Allen Wong

Reducing Nasopharyngeal Trauma: The Urethral Catheter-Assisted Nasotracheal Intubation Technique

Nasal intubation is an advantageous approach for dental procedures performed in the hospital, ambulatory surgery center, or dental office, when possible. Although many who provide anesthesia services are familiar and comfortable with nasal intubation techniques, some are reluctant and uncomfortable because of lack of experience or fear of nasopharyngeal bleeding and trauma. It has been observed from experiences in various settings that many approaches may be adapted to the technique of achieving nasal intubation. The technique that is described in this paper suggests a minimally invasive approach that introduces the nasoendotracheal tube through the nasopharyngeal pathway to the oropharynx in an expedient manner while preserving the nasopharyngeal structures, thus lessening nasal bleeding and trauma to soft tissues. The technique uses a common urethral catheter and can be incorporated along with current intubation armamentaria. As with all techniques, some limitations to the approach have been identified and are described in this paper. Cases with limited mouth opening, neck injury, and difficult airways may necessitate alternative methods. However, the short learning curve along with the many benefits of this technique offers the anesthesia professional additional options for excellent patient care.

Treatment planning considerations for adult oral rehabilitation cases in the operating room.

Treatment planning for adult oral rehabilitation starts before cases are scheduled and continues after the discharge phase. Practitioners providing dental care must be competent in all phases of dentistry and comfortable in the operating room setting. Dental caries risk assessment and medical risk assessment are important in developing comprehensive and predictable treatment plans. Oral rehabilitation in the operating room for patients who have special needs is a growing concern. Coordinating medical procedures with oral rehabilitation procedures while patients are under general anesthetic is an efficient use of sedation. A systematic approach for treatment plan consideration is explored for oral rehabilitation cases using general anesthesia or monitored anesthesia care.

Tuberous sclerosis complex: a case report

Tuberous Sclerosis Complex (TSC) was first described in the late 1800s as a relative of neurofibromatosis, but it has since been identified as a discrete disorder. Patients with TSC typically present with facial adenomas, seizure disorder, and a developmental disability. The syndrome is caused by mutations in either chromosomes 9 or 16, both of which code for cell development and maturation. This case report describes the unique findings of TSC, and suggests areas for future study. By understanding the dental and medical implications of TSC, early intervention may vastly improve a patients overall quality of life.

Secondary Sjögren syndrome: A case report using silver diamine fluoride and glass ionomer cement

BACKGROUND AND OVERVIEW The authors describe dental treatment for a patient with a complex medical history of secondary Sjögren syndrome with systemic lupus erythematosus and rheumatoid arthritis. CASE DESCRIPTION An 18-year-old womans rheumatology group referred her for oral evaluation; she had secondary Sjögren syndrome, systemic lupus erythematosus, and rheumatoid arthritis. The patient had multiple advanced carious lesions, extreme sensitivity, and hyposalivation. The patient selected a minimally invasive treatment plan that focused on silver diamine fluoride (SDF), partial caries removal, and glass ionomer cement (GIC) restorations. The SDF treatment and GIC restorations were successful in arresting carious lesions and restoring form and function but may not completely prevent new carious lesions from forming in the future. CONCLUSIONS AND PRACTICAL IMPLICATIONS The case shows that using less invasive treatments, such as SDF and GIC restorations can be used to manage complex cases involving extreme caries risk and be preferable to endodontic treatment and extractions.

Dental Care for Geriatric and Special Needs Populations

This article reviews considerations for oral health care associated with the most common causes of mortality and morbidity in older adults. Many of these diseases result in functional or cognitive impairments that must be considered in treatment planning to ensure appropriate, safe, and effective care for patients. Many of these considerations parallel those of adults who have lived with developmental disabilities over a lifetime and similar principles can be applied. Systemic diseases, conditions, and their treatments can pose significant risks to oral health, which requires prevention, treatment, and advocacy for oral health care as integral to chronic disease management.

The largest minority population in the U.S. without adequate dental care

A recent series of reports in Health Affairs reviewed the disparities in securing needed oral health services in the U.S. Despite an extensive oversight of the many issues involved, no direct mention is made of the particular conditions of the largest minority population in the U.S. unable to access dental care-the tens of millions of individuals with special health care needs. A review is provided of the particular barriers and conditions faced by this increasing population in its efforts to secure needed services.

A Smaller Percent of Hispanic Children Have Special Health Care Needs: Is that Possible?

The results from latest study of children with special health care needs indicate at the national and state levels that (except for Asian children) the proportion of Hispanic children with special needs is less than for other child populations. A review of a series of associated factors raises questions of the validity of these general national and state findings. The significant projected increases in the Hispanic population during the next decades points to the necessity of reconsidering the recent survey findings in light of what could be continued increases in the numbers of youngsters with special health care needs and the evolving family cultural adaptation, education and employment opportunities.

Comprehending the Number of Individuals with Disabilities and the Need for Oral Health Services

INTRODUCTION The use of mega-large numbers and percentages to describe the one billion people with disabilities in the world is beyond the comprehension of most people. We find it difficult to personalize such information and tend to skip over the data without considering the multitude of factors that impact on individuals with disabilities and their families. STUDY DESIGN A review of World Health Organization, U.S. Census Bureau, and Canadian and U.S. dental school accreditation agency documents were used to establish the current information on disability numbers, proportions and dental education programs. RESULTS More meaningful details from government agencies and the health professions and their educational institutions can provide data that could be used to demonstrate the increasing number of individuals with disabilities in a more meaningful manner; as well as preparing health professionals to provide the needed care. DISCUSSION The use of survey data for specific countries by: age, types of disabilities, race/ethnicity, family and individual economics, employment and regional distribution provides a more personalized presentation which can be used to reach legislative bodies and health providers.

Outcomes Assessment of Treating Completely Edentulous Patients with a Fixed Implant-Supported Profile Prosthesis Utilizing a Graftless Approach. Part 1: Clinically Related Outcomes

PURPOSE To assess outcomes of treating completely edentulous patients with a fixed implant-supported profile prosthesis utilizing a graftless approach for the maxilla and for the mandible, with emphasis on clinically related outcomes, specifically implant and prosthesis survival. MATERIALS AND METHODS This was a retrospective study with the following inclusion criteria: completely edentulous patients rehabilitated with a fixed implant-supported profile denture utilizing a graftless approach. Patients fulfilling the inclusion criteria were asked to participate in the study during their follow-up visits, and hence a consecutive sampling strategy was used. Data regarding implant and prosthesis cumulative survival rates (CSRs) were gathered and calculated. RESULTS Thirty-four patients were identified with a total of 220 implants placed. An overall CSR of 98.2% was recorded with an observation of up to 10 years. For tilted, axial, and zygomatic implants, CSRs of 96.9%, 98.0%, and 100%, respectively, were observed for up to 10 years. For provisional prostheses, CSRs of 92.3% at 1 year, and 84.6% at 2 years were observed. For final prostheses, a CSR of 93.8% was observed at 10 years. CONCLUSION The results suggest that treating completely edentulous patients with a fixed profile prosthesis utilizing a graftless approach in the maxilla and the mandible can be a reliable treatment option.

Dental Caries: An Update on Dental Trends and Therapy

Update on caries risk assessment (CRA). Describe the role of pediatric health care providers in oral health care with respect to caries risk assessment (CRA). Draw attention to patients with special needs and oral health from youth to adult. A new philosophy and trend in the minimally invasive approach to dental caries treatment. Dental caries is a preventable disease and all health care providers should be able to identify and refer high and extreme caries risk patients for care. Dental disease that does not cause pain to the patient may be treated in a noninvasive manner that is effective but has potential.