Blogs

A DOCS Education member seeks advice over patient with history of methemoglobinemia

A DOCS Education member seeks the faculty’s assistance:

I am an endodontist who has received a referral for a 31-year-old caucasian male with a history of methemoglobinemia in response to esophageal benzocaine spray. The patient needs two root canals on vital teeth #4 and #19 and seven fillings.

After reviewing the literature with my local anesthesiologist's help, bupivacaine seems to be the medication with the least amount of risk. The recommendation from the anesthesiologist is not to perform sedation in the office, other than possibly nitrous as well as having an IV ready for up to 50 mgs TOP DOSE of methylene blue 1.0 -2.0 mg/kg IV every 60 minutes and very small amounts of bupivacaine per session. The other option would be general anesthesia.

What are your thoughts?

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Spring has Sprung! And so has a brand new issue of DOCS Digest

It’s that time again: DOCS Digest is in the air. The case-study buds are blooming and the spotlight trees have new leaves.

As always, we celebrate the release of each DOCS Digest with an Incisor post, a fresh copy delivered to your mailbox and naturally, a digital flipbook through which you can (virtually) page, consuming articles to your heart’s content.

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Webinar: Braces – Now for Adults

No matter their age, everyone wants straight teeth. They look better, feel better and improve quality of life.

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Let Your Implementation Guide…Be Your Guide

Pretend you’re a fine arts professor. You know everything about oil painting down to the finest details: the techniques, the process, the history. You’ve written books on impressionism.

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A DOCS Education member seeks advice for treating a former drug addict.

A DOCS Education Member seeks the faculty’s assistance:

I had a 24-year-old, recovering drug addicted female weighing 142 lb presents with multiple caries. She will require extractions, implants and dentures. Her rehab therapy medications are Suboxone® 8 mg two times daily along with 12.5 mg of Klonopin® daily. The patient is anxious about her dental treatment. She states she can come off these meds two days before her appointment. Is this ok and is there an OCS protocol for her?

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Webinar Corner: Exclusive Gold Member Webinar by Dr. Fang

We are proud to announce an upcoming webinar for DOCS Education Gold Members. On Tuesday, May 20 at 6:00pm EST, DOCS Education Faculty, Dr. Leslie Fang will be hosting a webinar exclusively for our Gold Members. With the release of new anticoagulants and their interactions with existing antibiotics, it’s no surprise that new methods to properly care for your sedation patients are coming into play.

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If You Want to Lose a Tooth You May Need to Pull Some Strings

Irish boy removes baby tooth with the help of his father, a thread and a remote control helicopter.

Once a baby tooth is loose, most kids want it gone. Sure, the monetary gains post-loss are an obvious incentive, but the satisfaction of finally prying the tooth free can be its own kind of reward.

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The nation’s top endodontists want to teach you their secrets.

Renowned endodontists Drs. Lisa Germain and Lou Berman will host “Top Time Traps,” a comprehensive webinar for the general dentist looking to increase their knowledge, increase their patient base and get a foot in the door to the world of basic endo.

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Dr. Fang advises a DOCS Education member on a patient with chronic kidney disease

A DOCS Education member seeks the faculty’s assistance:

I have a patient who has a GFR of 31. I understand that the normal GFR is 131 to 140 and that the minimum acceptable level is 60.

The patient's nephrologist said he considers the patient stable and that she could under-go anesthesia. However, he acknowledged he did not understand which type of anesthesia we would be using.

He also said that any medications utilized should be dose adjusted for her GFR. Should I stay away from treating her totally? Or, with him considering her stable is there a way that I can treat her with local anesthesia and sedation safely?

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Dentistry’s New Dimension: The surge of 3D imaging and CAD/CAM technology in practices.

We all know how getting a crown goes: A mold is taken of the patient's tooth. The mold is then sent to a dental laboratory and used to make a permanent crown.

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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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I know that pregnancy is a contraindication for oral conscious sedation (OCS). But I have a patient that is trying to get pregnant and wants OCS. How accurate is a hospital administered pregnancy blood test (false positives)?


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A DOCS Education member asks: Have you had any personal experiences with sedating an autistic patient? Have you heard of any concerns with this issue?


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