks so untoward events are prevented or their impact mitigated. This article presents information useful for assessing risks and planning the delivery of safe dental care to those with IHD.     

Oral rehabilitation with dental implants after cancer treatment

Background: Patients who undergo surgical management of oral cancer may greatly benefit from an implant‐supported prosthesis. This study reports on the clinical experience of dental implant placement in patients following resection of oral cancer over a 15‐year period. Controversies including the use of dental implants in irradiated tissues, and hyperbaric oxygen treatment will also be discussed. Methods: Thirty‐one patients who had dental implants placed as part of their oral rehabilitation between 1992 and 2007 were investigated. Demographic data and factors including implant survival, type of prosthesis provided, radiotherapy and the hyperbaric oxygen therapy were analysed. Results: In this retrospective study, there was a retention rate of 110 implants from a total of 115 implants placed. A high rate of implant retention was found, with 5 implant failures from a total of 115 implants placed. The 5 failed implants occurred in free flap bone that had been irradiated. Conclusions: Dental implants provide an important role in the oral rehabilitation of oral cancer patients. There may be an increased risk of implant failure in free flap bone that has been irradiated.     

Melanoma: etiology, treatment, and dental implications

Melanoma is one of the most serious skin cancers. It arises from neural crest-derived melanocytes located in the epidermis or dermis of the skin. Melanoma also can arise from melanocytes located in other regions of the body such as the eye, meninges, digestive tract, mucosal surfaces, or lymph nodes. There are no proven causes of melanoma but the most commonly associated factor is episodic exposure to the sun. Melanoma is a common cancer that has been increasing in incidence for the last 35 years. The median age at the time of diagnosis is 53 years. It is much more common in whites than in people of color. Five-year survival rates for melanoma of the skin have been increasing since 1976. There are four types of melanoma: superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lintiginous melanoma. Clinical signs indicating possible melanoma are asymmetry, border irregularity, color variation, increase in diameter, elevation, ulceration, and bleeding of pigmented lesions. Histopathologic findings (tumor thickness, tumor invasion), surface ulceration, spread to lymph nodes, and distant metastases are used to project patient prognosis. Treatment consists of surgical excision, lymph node dissection, limb perfusion, regional chemotherapy infusion, radiation, intralesional immunotherapy, systemic chemotherapy, and/or interferon-alpha, depending on the staging of the melanoma. Oral melanomas are rare; however, approximately 20% of all melanomas are found in the head and neck region. The role of the dentist is to be alert for changes in pigmented lesions of the oral mucosa and skin of the head and neck. Lesions suspected of melanoma must be biopsied, which usually involves referral of the patient.     

Developmental stuttering: Manifestations, treatment and dental implications

Developmental stuttering (DS) is a disturbance in the normal fluency and time patterning of speech resulting in involuntary repetition, prolongation, or cessation of sound. The scientific literature has implicated the lack of strong left cerebral dominance and abnormal levels of the neurotranemitters dopamine and possibly serotonin in regions of the brain controlling the coordination of language processing and motor activity of the vocal apparatus as possible causative factors in DS. Speech-language therapy is the most common form of treatment, but antipsychotic, antide-pressant, and anxiolytic medications may be prescribed for some children and adults with persistent stuttering. These medications may cause xerostomia and adversely interact with certain antibiotics, analgesics, and sedatives routinely used in dentistry. Some people who stutter have sensory-motor and tactile-proprioceptive deficits that impede accurate and timely movements of the mandible, lips, and tongue, necessitating protection of the airway by staff during dental care.     

Glycogen storage disease and von Willebrand's disease implications for dental treatment: Dental management of a pediatric patient

Glycogen storage diseases (GSD) are metabolic disorders which impair the body's ability to store glucose and utilize it later, requiring patients to take multiple daily dietary supplementation with a high carbohydrate content. Patients undergoing this treatment modality are placed at increased risk for gross dental caries and other oral abnormalities. Additionally, GSD may prolong the patient's bleeding time, which may necessitate consultation with the treating physician. In the following case, our patient required a multi-disciplinary approach to address not only her dental needs, but also to coordinate the management of both her GSD and an additional complication, von Willebrand's disease. This was best achieved in a hospital setting     

Alzheimer's disease: psychopathology, medical management and dental implications

BACKGROUND: The authors review the clinical features, epidemiology, pathophysiology, medical management, dental findings and dental treatment of patients with Alzheimer's disease (AD). STUDIES REVIEWED: The authors conducted MEDLINE searches for 2000 through 2005 using the terms "Alzheimer's disease," "geriatric," "epidemiology," "pathophysiology," "treatment" and "dentistry." Reports selected for further review included those published in English in peer-reviewed journals. The authors gave preference to articles reporting randomized, controlled trials. RESULTS: AD is a progressive and fatal neurodegenerative disorder characterized by cognitive dysfunctions, particularly in learning and memory, and the emergence of behavioral abnormalities. Deficiencies in the cells responsible for storage and processing of information underlie the cognitive, functional and behavioral changes seen in patients with the disorder. CLINICAL IMPLICATIONS: As the elderly population grows, increasing numbers of Americans with AD will require dental treatment. The prevalence of dental disease likely will be extensive, because of diminished salivary flow and patients' inability to perform appropriate oral hygiene techniques. Preventive dental education for the caregiver and use of saliva substitutes and anticaries agents by the patient are indicated.     

Perioperative hemodynamic changes in ischemic heart disease patients undergoing dental treatment

Twenty patients with stable ischemic heart disease in functional capacity Class II-IV underwent dental treatment. Scaling was performed in seven patients without local anesthesia. In the remaining 13 patients, pain control for restoration placement was obtained by local anesthesia: in seven patients, the anesthetics contained epinephrine, while In six this drug was omitted. Heart rate, blood pressure, and electrocardiograph were continuously monitored during the dental session. All patients had elevated systolic blood pressure and rate pressure product during treatment. In the patients who received plain local anesthetics only, the elevation In systolic blood and rate pressures was, however, significantly lower than the ischemic threshold. Arrhythmia or ST segment depression of 1 millimeter were not recorded in any of the subjects. In severely compromised ischemic heart disease patients undergoing routine dental procedures of limited chair time, plain local anesthesia seems to be the preferred analgesic modality.     

Cocaine abuse: orofacial manifestations and implications for dental treatment

Millions of individuals in Europe and the United States use cocaine regularly. Use of cocaine may have several orofacial effects such as perforation of nasal septum and palate, gingival lesions and erosion of tooth surfaces. Recent use of cocaine may also increase medical risks during dental treatment, especially when local anaesthetics with epinephrine or epinephrine-impregnated retraction cords are used. Therefore, it is recommended to postpone dental treatment at least 6 to 24 hours after the use of cocaine.     

Restless legs syndrome: manifestations, treatment and dental implications

BACKGROUND: The authors reviewed the clinical features, epidemiology, pathogenesis and risk factors, medical management, dental findings and dental management of patients with restless legs syndrome (RLS). TYPES OF STUDIES REVIEWED: The authors conducted a MEDLINE search for the years 2000 through 2004 using the key terms "restless legs syndrome," "epidemiology," "pathophysiology," "treatment" and "dentistry." They selected articles published in English in peer-reviewed journals for further review, and they gave preference to articles reporting randomized controlled trials. CONCLUSIONS: RLS is a neurological disorder that is characterized by unpleasant sensations in the legs that occur at rest, especially at bedtime. These symptoms cause an irresistible urge to get out of bed and move the legs to relieve the discomfort, thereby delaying sleep onset and resulting in fatigue and dysphoria the next day. CLINICAL IMPLICATIONS: The prevalence of dental disease may be extensive in patients with RLS because of diminished salivary flow resulting from the medications used to treat RLS. Patient education, saliva substitutes and anticaries agents are indicated. Special precautions must be taken when prescribing or administering sedative-hypnotic agents that are likely to have adverse reactions with the medications used to treat RLS.     

Sickle cell disease and dental treatment

Sickle cell disease (SCD) and sickle cell trait (SCT) are found most frequently in individuals of African, Middle Eastern and Indian ethnicity. Population migration has made this disease more common worldwide, including Ireland. We present an overview of this disease, focusing on management and practical implications for dental practitioners.     

Age, dental infections, and coronary heart disease

Epidemiological and intervention studies have suggested that infections are risk factors for coronary heart disease (CHD). Dental infections have appeared as cardiovascular risk factors in cross-sectional and in follow-up studies, and the association has been independent of the "classic" coronary risk factors. This case-control study aimed at detailed assessment of the dental pathology found in various CHD categories (including elderly patients). Altogether, 85 patients with proven coronary heart disease and 53 random controls, matched for sex, age, geographic area, and socio-economic status, were compared with regard to dental status, assessed blindly with four separate scores, and to the "classic" coronary risk factors (seven of the controls had CHD, and they were not included in the analyses). The dental indices were higher among CHD patients than in the controls, but, contrary to previous studies, the differences were not significant (between the CHD patients and their matched controls or among the different CHD categories). This result could not be explained by potential confounding factors. The participants in the present study were older and had more often undergone recent dental treatment in comparison with subjects in our earlier studies. Age correlated with the severity of dental infections only in the random controls but not in the coronary patients who, although young, already had high dental scores. We believe that the higher age of the participants in the present study is the most likely reason for the results. Other possible explanations include an age-related selection bias among older CHD patients, and the fact that those participating in studies like this may have better general health and thus also less severe dental infections. Thus, the role of dental infections as a coronary risk factor varies according to the characteristics of the population studied.     

Anxiety disorders: dental implications

Anxiety disorders are the most frequently found psychiatric problem in the general population. The most common anxiety disorders are phobias, panic attack, generalized anxiety disorder, post-traumatic stress disorder and acute stress disorder. Recent terrorist attacks in the U.S. have had a marked impact on the mental health status of individuals directly affected by the attacks as well as those who were far from the scenes of destruction. To provide effective dental care, the dentist must be able to identify anxious patients and deal with their anxiety. This process may involve referring the patient for medical evaluation and treatment of very severe cases of anxiety. In most cases, the dentist can manage the patient by using behavioral and/or pharmacologic means.