Periodontitis and doxycycline (inhibit collgenase in clavicular fluid)
Effective against broad spectrum of microorganisms; used systemically and applied locally (subgingivally). Doxycycline has the same spectrum of activity as minocycline and may be equally as effective.18 Because doxycycline can be given only once daily (qd), however, patients may be more compliant. Compliance is also favored because its absorption from the gastrointestinal (GI) tract is only slightly altered by calcium, metal ions, or antacids, as is absorption of other tetracyclines. The mechanism of action is by suppression of the activity of collagenase, particularly that produced by polymorphonuclear leukocytes (PMNs). (Newman, Michael G.. Carranza’s Clinical Periodontology, 10th Edition. Saunders Book Company, 072006. 52.2.1).
Patient has hip replacement a year ago what kind of treatment can you render? Antib iotic Prohphylaxis “Given the potential adverse outcomes and costs of treating an infected joint replacement , the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia” (dental drug booklet p.79) Kaplan pg 292. Premedication fo knee and hip replacement is sometimes advised. They are more likely to be premedicated if recent years (0-2 years) and the AHA antibiotic regimens are often used. However if in doubt, send for medical consult.
What can you not give a patient with a heart condition Drug considerations: • For patients taking digitalis (CHF), avoid epinephrine ; if considered essential, use cautiously (maximum 0.036 mg epinephrine or 0.20 mg levonordefrin); avoid gag reflex; avoid erythromycin and clarithromycin, which may increase the absorption of digitalis and lead to toxicity. • For patients with NYHA class III and IV congestive heart failure, avoid use of vasoconstrictors; if use is considered essential, discuss with physician. • Avoid epinephrine-impregnated retraction cord. (use retraction chord with aluminum potassium sulfate instead) • Schedule short, stress-free appointments. • Use semisupine or upright chair position. • Watch for orthostatic hypotension, make position or chair changes slowly, and assist patient into and out of chair. • Avoid the use of nonsteroidal antiinflammatory drugs (NSAIDs). • Watch for signs of digitalis toxicity (i.e., tachycardia, hypersalivation, visual disturbances, etc.). • Nitrous oxide/oxygen sedation may be used with a minimum of 30% oxygen. (Little, James W.. Dental Management of the Medically Compromised Patient, 7th Edition. Mosby, 072007. 18.104.22.168).
Contraindication for implant-myocardial infarct, smoking, bone loss Or Adolesant The implant team should advise potential implant patients of the detrimental effects that smoking has on their oral and systemic health. Complications must be discussed and highlighted in the informed consent. Patients should be encouraged to start a smoking cessation program before implant treatment. Smoking is not an absolute contraindication; however, the risks and possible morbidity on the respective procedures must be evaluated. Note: Relative contraindications are ppl who have uncontrolled diabetes and smokers. ABSOLUTE CONTRAINDICATIONS: mental or physcho disorders, under age 16, ppl who are too critical, one cant please.
How long do you splint with avulsion. 7-10 days, bony fracture 2-8 weeks
(not sure where they got 2-8 weeks… bony fracture should be 3-4 weeks in children !!!) Splinting of avulsed teeth • Composite resin and nylon fibre (0.6 mm diameter) such as fishing line (20 kg breaking strain) or • orthodontic brackets with arch wire (0.014″ (0.4 mm)). • Orthodontic appliances are particularly useful as the time taken to apply the brackets is half that to set composite resin. • Splints should be flexible to allow normal physiological movement of the tooth. This helps to reduce the development of ankylosis; however, if there is a bone or root fracture present, then a rigid splint must be used so that there is no movement of the teeth and bony segments. • Splints should generally stay in place for 7–10 days if there are no complicating factors such as alveolar or root fractures. The occlusion may need to be relieved when the degree of overbite or luxation is such that the tooth receives unwanted masticatory force. This can be achieved by minimal removal of enamel, or construction of an upper removable appliance, or placement of composite resin on the molars to open the bite. Some physiological movement is necessary. Close reduction with plastic tooth ( with fingers). Dento-alveolar fractures With luxation of teeth, the alveolar plate can be fractured or deformed. Use firm finger pressure on the buccal and lingual plates to reposition. It should be remembered that alveolar fractures can occur without significant dental involvement. These alveolar fractures should be splinted for 3–4 weeks in children (6–8 weeks in adults). Luxated or avulsed teeth usually result in alveolar bone fracture and/or displacement. Firm pressure is needed to realign bony fragments. Splinting will be required for 3–4 weeks. Dental Secrets pg 242. Splinting times for root and alveolar fractures used to be 2-4 months but recent studies have shown splinting for 3 weeks is sufficient. (Cameron, Angus C.. Handbook of Pediatric Dentistry, 2nd Edition. Mosby Ltd., 062003. 5.16.4).
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