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Editorial

Caution: Maintain Anti-Platelet Therapy in Patients with Coronary Artery Stents

DDS, PhD

DOI: 10.2344/0003-3006(2007)54[161:CMATIP]2.0.CO;2

A recent science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and the American Dental Association with representation of the American College of Physicians states that coronary artery stent thrombosis is a very serious problem.* Their new advisory states that dual antiplatelet therapy consisting of aspirin and a thienopyridine drug such as clopidogrel (Plavix) or ticlopidine (Ticlid) should be given for at least a full year and perhaps even longer following certain types of stent placements for patients without major risk for bleeding. The leading adverse

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Special Reports

Anesthetic Efficacy of Buccal and Lingual Infiltrations of Lidocaine Following an Inferior Alveolar Nerve Block in Mandibular Posterior Teeth

DDS,

DDS, MS,

DDS, MS, and

DDS, MA

DOI: 10.2344/0003-3006(2007)54[163:AEOBAL]2.0.CO;2

Abstract

The authors, using a crossover design, randomly administered, in a single-blind manner, 3 sets of injections: an inferior alveolar nerve block (IANB) plus a mock buccal and a mock lingual infiltration of the mandibular first molar, an IANB plus a buccal infiltration and a mock lingual infiltration of the mandibular first molar, and an IANB plus a mock buccal infiltration and a lingual infiltration of the mandibular first molar in 3 separate appointments spaced at least 1 week apart. An electric pulp tester was used to test for anesthesia of the premolars and molars in 3-minute cycles for 60 minutes. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes following completion of the injection sets, and the 80 reading was continuously sustained for 60 minutes. For the IANB plus mock buccal infiltration and mock lingual infiltration, successful pulpal anesthesia ranged from 53 to 74% from the second molar to second premolar. For the IANB plus buccal infiltration and mock lingual infiltration, successful pulpal anesthesia ranged from 57 to 69% from the second molar to second premolar. For the IANB plus mock buccal infiltration and lingual infiltration, successful pulpal anesthesia ranged from 54 to 76% from the second molar to second premolar. There was no significant difference (P > .05) in anesthetic success between the IANB plus buccal or lingual infiltrations and the IANB plus mock buccal infiltration and mock lingual infiltration. We conclude that adding a buccal or lingual infiltration of 1.8 mL of 2% lidocaine with 1 : 100,000 epinephrine to an IANB did not significantly increase anesthetic success in mandibular posterior teeth.

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Five Year Outcomes Study of Dental Rehabilitation Conducted Under General Anesthesia for Special Needs Patients

DDS,

MD,

BSc, and

PhD

DOI: 10.2344/0003-3006(2007)54[170:FYOSOD]2.0.CO;2

Abstract

We assessed the safety of general anesthesia for dental treatment of special needs patients as it related to American Society of Anesthesiology Physical Status (ASAPS) classification, procedure, and other factors. After Institutional Review Board review and approval, special needs patients who were admitted to the outpatient surgical operating room for comprehensive dental rehabilitation (CDR) under general anesthesia within a period of 5 years had their medical records evaluated retrospectively for intraoperative and postoperative complications both related to anesthesia and surgery. All records were evaluated by an independent evaluator who tabulated the patients' age, gender, ASAPS, and duration of procedure. N = 363, age mean = 46.93 ± 16.835 years, age median = 48 years, male patients = 180, female patients = 183, ASAPS I = 183, ASAPS II = 127, ASAPS III = 53, duration of surgery mean = 140.631 ± 23.104 minutes, duration of surgery median time = 142.000 minutes, and number of complications = 2. One complication resulted in an ASAPS I 16-year-old boy, which was airway related, and a second was an ASAPS III 22-year-old woman, which was surgically related. Both led to unplanned inpatient admissions and were treated successfully with no residual morbidity. Dental rehabilitation of special needs patients under general anesthesia is safe. While morbidity is very low, larger studies are needed to establish risk versus benefit stratification among this patient population.

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Brief Review

A Case for the Lowly Case Report

DMD, PhD, MPH

DOI: 10.2344/0003-3006(2007)54[175:ACFTLC]2.0.CO;2

The standard for the most valuable and highest level of scientific evidence is a systematic review using a meta-analysis. By combining the results of all available randomized clinical trials, a meta-analysis can confirm the relative efficacy of a treatment. The importance of the case report is that it identifies and documents unusual and unexpected events. By identifying potential and rare risks, a case report is often the first step in determining the safety of a treatment. A carefully documented case report allows readers to reflect on their own treatment experiences. Several examples of the importance of the lowly case report

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Continuing Education

Cardiovascular Drugs: Implications for Dental Practice Part 1 — Cardiotonics, Diuretics, and Vasodilators

DDS

DOI: 10.2344/0003-3006(2007)54[178:CDIFDP]2.0.CO;2

Abstract

Appropriate preoperative assessment of dental patients should always include analysis of their medications. Cardiovascular diseases are the most common group of medical disorders that dentists encounter, and the number of drugs prescribed for managing these conditions is staggering. This justifiably raises concern and probable confusion regarding side effects and possible drug interactions with medications the dentist may deem necessary for dental care. This continuing education article is the first in a series that will address essential pharmacology of medications commonly prescribed for chronic medical care. A reasonable understanding of these agents will allow the dentist to better appreciate the medical status of their patients and avoid adverse interactions with drugs they might administer or prescribe.

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Departments

Anesthesia Progress Continuing Education Program

DOI: 10.2344/0003-3006-54.4.187

Please see the PDF version of this article to view and print the Continuing Education Questions answer sheet for submission to the Anesthesia Progress Continuing Education Program.

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IFDAS Abstracts

DDS, PhD and

DDS, PhD

DOI: 10.2344/0003-3006(2007)54[188:IA]2.0.CO;2

Making Patients Safe and Comfortable: Application of Midazolam During Removal of Impacted Third Molars

Kai-jin Hu, Fan-wen Meng, and Guo-liang Zhang, College of Stomatology, FMMU, Chinese Taipei

Aims. To assess the safety, acceptability of local anesthesia combined with midazolam.

Methods. 100 patients who required removal of four impacted third molars aged 18–36 years old were randomly divided into two groups. Group I (test group): 50 patients were to have the teeth removed under local anaesthetic (2% lignocaine and 1/100 000 adrenaline) and i.m midazolam 0.1 mg/kg. Group II (control group): the other 50 were to have the teeth

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Caution: Maintain Anti-Platelet Therapy in Patients with Coronary Artery Stents

Anesthetic Efficacy of Buccal and Lingual Infiltrations of Lidocaine Following an Inferior Alveolar Nerve Block in Mandibular Posterior Teeth

Abstract

Five Year Outcomes Study of Dental Rehabilitation Conducted Under General Anesthesia for Special Needs Patients

Abstract

A Case for the Lowly Case Report

Cardiovascular Drugs: Implications for Dental Practice Part 1 — Cardiotonics, Diuretics, and Vasodilators

Abstract

Anesthesia Progress Continuing Education Program

IFDAS Abstracts

Making Patients Safe and Comfortable: Application of Midazolam During Removal of Impacted Third Molars

The Temporo-Masseteric Nerve Block (TMNB) for Alleviating Acute Postextraction Masticatory Myalgia: A Case Series

Time Limits for Anesthesia in Dentistry?

Book Review

Obtaining Written Informed Consent for the Administration of Local Anesthetics in Dentistry in 2024, a 20-Year Follow-Up Study

Local Perfusion Failure Caused by the Incorrect Attachment of an SpO₂ Sensor During General Anesthesia