Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry
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Comparative Study
General anesthesia for developmentally disabled dental care patients: a comparison of reinforced laryngeal mask airway and endotracheal intubation anesthesia.
Providing dental care for developmentally disabled patients who require general anesthesia is challenging for both and dentists and anesthesiologists. This study aimed to compare the efficacy of two anesthetic methods for dental care. The researchers retrospectively analyzed morbidity data following anesthesia using either a reinforced laryngeal mask airway (LMA) or endotracheal intubation anesthesia for a two-year time period. ⋯ Nausea and vomiting were the major complications in the postanesthetic care unit and after discharge. When complication rates were compared in the two patient groups, nausea and vomiting were significantly higher during postanesthetic care and after discharge in the intubated group. In conclusion, reinforced laryngeal mask airway provides general anesthesia with less risk of side effects for developmentally disabled patients undergoing dental care.
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Spontaneous gingival bleeding can occasionally be the only sign of systemic bleeding problems. The diagnosis and management of such conditions may challenge the skills of both the hematologist and the oral physician. ⋯ This case history also highlights the fact that medical intervention to correct the underlying aberration of hemostasis is necessary for local dental measures to successfully stop bleeding. In contrast with the definition of thrombocytopenia, the "within normal" count of platelets should not exclude the possibility of idiopathic thrombocytopenia purpura; a fact that, if ignored, can make the diagnosis and management of bleeding troublesome.
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The authors review the literature on pain experience and pain assessment in people with cognitive impairments, focusing on individuals with dementia and mental retardation. The impact of cognitive impairments on pain sensation is not well understood, although some observations have been published. For example, research suggests that pain experience can be influenced by neuropathological processes in the brain and memory impairments. ⋯ Individuals with limited ability to report pain can use pain assessment methods that rely on simple cognitive tasks. For individuals who have no ability to report pain, an outside observer must describe the discomfort experienced by interpreting the patient's body language. The authors conclude that further research is needed to develop valid and reliable assessment methods for people with cognitive impairments.
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This research analyzes transcripts of semi-structured interviews with patients presenting with tooth pain at a rural dental clinic in North Florida. The primary objectives are to identify the strategies patients use to manage their pain and to elucidate the decision-making process leading to the clinic visit. Although respondents understood that their condition was not self-limiting, only about one-half contacted the clinic within several days of the onset of their pain. Most tried one or more lay management strategies.
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A condition called "Post-polio Syndrome" (PPS) is a special type of neuromuscular disturbance that affects some elderly patients who had polio myelitis either as children or as young adults. It has been reported that approximately 1,600,000 polio survivors are alive today. ⋯ Special emphasis is placed on physical impairments, breathing problems, and difficulty swallowing. Also included are sections discussing such topics as patient scheduling, office design and housekeeping, patient management, oral hygiene, diagnostic procedures, drug and pain management, and general health considerations.