Stuart L. Segelnick

New York State Ear, Nose, and Throat Specialists' Views on Pre-Sinus Lift Referral

BACKGROUND Dental implant surgery in the posterior maxilla often involves the maxillary sinuses. Sinus surgery for dental implants is highly successful, but the preoperative risk is difficult to assess because a routine preoperative evaluation does not include an intranasal examination by an otolaryngologist. The purpose of the present study is to obtain the opinions of ear, nose, and throat (ENT) specialists located within New York state in an effort to establish a referral protocol before performing a maxillary sinus elevation. This study assesses the need to consult an ENT specialist for evaluation and treatment recommendations in the pretreatment workup. METHODS A questionnaire and a stamped, return envelope with an identification number was mailed to 302 physicians who maintained a current ENT-specialty practice or practiced that specialty in a hospital or clinic setting in New York state. The requirement criteria included a valid address and specialty designation. Up to two follow-up phone calls were made, and another questionnaire was mailed 30 days after the initial mailing. The questionnaire included eight computerized tomography (CT)?scan images that represented different sinus configurations. Answers to the five questions were statistically evaluated and analyzed. A total of 63 recipients returned the questionnaire and were included in the study. RESULTS A majority of 58.7% (95% confidence interval: 46.9% to 71.1%) of respondents recommended that a maxillary sinus CT scan should be routinely prescribed before a sinus-lift surgery. Patient symptoms that ENT specialists suggested indicated referral included nose complications/problems (40.1%) and sinus issues (23.6%). Of the eight CT-scan images, referral suggestions were >50% for the following: an occluded sinus with septum, inflammation at the base of the sinus only, a sinus with a generalized thickened membrane, an oroantral fistula, a thickened sinus membrane in association with teeth that had endodontic and/or periodontic involvement, and a nearly completely occluded sinus that was missing palatal bone. For patients with seasonal allergies, ENT specialists suggested delaying surgery (20.6%) or controlling symptoms before surgery (41.3%). Concerns included a past history of a sinus surgery (87.3%), chronic sinusitis (85.7%), presence of ostium stenosis (68.3%), nasal or sinus obstruction (82.5%), and oroantral fistulation (74.6%). CONCLUSIONS Within the limits of the study, an attempt is made to develop a preoperative protocol, and 63 responses from ENT specialists suggested that the majority (58.7%) would recommend a maxillary CT scan before a sinus-lift surgery. Their greatest concerns were a prior sinus surgery, severe sinus inflammation, nasal/sinus obstruction, and oroantral fistulation.

The periodontist's role in obtaining clearance prior to patients undergoing a kidney transplant.

T here is ample evidence for the overall maintenance of good periodontal/dental health in patients with a chronic disease, including kidney disease,1,2 cardiovascular disease,3 respiratory diseases,4 pregnancy complications,5 Alzheimer’s disease,6 osteoporosis,7 and some types of cancer.8 A recent study9 documented that edentulism and low titers of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) may be risk indicators for chronic kidney disease. Recently, a prediction model using multiple risk factors, including periodontal disease, was proposed to help identify individuals at high risk for chronic kidney disease.10 On the contrary, there are no epidemiologic studies documenting the benefit of periodontal treatment on the success of patients undergoing a kidney transplant. However, the role of the periodontist in controlling inflammation before the patient is cleared for transplant surgery continues to be important in the comprehensive medical/dental treatment of the patient. The need for periodontal/dental clearance for patients undergoing a kidney transplant was brought to our attention when a 41-year-old white male patient entered the private practice (of SLS) on September 11, 2008 with severe chronic periodontitis. The patient asked us to begin treatment immediately. He was waiting for a kidney transplant and reported that 14 potential donors had come forward since March 2008 who were the correct blood match but were disqualified for other medical reasons that were not disclosed. He was medically cleared on July 27, 2008 for the kidney transplant, but none of the physicians had inquired about or evaluated his dental health. Because he was aware of his periodontal disease, he searched the Internet for information about kidney transplants and came across a number of sites explaining that if his periodontal and dental health was not corrected, then a transplant could and should be denied. As of October 3, 2008, a potential female donor had gone farther in the process of donor acceptance, and the patient was cautiously optimistic that the female donor would be qualified. However, the patient was fearful that his periodontal condition would be discovered during the final medical evaluations, and he would be denied the transplant. Consequently, we completed his periodontal and dental treatment prior to his recent successful kidney transplant. In theUnitedStates, approximately257,000people have end-stage renal disease (ESRD),11,12 with an annual steady increase in newly diagnosed cases of ;10%.The twomaincausesofESRDarehypertension and diabetes mellitus, both of which have significant long-term deleterious effects on the cardiovascular system as well as the renal system.12 These already cardiovascularly compromised transplant patients are at a high risk for adverse cardiac outcomes. Other causes of ESRD include glomerulonephritis, chronic pyelonephritis, urologic disorders, and autoimmune diseases.11 Renal disease can be treated by monitoring the diet and fluid intake, dialysis, or a kidney transplant.13 As of 2009, patients on the waiting list for a kidney transplant has reached 100,000. The last published data in 2006 reported only 17,092 patients received a kidney transplant that year.14 The possible benefits of periodontal treatment on the success of patients undergoing an organ transplant are the control of oral inflammation and infection.13 Inflammation is widely recognized as playing a pivotal role in kidney disease15 and kidney transplant rejection.16 A recent study17 showed that serum interleukin (IL)-6 levels could identify individuals who are at greater risk for rejection, especially during the first year following transplant surgery, which is the most crucial time. Ioannidou et al.17 found that periodontal tissue destruction and local IL-6 synthesis were associated with elevated serum IL-6 levels in transplant recipients by being proinflammatory. Cardiovascular disease (atherosclerosis) is the leading cause of death in renal transplant recipients, andsystemic andperiodontal inflammationhave been suggested to be causal in its development.18 Seventy percent to 90% ofpatients who have undergonea renal transplant develop left ventricular hypertrophy

Periodontal Management of a Patient Undergoing Liver Transplantation.

This case report describes the periodontal management of a patient with end-stage liver disease undergoing liver transplantation. In the first part of this article, all medical and dental findings are reported to elaborate adequate diagnoses. A patient-specific treatment plan was structured given the challenging periodontal and systemic scenarios. The second part describes the periodontal therapy delivered in close interaction with the referring physicians. Last, the article reviews current principles and protocols in managing these patients.

The Dentist's Quick Guide to Medical Conditions: Weinberg/The Dentist's Quick Guide to Medical Conditions

The dentists quick guide to medical conditions , The dentists quick guide to medical conditions , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی