Nederlands tijdschrift voor tandheelkunde
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Ned Tijdschr Tandheelkd · Apr 2008
Review[Dental procedures for patients using oral anticoagulation: new insights].
What treatment is appropriate for a patient who has to undergo an invasive dental procedure if that patient is using medication that influences the blood coagulation system? Should the medication be stopped before the invasive procedure, with the risk of complications involving re-thrombosis? Or should the procedure be carried out without adjusting the medication? What is the risk of bleeding complications? Recent studies appear to indicate that temporarily stopping medication is in many cases unnecessary and can even harm the patient. In recent decades dentists have received a great number of diverse recommendations. In this article recent research in this field is summarized and evaluated. The authors advocate the development of evidence-based clinical guidelines.
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Ned Tijdschr Tandheelkd · Jan 2008
Case Reports[Atypical pain in the mandible caused by trigeminal neuralgia].
A 58-year-old woman came to her dentist with atypical pain on the right side of the mandible. The pain diminished with the use of carbamazepine, paracetamol and diclofenac, and eventually disappeared completely. ⋯ The condition can be divided into idiopathic and symptomatic trigeminal neuralgia. It is important to consider a possible trigeminal neuralgia in case of atypical pain in the oral region in order to prevent unnecessary dental procedures.
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Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either be located in a healthy tooth or in the temporomandibular joint. ⋯ In 2 cases trigeminal neuralgia is successfully managed with a neurosurgical microvascular decompression procedure according to Jannetta. Characteristic pain attacks resembling neuralgic pain result from well understood pathophysiological mechanisms. Consequently, adequate therapy, such as a Janetta procedure and specific pharmacological therapy, is available.
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In accordance with current views on pain, a distinction is made, on a physiological basis, among 'normal', or nociceptive pain, inflammatory pain and neuropathic pain. 'Normal', nociceptive pain is a reaction to possible or actual tissue damage. Inflammatory pain is a response to actual tissue damage, in which not only nociception occurs but the sensitivity of nocisensors changes through morphological transformation. This phenomenon is called sensitization and lies at the root of multiple types of chronic pain. Sensitization also plays an important role in neuropathic pain as a result of damage to the neuronal structures themselves.
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Ned Tijdschr Tandheelkd · Oct 2006
Case Reports[Transient paresis after mandibular block anaesthesia].
Mandibular block anaesthesia is frequently used in dentistry. The technique is more susceptible to failure than local anaesthesia by infiltration. Two cases of patients who were afflicted by transient paresis of (branches of) the facial and vagus nerves after mandibular block anaesthesia have been analysed. With reference to both these cases advice is given on how to react in case of a misdirected mandibular block anaesthesia.