Naloxone as a Potential Lifesaving Medication: A Primer for Dentists.

Despite garnering considerable attention in recent years, the opioid epidemic in the United States has remained a challenge. Oral healthcare practitioners have been urged to take a leadership role in the face of this epidemic and consider carrying naloxone in dental offices. The US Food and Drug Administration recently deregulated naloxone 4-mg nasal spray to nonprescription status to increase its availability and access. This article, therefore, is intended to serve as a primer for dentists on the history, pharmacology, appropriate use, and administration of this critical, potentially lifesaving medication.

Analgesics in Pregnancy and Lactation: Safe Medication Practices.

Studies have found that the use of prescription drugs during pregnancy is common and has been increasing over time, with some researchers showing that two-thirds of women take prescription medications during pregnancy. Additionally, it is generally accepted that breastfeeding women take significantly more medications per month than pregnant women. Within the context of the recent opioid epidemic and renewed concerns for appropriately addressing patients' pain, along with the publication of recent guidelines and updated safety concerns for certain pain medications such as acetaminophen, some uncertainty may exist regarding the safe analgesic prescribing for pregnant and/or breastfeeding women. The purpose of this article is to provide an organized source of information about analgesic use for the pregnant or breastfeeding dental patient. With data regarding commonly used medications and pregnancy categories established by the US Food and Drug Administration, oral healthcare providers that are prepared with evidence-based information about the safety of medication use during pregnancy and breastfeeding can effectually advise their patients regarding medication therapy, helping to ensure healthy outcomes for both mother and child.

Acetaminophen: Is Too Much of a Good Thing Too Much?

Acetaminophen is a popular, universally used, over-the-counter pain medication contained in more than 600 different products and available in a plethora of dosage forms. Acetaminophen is an important adjunct to manage postoperative dental pain in combination with a nonsteroidal anti-inflammatory drug such as ibuprofen. For the treatment of more severe pain, acetaminophen is often formulated with non-opioid and opioid agents. Because of the accessibility of acetaminophen and its widespread use, dental practitioners need to be cognizant of any significant safety concerns that may be associated with this drug, including acetaminophen toxicity. This article discusses the history of acetaminophen, its pharmacology, metabolism, and toxicity, as well as strategies to help address some of the potential safety issues with this medication, including unintentional overdosing.

Emerging antiresorptive medications and their potential implications for dental surgeries.

BACKGROUND: The aim of this review was to discuss the current and newly emerging antiresorptive medications and their potential implications for dental surgeries. TYPES OF STUDIES REVIEWED: The authors searched PubMed (MEDLINE), Cochrane, Embase, and other electronic databases for articles related to osteonecrosis of the jaw and medication-related osteonecrosis of the jaw (MRONJ). In addition, the authors hand searched the bibliographies of all relevant articles, the gray literature, textbooks, and guidelines in association position statements. RESULTS: The following information for MRONJ risk should be evaluated before any invasive dental procedure: metastatic carcinoma has a higher risk than osteoporosis; parenterally administered bisphosphonates and denosumab have a higher risk than orally administered bisphosphonates or antiangiogenic agents; dose and duration of medication received; adjunctive medications or combination of antiresorptive agents also may increase the risk of MRONJ; additive factors and comorbidities such as diabetes, autoimmune disease, immunosuppression, or any condition that might affect healing negatively would result in potentially higher risk of developing MRONJ; angiogenic inhibitors as part of a cancer treatment regimen, with or without antiresorptive medication, are considered high risk. PRACTICAL IMPLICATIONS: Patients who received antiresorptive therapy for malignancy were at higher risk of developing MRONJ than those who received the therapy for osteoporosis, regardless of the route of administration and type of drug. Antiangiogenic agents, bevacizumab, aflibercept, and tyrosine kinase inhibitors such as sunitinib were implicated most commonly in the development of MRONJ. Patients who are taking multiple doses of angiogenic inhibitors should be monitored closely for early diagnosis of possible MRONJ.

Serratia Marcescens Endophthalmitis and Bacteraemia following Complicated Cataract Surgery.

A 93-year-old male presented with left eye pain, fever and loss of vision two days after complicated cataract surgery. A diagnosis of Serratia marcescens endophthalmitis and systemic bacteremia was made after the organism was identified on vitreous and peripheral blood cultures. This case demonstrates that an aggressive intraocular infection can lead to bacteremia.

Taking Local Anesthesia to the Next Level: Four Strategies Clinicians May Consider.

The importance of effective local anesthesia delivery in dentistry cannot be overstated, as many dental procedures could not be performed without it. Despite the availability to oral healthcare professionals of various successful local anesthetics, the administration of local anesthesia continues to provoke anxiety among dental patients and remains an often unpleasant experience. A number of techniques may be utilized to help mitigate injection pain and improve the patient experience. This article reviews four strategies clinicians may consider to increase the effectiveness of their delivery of local anesthesia: warming or cooling of local anesthetic solutions, vibration and distraction techniques, liposomal encapsulation, an buffering or alkalinization of dental local anesthetics.

Perioperative Antiplatelet and Anticoagulant Management with Endodontic Microsurgical Techniques.

INTRODUCTION: The purpose of this study was to review evidence-based recommendations for the safe perioperative management of patients undergoing endodontic microsurgery who are currently taking antiplatelet or anticoagulant medications. Using the PICO (Population, Intervention, Comparison, Outcome) format, the following scientific question was asked: In patients taking anticoagulant or antiplatelet agents, what is the available evidence in the management of endodontic microsurgery? METHODS: MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov databases were searched to identify current recommendations regarding the management of antiplatelet and anticoagulant medications in the context of outpatient dental surgical procedures. Additionally, the authors hand searched the bibliographies of all relevant articles, the gray literature, and textbooks. Because of the lack of clinical studies and evidence on this subject, articles and guidelines from other organizations and association position statements were included. RESULTS: Because any minor surgery can become a major surgery, the treating doctor needs to best assess the risk of bleeding, especially if the surgery is anticipated to take longer than 45 minutes. Every patient should be stratified on a case-by-case basis. Consultation with the patient's physician is highly recommended. CONCLUSIONS: In order to maximize the effects of these medications (to prevent thrombosis) while minimizing the potential risks (procedural hemorrhage), clinicians should be aware of the best available evidence when considering continuation or discontinuation of antiplatelet and anticoagulant agents perioperatively for endodontic microsurgery. Ideally, a joint effort from an expert panel for microsurgery would be warranted.