The New Zealand dental journal
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Randomized Controlled Trial Clinical Trial
Effectiveness of tramadol as an analgesic in oral surgery.
In a randomised, double-blind, cross-over trial, 15 healthy, young patients undergoing surgical removal of bilateral, impacted, third-molar teeth received the analgesic tramadol 50 mg, as a single dose, either 2 hours prior or immediately before the surgical procedure. There were no differences in the post-operative pain levels or degree of trismus between the two methods of administration of tramadol (P > 0.05), suggesting absence of any pre-emptive analgesic effect for the drug in the dose studied. The prevalence of unwanted side effects such as nausea (37 percent) was high within the first 24 hours.
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This paper discusses the rights and responsibilities of patients and providers in New Zealand when a patient has diminished capacity to understand and provide consent for dental care. The Code of Health and Disability Services Consumers' Rights 1996, the Protection of Personal and Property Rights Act 1988, and the New Zealand Bill of Rights Act 1990 all affect decisions that relate to the provision of dental care for patients with diminished capacity to consent. ⋯ Welfare guardians and power of attorney may exist for some patients with diminished capacity to consent, but the documentation of appointment to those roles should be read by the dentist to verify the extent of the appointment. When a patient is not competent to make an informed choice and give informed consent, treatment providers may provide care under Right 7.4 of the Code of Health and Disability Services Consumers' Rights 1996 if the appropriate provisions within the Code are satisfied.
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Despite evidence to the contrary, many dentists still cling to outdated beliefs and practices regarding the aetiology and management of chronic temporomandibular disorders (TMDs). Chronic pain disorders require a multidisciplinary approach with a strong focus on psychological factors. Treatment failures and relapse are likely if such factors are not considered. ⋯ Conservative measures used for other types of chronic muscular pain are generally recommended. All health practitioners who deal with acute and chronic pain should be aware of recent major advances in the understanding of pain mechanisms. Along with psychosocial considerations, these must be emphasised in undergraduate and continuing education programmes.
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This report reviews the relationship between lingual frena, gingival recession, and tongue-tie, and describes a man with tongue-tie, localised gingival recession, and a speech impediment. The patient was treated surgically, with a satisfactory result 11 years later.