Dental update
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Paracetamol (acetaminophen) is a commonly used analgesic; its 'over the counter' availability, low cost and popularity amongst patients often make it the first choice for dental pain. It is in this that its potential toxicity, made more complicated by the ever extending range of paracetamol-containing products, make the understanding of this medication key to the safe management of patients presenting to surgery with dental pain. Clinical relevance: The purpose of this article is to supply dental practitioners with the knowledge to manage patients who present having taken an oral supra-therapeutic paracetamol overdose. Consideration is given to those patients who can be treated safely in primary care and to those who require transfer to Accident and Emergency (A&E).
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The use of supari (areca nut) and smokeless tobacco products are seen as a major risk factor for oral cancer. There are increasing rates of oral cancer across the United Kingdom, along with the increase of the use of these products. ⋯ A rethink is also suggested on the policy of taxation of such products. CPD/Clinical Relevance: With the rates of oral cancer increasing across the United Kingdom, it is important for us as dental professionals to tackle the use of areca nut and smokeless tobacco products.
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Chlorhexidine is an effective antiseptic which is widely used in dentistry. Over recent years, it has also been used in other healthcare products as well as in cosmetics. Anaphylaxis to chlorhexidine has been increasingly reported throughout the world, including two incidents in the UK where chlorhexidine-containing mouthwash had been used to wash tooth sockets following recent tooth extraction. ⋯ Dentists need to consider whether the washing out of a tooth socket with chlorhexidine solution should be avoided in the treatment of established dry socket. On current evidence the potential risks of using chlorhexidine as irrigation solution for treating an established dry socket appears to outweigh any known benefit. CPD/Clinical Relevance: Chlorhexidine has the potential to cause anaphylaxis in the dental surgery.
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Dental anxiety is common and frequently poses a barrier to necessary dental treatment. The increasing availability of conscious sedation in dental practice has made treatment much more accessible for anxious patients. ⋯ An understanding of the mechanism of action of benzodiazepines should inform our practice and deepen our understanding of why and how sedation may fail. CPD/CLINICAL RELEVANCE: As an increasing number of dentists provide sedation for their patients an update on benzodiazepines is timely.
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The removal of mandibular third molars can be complicated by injury to the inferior alveolar nerve (IAN). Coronectomy retains the tooth root; this method has been found to be preferable to extraction in the context of mandibular third molars. A failed coronectomy may cause mobilization of these roots, thereby requiring a subsequent extraction. ⋯ Longer studies need to be conducted to evaluate the long term benefits of coronectomy. CPD/CLINICAL RELEVANCE: The removal of mandibular third molars can be complicated by the presence of the close lying inferior alveolar nerve. Coronectomy can be useful in this setting and therefore it is important to be aware of the pros and cons of this technique.