Blogs

Central Adrenal Insufficiency may raise a patient to ASA 3/4

A member of DOCS Education writes:
I have a 55 year old female being treated for central adrenal insufficiency, multiple sclerosis, hypertension, hypercholesterolemia, ADD, hypothyroidism and hormone replacement therapy. All are well controlled at this time. Her physician has recommended tripling her dose of Cortef® the day of surgery. She has been a patient for years and is very relaxed in the chair, even for long appointments.

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Where to go when you need to know who’s on the other side of cyberspace

The internet is a weird, malleable thing, isn’t it? It’s the double-edged blade of communication. The efficiency machine that eats up our days. The internet is filled with everything from the thickest gibberish imaginable to the most exquisite observations obtainable.

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With extraction, you may be losing more than just a tooth.

Losing a tooth: it’s jarring, painful and inconvenient. However, a recent study suggests there may be even more serious repercussions to lost teeth than slightly diminished chomping abilities.

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A long day’s journey into sedation

A Member of DOCS Education asks:
I have a 61 year old, 175 lbs female patient requiring a long sedation appointment. She is currently taking Advair®, Cartia XT®, losartan HCT and fenofibrate. Due to the medication interactions we cannot use diazepam or triazolam. Would it be possible for me to use lorazepam the night before, and if so, at what dosage should it be administered? Then at what incremental and loading dose should the lorazepam be given an hour prior to the appointment? After assessing the patient on arrival, what dose of hydroxyzine should be given? Finally, what incremental doses of lorazepam should be given at what intervals?

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The 5 WORST Blunders a Sedation Dentist Can Make

Plus 3 Common Mistakes
Whether you're an experienced sedation dentist, or just becoming interested in the field, everyone wants to know what NOT to do. Read on to find out the 5 most terrible, horrible, atrocious mistakes a sedation dentist could ever make.

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The Early Bird Gets the Worm: How Tweeting Can Draw in Patients

Sedation dentists help patients other dentists cannot. Those people who swore they'd never set foot in a dentist's office? Sedation can change their mind. Having a unique skill set is one way to gain a leg-up in the world of dentistry. But it's not the only way. What else can you do to help you stay ahead of the game?

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Following your gut: When not to sedate a patient

A member of DOCS Education writes:
I have been sedating patients for over ten years but I wanted your help. I have an 85 year old insulin-dependent diabetic patient that has requested sedation. Her BP reads 146/74, pulse 69. She takes 20 units of Lantus® insulin at 100 unit/ML once a day and 15 units of Humalog® insulin at 100 unit/Ml once a day. If I were to sedate her, should she eat a small dinner and her normal small breakfast and not take any insulin on the day of sedation? Other medications the patient is taking are: amlodipine 5mg, lovastatin 40 mg, quinapril GCL 10 mg, HCTZ 12.5 mg, aspirin 325 mg, 2 x 220 mg Aleve®, CalCarb 600/D 600-400 MG-unit. The patient does not have asthma or any breathing issues but I don't feel comfortable with sedation.

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Ancient Flossify

The recent analysis of chemical information left behind on 11 species of hominins (or early humans) and other East-African primates indicated a remarkable change in diet 3.5 million years ago. The results were published among four papers appearing in PNAS journal.

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With apologies to the lactose intolerant

We all hear that cheese and dairy products are great sources of calcium and help us maintain healthy bones. But have you ever heard that cheese may protect against tooth erosion?

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A patient’s severe health complications present concerns for limited sedation protocols

A member of DOCS Education asks:
I have a patient interested in sedation but I have several concerns with her health. The patient has lupus, sarcoidoisis and rheumatoid arthritis. My practice is located in VA and, therefore, I am only able to use single dose protocols. With the fact that she takes Azathrioprine, Ventolin® and Hydroxycholorquine for her systemic issues, would you recommend IV sedation instead of oral? Patient is coming in tomorrow for a consultation and I have been waiting to get the medical consults back. Her primary care physician took no issue with the use of normal protocols, but I am not comfortable doing that. I have yet to hear from her pulmonary physician or the rheumatoid doctor. What would your advice be for this case? Thank you.

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Any contraindications with the normal triazolam protocol for a dentophobic patient using a SynchroMed® pump to deliver Dilaudid® 10 mg/ml (2.5 mg/day) and clonidine 100 mcg/ml (25 mcg/day) to the lumbar area of the spine for kidney pain?
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I have a patient with extremely high dental anxiety, severe Fibromyalgia, and thick, ropey saliva. What would you recommend regarding this case?
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I have a fearful patient who states that she previously hallucinated when given IV Valium® at a different office. I was planning on anxiolysis with triazolam. Should I be concerned about a similar reaction?
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I recently had two sedation patients who were very restless during their procedures. Should I have administered more sedation medication to the patients?
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We recently had a patient whose medical history revealed serum disease as part of a sensitivity to narcotic agents. Is this a concern if we choose to use conscious sedation medications with her?
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I have a 24-year-old moderately anxious female patient with sarcoidosis in remission and diagnosed with Graves' disease at age 14. Are there any thoughts, suggestions or warnings?


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