Blogs

Sedation of Asthma Patient

What is the protocol for a patient who carries a prophylactic asthma inhaler? Can they receive treatment under sedation?

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Seven Great Candy Alternatives for Halloween

No one wants to be the "disappointing house" during Halloween, so check out these fun alternatives to candy that will still delight trick-or-treaters.

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Tumors with Teeth: The Terrifying Teratoma

What looks like an homage to John Carpenter's The Thing, and in rare cases can grow up to five pounds in weight? An unusual form of tumor known as the teratoma!

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Why Use a Slurry?

The mechanics of medication absorption are an important factor in dosing to effect. A DOCS Education member inquires as to the delivery method of the different medications.

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Looking to Ward off the Flu? Start by Brushing Your Teeth

Oral health has major implications for the rest of the body, including risk of infection. Maintaining good oral health may increase resilience against seasonal illness, including the flu.

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Should Hygienists Practice Independently in Underserved Areas?

Access to care remains a significant problem in poor and rural communities. Many hygienists argue that preventative care could be made more accessible by practicing without direct oversight.

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Sedation of Athlete with Repeated Head Trauma

An athlete with recurrent migraines presents for treatment, and the clinician recognizes gabapentin as a possible interaction. Are there more considerations to be made?

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Need a New Tooth? Just Pee.

Could human teeth be grown from cells harvested in our urine? Researchers have reverse-engineered stem cells that could be used as a natural tooth-replacement therapy.

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"It's all in your mouth!" Occlusion and Balance Found to be Related.

Could a bad bite throw more than just your oral health out of balance? Researchers have found an link between the mouth and one's balance and posture.

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Forum: Why No Triazolam and Lorazepam Protocol?

Many of the DOCS protocols combine two different drugs of the same class to achieve a more consistent, smoother or longer-lasting result. A DOCS member asks about a new combination.

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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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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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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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A DOCS Education member seeks the faculty’s assistance:

I would like to get all suggestions for sedating a 79-year-old female with a pacemaker and a history of heart problems. The patient is on clonazepam, 81 mg aspirin, verapamil, digoxin, hydroxychlorine, levothyroxine, meloxicam, metropolol, saccurate(?), Nitrostat® and potassium. Her MD has instructed us not to use any epinephrine. The patient is allergic to penicillin and MD suggested clindamycin, which is what I will prescribe.


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A DOCS Education member seeks the faculty’s assistance:

I have a patient who is ASA III, Mallampati 2, base line BP 135/86 Spo2 98%. The patient has depression, stable angina, high blood pressure, hyperlipidemia and arthritis. Last exam was 3 weeks ago.


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A DOCS Education member has an upcoming diabetic patient who takes their medication, but does not monitor their blood sugar. How will this affect a planned, upcoming sedation dentistry procedure?


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