tips and tricks

The medical history is something that is only important when it is important. By that I meant that the vast majority of people we encounter will have no medical conditions that will significantly affect the way we do our work but when we have a patient with significant comorbidities it is vital that we identify these so we can plan accordingly. This may involves modifying our treatment plan, omitting certain procedures or consulting with our medical colleagues for advice or to arrange multidisciplinary treatment. Some patients who are significantly ill are not suitable to be treated in the general practice setting and may have to be referred onto colleagues with experience treating medically compromised patients or have to be treated in a hospital setting. A common mistake we make in private practice is that the medical history is often left to the patient to fill out and there is often not enough emphasis from the practitioner on the importance of this legal document. The issue with t...

As dentists we are trained to look for the signs of gastric reflux as they are reflected in the oral cavity but our knowledge of their causes and management is lacking. Our medical colleagues are well versed in the diagnosis, causes and management but their knowledge and screening of dental effects is lacking. This represents one of many areas where the bridge between the two professions can be improved immensely. -Acid erosion is reflected in the mouth as progressive loss of mineralised tooth structure. Loss of surface texture (perikymata) and smooth, shiny enamel is a good sign that there has been acid erosion in the past -Thinning of enamel allows dentine lobes to show through more obviously. If you can see the shadowy texture of dentine through the enamel there has already been irreversible tooth loss. -Scratches into enamel in various patterns either horizontally or randomly are a sign that the patient has a habit of brushing their teeth after an acid attack -Erosion from gas...

Background on bacterial endocarditis Infective endocarditis is an infection of the endocardium (internal surface of the heart). Effects may include: 1.        Severe valvular insufficiency 2.        Congestive heart failure 3.        Myocardial abscess 4.        Death if left untreated Infective endocarditis is a relatively uncommon illness with high morbidity and mortality. The incidence in Australia is approximately five cases per 100 000 person–years and the in-hospital mortality is 15% to 20% Bacteraemia  associated with dental procedures usually involves  viridans  group streptococci, which are known to cause infective  endocarditis . Traditionally, the presence of 'significant bleeding' associated with a dental procedure was assumed to be an indication of  bacteraemia  and hence a need for prophylaxis; h...

For the 3062 presentation we had an anaphylaxis case study and this is just a summary from memory of the clinical protocols: A patient's hypersensitivity reaction may occur as redness or urticaria (Rash), breathing problems from bronchospasm or odema, systemic odema. Oral manifestations include    Pruritus of lips, tongue and palate, edema of lips and tongue. If there is suspicion of an allergic reaction or an allergen has been administered e.g. LA, penicillin then administer 10mg chloramphenamine and 100mg hydrocortisone. Lie the patient down to counter hypotension unless there is airway involvement then keep the patient upright. Administer oxygen if symptoms appear and if there are serious symptoms or breathing problems then administer 1:1000 epinephrine  Intramuscularly via epipen in lateral of thigh or arm. You may need to readminister adrenaline every 5 minutes or so due to adrenaline's low half life until the chloramphenamine has taken effect. If serious symptom...