Multiple myeloma
Pat Price, Karol Sikora in Treatment of Cancer, 2014
The Medical Research Council (MRC) Myeloma IX trial showed significant benefits of zoledronic acid over sodium clodronate in reduction of skeletal-related events (27% vs. 35.3%; p = .0004), in overall survival (OS; 50 months vs. 44.5 months; p = .0118) and progression-free survival (PFS; 19.5 months vs. 17.5 months, p = .0179).149 There was, however, a higher incidence of bisphosphonate-associated osteonecrosis of the jaw (BONJ) in the zoledronic acid group (3.5% vs. 0.3%). The benefit in the aforementioned studies was not confined to patients with bone disease at the start of treatment and it is currently recommended that all patients who require treatment for their myeloma should receive a bisphosphonate. Prophylactic bisphosphonates can reduce the extent of skeletal disease in asymptomatic patients but do not delay disease progression and are not currently recommended in current guidelines despite being likely to reduce skeletal-related events. Prolonged administration of zoledronate may be associated with the development of osteonecrosis of the jaw (ONJ) in approximately 4% of the patients. Risk factors included over 36 months of treatment, previous dental surgery and poor dental hygiene. Dental problems should be addressed at an early opportunity before starting zoledronate and patients with ongoing dental problems should probably receive an alternate bisphosphonate. For all bisphosphonates, care should be taken in patients with renal dysfunction and dose modification may be required.
Treatment Planning for Successful Whitening
Linda Greenwall in Tooth Whitening Techniques, 2017
Before any dental treatment is begun, it is essential to have a treatment planning discussion with the patient. During this appointment the patient’s clinical situation can be discussed with the patient. The patient is given a tour of the mouth on the computer screen, which may include digital dental photographs, intraoral digital photographs, the patient’s digital radiographs, study models, diagnostic wax-ups, or digital images of the possible outcome. The treatment can be explained and discussed, as well as treatment sequencing and any further treatment that may be required. Tooth whitening may not solve the patient’s esthetic requirements completely, and all associated and additional treatments need to be fully discussed with the patient. At this time the patient can have the opportunity to ask further questions and gain clarification of what is involved in the proposed treatment, particularly regarding the dentist-prescribed home whitening treatment. It is prudent to give the patient an informed consent form to sign. The benefits and risks need to be discussed as well as the advantages, disadvantages, and alternatives to whitening and other treatment options (see Figure 4.15). Two copies should be signed; one is given to the patient and one is kept with the patient’s dental records. Any expected or possible side effects need to be mentioned.
Oral Cavity Tumours Including Lip Reconstruction
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The formal examination should ideally be conducted in a dental chair with good lighting. The neck should be systematically palpated for cervical lymphadenopathy, although imaging of the neck in all patients with suspected oral malignancy should be conducted. Using two dental mirrors to help with retraction and visualization, the oral cavity and oropharynx should be examined in their entirety in a systematic manner. All patients should undergo flexible endoscopic assessment of the upper aerodigestive tract mucosa if there is a high index of suspicion for oral cancer. A dental examination should form part of the initial consultation so that dental treatment may be started early in anticipation of surgery or radiotherapy.
Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth
Published in Acta Odontologica Scandinavica, 2019
Joséphine Brodén, Thomas Davidson, Helena Fransson
Health economic evaluations are assuming an increasingly important role in healthcare, because in times of limited resources, decisions must be made about optimal allocation. The cost-effectiveness analysis, deals with the costs and the consequences of a specific procedure, for example, an item of dental treatment, and provides a comparative analysis of the treatment alternatives. The purpose of a health economic evaluation is to aid decision-makers in the most efficient allocation of healthcare resources. Economic evaluations intended to inform decision-making should include all relevant evidence and compare all appropriate treatment options. One approach is to use analytic modelling. The input data can, for example, be retrieved from previously published clinical trials [15]. This way of studying treatment alternatives for carious exposures without conducting a new clinical trial has been published by Schwendicke and Stolpe using a model with a 20-year-old male over a lifetime in a German context [5]. To contribute with information on the most effective treatment of young permanent teeth with a pulp exposure due to caries in a Scandinavian setting, the aim of this study was to compare the cost-effectiveness of pulp capping and root canal treatment of cariously exposed posterior permanent vital teeth in children and adolescents.
Self-perception of orofacial appearance: Brazil–Finland cross-national study
Published in Acta Odontologica Scandinavica, 2022
Lucas Arrais Campos, Juliana Alvares Duarte Bonini Campos, Minna Kämäräinen, Anna-Sofia Silvola, João Marôco, Timo Peltomäki
Understanding the perception of OA is complex, since individual idiosyncratic behaviours, constructed from individual experiences and life in a specific culture, contribute to the formation of this perception [9]. Despite variability in perception of OA explained by idiosyncratic differences, some characteristics seem to be shared [9]. These can be individual or cultural characteristics [7,10–12]. Regarding individual characteristics, Campos et al. [10] observed that dental patients who have received aesthetic dental treatment and therefore like their own smile, dental appearance seems to have a lower psychosocial impact on their lives. Regarding cultural factors, it is a common thought that physical aspects (body and orofacial appearance) are perceived differently in different cultures (culture-specific theory) [7], but some authors have observed agreement in the perception of traits (cross-cultural coherence theory) [11,12]. Therefore, studies that compare OA in countries with different cultures may be relevant for a better understanding of this perception.
Triage and urgent dental care for COVID-19 patients in the Hospital District of Helsinki and Uusimaa
Published in Acta Odontologica Scandinavica, 2022
Maria Kaarina Mikkola, Jenny Johanna Gästgifvars, Jaana Sisko Helenius-Hietala, Johanna Tuulikki Uittamo, Jussi Oskari Furuholm, Hannamari Välimaa, Hellevi Merja A. Ruokonen, Karita Maaria Nylund
If dental staff had any COVID-19 symptoms, they were instructed to stay home and referred to COVID-19 testing. One asymptomatic day was required before returning to work. All dental staff were protected by a FFP2-mask, disposable liquid impermeable protective gown, a cap, goggles/face shield, nitrile or latex gloves, and disinfectable shoes. PPE was put on in an isolated, separate space that was specifically prepared for this purpose. In the operating room, the patient was given antimicrobial hydrogen peroxide (1.5%) mouth rinse to rinse for 1 min as recommended earlier [3]. The dentist checked the medical and dental history and oral symptoms, examined the patient and possible X-ray image, assessed the diagnosis and gave the necessary dental treatment in agreement with the patient. Dental nurses prepared for the upcoming procedure and only the necessary instruments were provided to avoid contamination. There was one dental nurse in the operating room and another outside ready to assist with necessary instruments if needed. Using rubber dam was recommended whenever possible based on its efficacy to significantly reduce airborne particles [24]. Between patients longer breaks than usual were taken, which allowed better ventilation in operating rooms [8]. Staff was instructed not to enter operating room without FFP2-mask at least for 30 min after AGP. The treatment protocol is shown in Figure 3.
Related Knowledge Centers
- Apicoectomy
- Dentition
- Endodontics
- Pulpotomy
- Root Canal Treatment
- Surgery
- Medical Procedure
- Pulp
- Tooth
- Gums