Dental care for cardiac transplant patients in the UK.

Cardiac transplantation replaces a severely damaged non-functioning heart with a healthy heart from a donor. Within the UK, the number of cardiac transplants being performed each year is increasing, with significant improvements in longer-term survival. Dental professionals are therefore more likely to see and manage these patients in the pre- and post-transplant periods. This paper proposes a protocol for the dental management of these patients, reinforced by a case series from Scotland and London.

Dentistry and Parkinson's disease: learnings from two case reports.

Parkinson's disease is one of the most common conditions affecting the older generation. It is a progressive neurological condition presenting with motor, non-motor and behavioural symptoms that may impact upon oral health. Protecting and maintaining oral health for these individuals is paramount to their comfort, function and quality of life. To do so requires an individualised care plan considering the current stage and progression of their condition, access to care, ability to safely tolerate treatment and oral prostheses, their supporting network, and their own wishes. This paper reviews the current literature on Parkinson's disease and discusses two case reports of patients at differing stages of the condition. It emphasises the importance of a multidisciplinary approach, reasonable adjustments and the use of various techniques and skills within a dentist's armamentarium.

Periodontal Treatment in Patients with Learning Disabilities Part 2: Professional Mechanical Intervention.

The first part of this two part series discussed the potential barriers and risk factors that may lead to an increased incidence and severity of periodontal disease amongst patients with learning disabilities. Additionally, preventive strategies and tools that can be used by general dental practitioners, oral health promotion teams as well as specialists within the field to control and prevent disease progression were explored. To prevent periodontal disease progression and attain optimal periodontal health, a combination of prevention and professional mechanical instrumentation is usually required. The second part of the series concentrates on the role of the dental professional in implementing professional mechanical instrumentation to attempt to reduce the burden of disease further in this patient group. Clinical relevance: Although research continues into which professional techniques for instrumentation are the most successful amongst patients with periodontal disease, very little data specifically explore the needs of patients with learning disabilities, despite their high unmet needs. This paper aims to report on any available data present to produce suggestions for care.

A retrospective audit to evaluate the effect of the change in midazolam concentration from 10 mg/5 ml to 5 mg/5 ml ampoules on midazolam doses given to sedation patients following the rapid response report (RRR).

UNLABELLED: The technique of intravenous sedation with a benzodiazepine is a well documented and successful method for reducing fear and anxiety in many patients who regard dental treatment as challenging and potentially painful. One of the most important factors to achieving a well sedated patient is ensuring the dose of the drug given is titrated to the individual patient. Five years ago, a Rapid Response Report issued by the National Patient Safety Agency changed the concentration of midazolam within a 5 ml ampoule from 10 mg/5 ml to 5 mg/5 ml. A retrospective audit of 300 patients undergoing oral surgery treatment under intravenous midazolam sedation at Birmingham Dental Hospital was carried out over a 6-month period to assess whether this difference in midazolam concentration had any influence on the average dose of midazolam given to these patients. STUDY GROUP: The midazolam doses given by five clinicians were audited both before and after the concentration change. RESULTS: the mean midazolam dose that was administered by three clinicians decreased following the change in concentration. In addition, the number of patients given greater than 5 mg midazolam following the change decreased with all five clinicians. CONCLUSIONS: The change in midazolam concentration from 10 mg/5 ml to 5 mg/5 ml ampoules has resulted in the overall average dose of midazolam given by five clinicians at Birmingham Dental Hospital to decrease.