scholarly journals Anesthetic Management of the Pregnant Patient: Part 1

2021 ◽  
Vol 68 (1) ◽  
pp. 52-62
Author(s):  
Jaimin Shin
Keyword(s):  
Dental Treatment ◽  
Anesthetic Management ◽  
Pregnant Patient ◽  
Developed Countries ◽  
Anesthetic Agents ◽  
Dental Procedures ◽  
Dental Patient ◽  
The Many ◽  
Dental Providers ◽  
The Impact

As delays in the age for a mother's first pregnancy continue to trend upward globally, particularly in developed countries, many pregnant patients are increasingly educated on the importance of obtaining dental care throughout their pregnancies. Guidelines set forth by the American Dental Association and the American College of Obstetrics and Gynecologists highlight the importance of dental treatment for optimizing maternal-fetal health across all trimesters, especially for emergent dental issues. The pregnant dental patient undergoes significant physiologic remodeling unique to each trimester, which may complicate treatment. Providing safe anxiety and pain control for dentistry can be further complicated if sedation or general anesthesia is required for the parturient. This is even more true when superimposed with increasingly prevalent underlying comorbidities like hypertension and diabetes. As dental providers, there is a clear need for continuing education on the many challenges associated with caring for pregnant patients due to this being an often overlooked subject in undergraduate and postgraduate dental education. Part 1 of this review will present the maternal and fetal physiologic considerations and the impact on patient management from an anesthetic perspective. Additional discussion focusing on common sedative and anesthetic agents used during dental procedures and their considerations will follow in Part 2.

Surveying adherence of dental clinic patients to preventive measures in oral cavity

2019 ◽  
Vol 24 (2) ◽  
pp. 167-172 ◽  
Author(s):  
T. V. Kudryavtseva ◽  
V. V. Tachalov ◽  
E. S. Loboda ◽  
L. Yu. Orekhova ◽  
E. Yu. Nechai ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Working Conditions ◽  
Oral Hygiene ◽  
Preventive Measures ◽  
Periodontal Diseases ◽  
Dental Health ◽  
Developed Countries ◽  
Dental Clinic ◽  
The Many ◽  
The Impact

Relevance. Periodontal diseases are a medical and social problem due to the wide spread among the population of developed countries and the impact on the quality of life. Among the many factors that are important in the development of inflammatory periodontal diseases, an important role is played by adherence to the recommendations of the dentist in respecting oral hygiene. Aim of the work was to study the adherence of patients of the dental clinic to compliance with preventive measures in the oral cavity.Materials and methods. A total of 98 patients of dental clinic, 62 female (medial age 38,6 ± 14,0 years) and 36 male (medial age 37,2±13,1 years) participated in survey. The study participants flled in the profle and answered questions about age, gender, harmful working conditions and bad habits, frequency of visits to the dental clinic, attitudes to the prevention of dental diseases, knowledge about the means and methods of oral hygiene.Results. As a result of the study, it was found that in the vast majority of cases, respondents are employed in production that does not adversely affect their health (91%), only 8% of patients indicated harmful working conditions.Conclusions. The study revealed that, despite the recommendations of the dentist, patients are not always committed to the implementation of preventive measures in the oral cavity. Dentists need to motivate patients to use not only the usual methods and means of hygiene, but also additional ones necessary for maintaining dental health.

scholarly journals Anesthetic Management of a Patient With Systemic Sclerosis and Microstomia

2020 ◽  
Vol 67 (1) ◽  
pp. 28-34
Author(s):  
Yoshiki Shionoya ◽  
Hatsuko Kamiga ◽  
Gentarou Tsujimoto ◽  
Eishi Nakamura ◽  
Kiminari Nakamura ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Respiratory Depression ◽  
Dental Treatment ◽  
Anesthetic Management ◽  
Moderate Sedation ◽  
Emergency Airway ◽  
Analgesic Effects ◽  
Anesthetic Agents ◽  
History Of ◽  
Skin Blood Vessels

Systemic sclerosis (SSc) is an autoimmune disease that can cause fibrosis in vital organs, often resulting in damage to the skin, blood vessels, gastrointestinal system, lungs, heart, and/or kidneys. Patients with SSc are also likely to develop microstomia, which can render dental treatment difficult and painful, thereby necessitating advanced anesthetic management. This is a case report of a 61-year-old woman with a history of SSc with microstomia, interstitial pneumonia, and gastroesophageal reflux disease in whom intravenous moderate sedation was performed using a combination of dexmedetomidine and ketamine for dental extractions. Both anesthetic agents are known to have analgesic effects while minimizing respiratory depression. Consequently, the increased discomfort caused by opening the patient's mouth and stretching the buccal mucosa was sufficiently managed, permitting an increase in maximum interincisal opening and completion of treatment without complications. Patients with SSc present with serious comorbidities that can negatively impact anesthetic management, so the implementation of an anesthetic plan that takes such risks into account is required. Furthermore, emergency airway management is likely to be difficult in patients with microstomia. For intravenous moderate sedation, combined use of dexmedetomidine and ketamine, which have analgesic effects while minimizing respiratory depression, may be particularly effective in patients with SSc and microstomia.

scholarly journals Investigation of Oral Microbiome in Donkeys and the Effect of Dental Care on Oral Microbial Composition

Animals ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 2245
Author(s):  
Yiping Zhu ◽  
Wuyan Jiang ◽  
Reed Holyoak ◽  
Bo Liu ◽  
Jing Li
Keyword(s):  
Dental Treatment ◽  
16S Rrna Gene Sequencing ◽  
Oral Microbiome ◽  
Rrna Gene ◽  
Microbial Composition ◽  
Dental Procedures ◽  
Significant Difference ◽  
Dental Diseases ◽  
Rrna Gene Sequencing ◽  
The Impact

The objective of this study was to investigate the oral microbial composition of the donkey and whether basic dental treatment, such as dental floating, would make a difference to the oral microbial environment in donkeys with dental diseases using high-throughput bacterial 16S rRNA gene sequencing. Oral swab samples were collected from 14 donkeys with various dental abnormalities on day 0 (before treatment) and day 20 (twenty days after treatment). It is the first report focusing on the oral microbiome in donkeys with dental diseases and the impact of common dental procedures thereon. Identified in group Day 0 and group Day 20, respectively, were 60,439.6 and 58,579.1 operational taxonomic units (OTUs). Several taxa in Day 0 differed significantly from Day 20 at the phylum and genus levels, but no statistically significant difference was observed in richness and diversity of Day 0 and Day 20. The results also indicated that a larger-scale study focusing on healthy donkey oral microbiome, as well as the correlation of dental diseases and oral microbiomes at different time frames following more specific and consistent dental treatment, are warranted.

Anesthetic Implications of Obesity and Obstructive Sleep Apnea

2017 ◽  
Vol 35 (1) ◽  
pp. 17-35
Author(s):  
Jennifer Greenwood
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Best Practice ◽  
Anesthetic Management ◽  
Developed Countries ◽  
The Past ◽  
Practice Recommendations ◽  
Obstructive Sleep ◽  
The Impact ◽  
Complications And Mortality

The incidence of morbid obesity has tripled within the past 25 years in developed countries, with the highest rate of growth noted among people with body mass index (BMI) greater than 50. The physiologic derangements that accompany obesity affect almost every organ system leading to a vast array of comorbid conditions including obstructive sleep apnea (OSA). This review focuses on the unique perioperative management considerations that the nurse anesthetist must address when caring for these patients as well as the impact of obesity and OSA on postoperative complications and mortality rates. Current research is reviewed to highlight best practice recommendations for all phases of anesthetic management including implications for bariatric surgery and office-based practice.

scholarly journals Emergency and Urgent Dental Visits among Medicaid Enrollees from 2013 to 2017

2020 ◽  
Author(s):  
Rebekah Fiehn ◽  
Ilya Okunev ◽  
Mary Bayham ◽  
Steven Barefoot ◽  
Eric Tranby
Keyword(s):  
Dental Treatment ◽  
The United States ◽  
Definitive Treatment ◽  
Dental Visits ◽  
Dental Procedures ◽  
Nationally Representative ◽  
Ibm Watson ◽  
Dental Emergency ◽  
Dental Providers ◽  
Medical Claims Database

Abstract Background: Efforts to combat the spread of COVID-19 have led to guidance to restrict dental practice to treating emergency and urgent dental visits and reduce or eliminate elective dental procedures. Better understanding of the frequency of dental emergencies and the procedures performed during those emergency visits can help providers, insurers, and policymakers understand workforce and care provision needs.Methods: Procedures performed at an emergency dental encounter and in the encounter following that encounter are assessed. Emergency dental encounters are those with a CDT code of D0140, D0160, or D0170. Data was analyzed from the IBM Watson Medicaid Marketscan data from 2013 to 2017, a nationally representative dental and medical claims database from 13 deidentified states in the United States. Result: Consistently over time, about 10% of all dental encounters are due to a dental emergency. 28% of emergency dental encounters had no other procedure performed during those encounters. When other procedures were performed during the encounter, the majority were diagnostic in nature, primarily radiographs. Among patients who returned to the dentists following an emergency visit, 43% returned for more definitive dental treatment, most within 30 days. Conclusions: The majority of dental emergency encounters do not result in definitive treatment, rather patients often return to the dentist at a later date for that treatment. Where possible, dental providers could utilize teledental services to triage patients to appropriate care.

scholarly journals Emergency and Urgent Dental Visits Among Medicaid Enrollees from 2013 to 2017

2020 ◽  
Author(s):  
Rebekah Fiehn ◽  
Ilya Okunev ◽  
Mary Bayham ◽  
Steven Barefoot ◽  
Eric P Tranby
Keyword(s):  
Dental Treatment ◽  
Definitive Treatment ◽  
Emergency Visit ◽  
Dental Visits ◽  
Dental Procedures ◽  
Nationally Representative ◽  
Ibm Watson ◽  
Dental Emergency ◽  
Dental Providers ◽  
Medical Claims Database

Abstract Background: Efforts to combat the spread of COVID-19 have led to guidance to restrict dental practice to treating emergency and urgent dental visits and reduce or eliminate elective dental procedures. Better understanding of the frequency of dental emergencies and the procedures performed during those emergency visits can help providers, insurers, and policymakers understand workforce and care provision needs.Methods: Procedures performed at an emergency dental encounter and in the encounter following that encounter are assessed. Emergency dental encounters are those with a CDT code of D0140, D0160, or D0170. Data was analyzed from the IBM Watson Medicaid Marketscan data from 2013 to 2017, a nationally representative dental and medical claims database from 13 deidentified states.Result: Consistently over time, about 10% of all dental encounters are due to a dental emergency. 28% of emergency dental encounters had no other procedure performed during those encounters. When other procedures were performed during the encounter, the majority were diagnostic in nature, primarily radiographs. Among patients who returned to the dentists following an emergency visit, 43% returned for more definitive dental treatment, most within 30 days. Among patients who returned to the dentists following an emergency visit, 43% returned for more definitive dental treatment, with the majority returning within 30 days for that treatment.Conclusions: The majority of dental emergency encounters do not result in definitive treatment, rather patients often return to the dentist at a later date for that treatment. Where possible, dental providers could utilize teledental services to triage patients to appropriate care.

scholarly journals Anesthesia and Alzheimer's disease: time to wake up!

2012 ◽  
Vol 25 (3) ◽  
pp. 341-344 ◽  
Author(s):  
David A. Scott ◽  
Brendan S. Silbert ◽  
Lisbeth A. Evered
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Laboratory Data ◽  
The Elderly ◽  
Developed Countries ◽  
General Anesthetic ◽  
Anesthetic Agents ◽  
The Impact ◽  
The Brain

It has long been observed that some patients suffer a significant cognitive impact following anesthesia and surgery. This should not be surprising when considering that not only is the target organ for general anesthetic agents the brain itself but also that the process of anesthesia is a form of deep, pharmacologically induced coma rather than “sleep.” The expectation that such a process should be fully reversible with transient neurophysiological effects contradicts our experience with repeated abuse of other central nervous system depressants such as glue, petrol, and alcohol. Of great concern is that, while approximately 10% of populations in developed countries undergo anesthesia and surgery of some form each year, the proportion of the elderly making up this group is much greater. In addition, it is the elderly who are potentially at a greater risk of cognitive impairment following such procedures because many have decreased cognitive reserve, either due to pre-existing mild cognitive impairment (MCI) or frank dementia, which may be diagnosed or unknown. The impact of anesthesia on these individuals is poorly understood, as are the implications of the emerging laboratory data that suggest an effect of anesthetic agents on the pathological processes of Alzheimer's Disease (AD) itself.

Clinical Implications of Mitochondrial Dysfunction

2006 ◽  
Vol 105 (4) ◽  
pp. 819-837 ◽  
Author(s):  
Stanley Muravchick ◽  
Richard J. Levy ◽  
David C. Warltier
Keyword(s):  
Oxidative Stress ◽  
Mitochondrial Dysfunction ◽  
Current Knowledge ◽  
Anesthetic Management ◽  
Metabolic Energy ◽  
Surgical Patients ◽  
Clinical Implications ◽  
Anesthetic Agents ◽  
Mitochondrial Functions ◽  
The Many

Mitochondria produce metabolic energy, serve as biosensors for oxidative stress, and eventually become effector organelles for cell death through apoptosis. The extent to which these manifold mitochondrial functions are altered by previously unrecognized actions of anesthetic agents seems to explain and link a wide variety of perioperative phenomena that are currently of interest to anesthesiologists from both a clinical and a scientific perspective. In addition, many surgical patients may be at increased perioperative risk because of inherited or acquired mitochondrial dysfunction leading to increased oxidative stress. This review summarizes the essential aspects of the bioenergetic process, presents current knowledge regarding the effects of anesthetics on mitochondrial function and the extent to which mitochondrial state determines anesthetic requirement and potential anesthetic toxicity, and considers some of the many implications that our knowledge of mitochondrial dysfunction poses for anesthetic management and perioperative medicine.

Association between Anxiety and Pain in Dental Treatment: A Systematic Review and Meta-analysis

2016 ◽  
Vol 96 (2) ◽  
pp. 153-162 ◽  
Author(s):  
C.-S. Lin ◽  
S.-Y. Wu ◽  
C.-A. Yi
Keyword(s):  
Dental Treatment ◽  
Meta Analysis ◽  
Dental Anxiety ◽  
Clinical Group ◽  
Anxiety Management ◽  
Dental Patients ◽  
Dental Procedures ◽  
Treatment Procedures ◽  
The Impact

Accumulating evidence has revealed that dental anxiety (DA), as a dispositional factor toward the dental situation, is associated with the state anxiety (SA) and pain related to dental procedures. However, conclusions from individual studies may be limited by the treatment procedures that patients received, the tools used to assess DA, or the treatment stages when anxiety or pain was assessed. It is unclear whether DA, at the study level, accounts for the variance in pretreatment SA. The impact of DA and SA on pain at different treatment stages has not been systematically investigated. To address these questions, we present novel meta-analytical evidence from 35 articles (encompassing 47 clinical groups) that investigated DA in a clinical group. Subgroup analyses revealed that the studies of surgical and nonsurgical procedures did not significantly differ in either DA or pretreatment SA. Furthermore, metaregressions revealed DA as a significant predictor that explained the variance in SA assessed before and during treatment but not after treatment. The findings suggest that patient DA has a significant impact on patient SA. Metaregressions revealed DA as a significant predictor that explained the variance in expected pain, pain during treatment and posttreatment pain. In contrast, pretreatment SA was a significant predictor that explained the variance in expected pain. The findings reveal that DA has a consistent impact on pain through the entire period of dental treatment. Altogether, the findings highlight the role of DA as an overall indicator for anxiety and pain, across different types of dental procedures or treatment stages. We conclude that anxiety should be assessed as a critical step not only in anxiety management for high-DA patients, but also in pain control for all dental patients.

scholarly journals Dental Treatment for the Pregnant Patient

2014 ◽  
Vol 17 (3) ◽  
pp. 3 ◽  
Author(s):  
Thalita Guarda Fagoni ◽  
Rafaela Andrade de Vasconcelos ◽  
Paula Elaine Cardoso ◽  
Ana Paula Martins Gomes ◽  
Carlos Henrique Ribeiro Camargo ◽  
...  
Keyword(s):  
Literature Review ◽  
Pregnant Women ◽  
Dental Treatment ◽  
Pregnant Patient ◽  
Therapeutic Agents ◽  
Dental Procedures ◽  
Dental Professional

<p>Dental treatment of pregnant women should be accomplished with safety. Consequently, the dental professional should evaluate its real need and risks for the mother and the baby. This paper reports, through a literature review, the caution with the clinical dental procedures commonly performed and possible risks of the therapeutic agents used, allowing the dentist to evaluate the treatment and the drug to be administered to the pregnant women.</p><p> </p>

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