Study of the impacts of patient-educators on the course of basic sciences in dental studies.

Ever since 2006, Nantes University dental educators have started organising lectures led by the mother of a young patient suffering from ectodermic dysplasia (patient-educator) to help second-year students to better understand how important it is for their future dental work to better understand basic sciences. In this study, we have analysed this training experience on students' motivation. For this purpose, students were asked to complete questionnaires 10 days after the patient-educator's lecture (early assessment; n = 193) and 4 years later, during the last year of their dental studies (delayed assessment; n = 47). Moreover, 3 years after the first lecture, we analysed the ability of students to diagnose a mother carrying the ectodermic dysplasia genetic disorder, using a case-based learning exercise with a patient showing dental features similar to those exposed by the patient-educator (measure of knowledge; n = 42). Ten days after the lecture, the early assessment shows that all the students were interested in the lecture and 59% of the students declared being motivated to find out more about genetics whilst 54% declared the same thing about embryology courses. Moreover, 4 years later, 67% of the students remembered the patient-educator's lecture a little or very well. Three years after the course, 83% of the students diagnosed ectodermal dysplasia whilst studying the case-based example that listed typical dental phenotypes. In conclusion, this study shows that this original educational approach enhances dental students' motivation in learning basic sciences and that patient-educators could offer many benefits for students and patients.

Medical and dental standardization for solid organ transplant recipients.

Communication between the organ transplant team and dentist is important in formulating individualized care plans to reduce the incidence of pre- and post-transplant complications. Periodontal diseases and other oral infections may present serious risks that could compromise the success of a solid organ transplant. This article reviews why dentistry is an important component of total transplant care while the patient is on the waiting list for a transplant and after the transplantation. Recommendations regarding the care of the organ transplant patient are given.

Access to primary dental care for patients with inherited bleeding disorders.

Patients with inherited bleeding disorders (IBD) can face difficulty in accessing primary dental care either due to disease-specific or patient-related barriers. This can lead to poor oral health and increase the need for more invasive dental treatment. This study aimed to highlight actual and perceived barriers that IBD patients from the East London area were experiencing. It also gives an overview of the experience history of the General Dental Practitioners (GDPs) treating these patients. Information was gathered via pre-designed surveys as part of a service development audit. A total of 105 anonymous patient surveys and 50 GDP surveys were completed between December 2010 and July 2011. The patient survey highlighted more patients to be affected by patient-related than disease-specific barriers to access dental care. The GDP survey identified that just under half of GDPs questioned were not confident in the dental management of patients with bleeding disorders. Identifying misconceptions and barriers to access primary dental care will enable further development of our shared-care approach between General Dental Services, Hospital or Community Dental Services and Haemophilia Centre, optimizing regular preventative advice and follow ups to prevent dental disease and invasive dental treatment requiring haemostatic treatment.

A new approach to ensuring oral health care for people living with HIV/AIDS: the dental case manager.

INTRODUCTION: The American Dental Association has identified several barriers to adequate dental care for vulnerable populations, including appropriate case management. The objective of this study was to examine the perceptions, attitudes, and beliefs of dental patients living with HIV/AIDS on the role and value of the dental case manager (DCM) and the effect of DCM services on their oral or overall health. METHODS: We used a qualitative descriptive study design and focus groups. Twenty-five people who had received DCM services on Cape Cod, Massachusetts, attended 1 of 5 focus groups in 2009 and 2010. Digital recordings of the groups were transcribed verbatim. Textual data were categorized using directed qualitative content analysis techniques. We identified major themes and representative quotes. RESULTS: The following themes emerged from discussions on the DCM's role: being available, knowledgeable about clients and insurance, and empathetic; increasing access; and providing comfort. Most participants credited their oral and overall health improvements to the DCM. All participants believed that the DCM was a valuable addition to the clinic and noted that other at-risk populations, including the elderly and developmentally disabled, likely would benefit from working with a DCM. CONCLUSION: The addition of a DCM facilitated access to dental care among this sample of people living with HIV/AIDS, providing them with an advocate and resulting in self-reported improvements to oral and overall health.

Endocarditis following IUD insertion in a patient with tetralogy of Fallot.

The role of antibiotic prophylaxis for prevention of infective endocarditis is unknown. Endocarditis prophylaxis is recommended for certain high-risk individuals prior to dental procedures. To our knowledge, this is the first case reported in the literature of a patient with complex congenital heart disease developing endocarditis in the period immediately following otherwise uncomplicated intrauterine device insertion.

Childhood leukaemia: experiences of children and attitudes of parents on dental care.

Parental perceptions in the importance of dental care and preferences with regard to its provision while profiling the level of dental health knowledge of parents of leukaemic children were elicited. The setting was the Paediatric Dental Care Unit located in Medical Faculty. Data were collected by means of a structured interview, employing a questionnaire. Level of knowledge on both dental facts and preventive dentistry of the participants was insufficient. Major source of dental care was the resident paediatric dentist both in prior to (78.2%) and following (100%) diagnosis. Tooth extraction (17.6%) was the only treatment provided prior to diagnosis. Following diagnosis, 60 (69%) of these children had received operative dental treatment. The source of preventive advice was inconsistent. Parents appeared to place a high level of importance on their children's dental care and the preference for this to be provided within the hospitals in which the child has been treated. There is clearly a need to establish dental care units in hospitals in which treatment of childhood malignancy is provided. The provision for the future should be the continuous education of dentists, physicians and nurses who work in hospitals and public health services.

Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group.

BACKGROUND: The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis, which were last published in 1997. METHODS: and RESULTS: A writing group appointed by the AHA for their expertise in prevention and treatment of infective endocarditis (IE) with liaison members representing the American Dental Association, the Infectious Diseases Society of America and the American Academy of Pediatrics. The writing group reviewed input from national and international experts on IE. The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and IE; in vitro susceptibility data of the most common microorganisms, which cause IE; results of prophylactic studies in animal models of experimental endocarditis; and retrospective and prospective studies of prevention of IE. MEDLINE database searches from 1950 through 2006 were done for English language articles using the following search terms: endocarditis, infective endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental, gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental surgery, pathogenesis, vaccine, immunization and bacteremia. The reference lists of the identified articles were also searched. The writing group also searched the AHA online library. The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used. The article subsequently was reviewed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee. CONCLUSIONS: The major changes in the updated recommendations include the following. (1) The committee concluded that only an extremely small number of cases of IE might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 percent effective. (2) IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE. (3) For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of IE. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when IE prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.

Prevention of infective endocarditis: revised guidelines from the American Heart Association and the implications for dentists.

Infective endocarditis is a rare but life-threatening microbial infection of the heart valves or endocardium, most often related to congenital or acquired cardiac defects. The American Heart Association (AHA) recently updated its recommendations on prophylaxis during dental procedures. The revisions will have a profound impact on both the patient and the dental practitioner. The purpose of this paper is to review the pathogenesis and clinical presentation of infective endocarditis and discuss the 2007 AHA guidelines and their implications for dentists.

Antibiotic prophylaxis in dentistry: an update.

Antibiotics are used in dentistry to treat an existing infection therapeutically or to prevent an infection prophylactically. To prevent a perioperative infection (primary prophylaxis), prophylactic antibiotics may be administered when a surgical device, such as a prosthetic cardiac valve, is placed. They also may be administered to patients who have an existing medical condition or have received a previously placed device to reduce the risk of infection from a bacteremia (secondary prophylaxis). Although it is common to prescribe secondary prophylaxis for many dental conditions, there is a general lack of scientific evidence of its effectiveness and accumulating evidence suggests that such prescriptions may be unnecessary. In the past, antibiotic prophylaxis has been used for conditions with no proven benefit. Risks associated with antibiotics include allergic reactions (for example, anaphylaxis), development of antibiotic-resistant bacteria, development of superinfections, pseudomembranous colitis, cross-reactions with other drugs, and death. The costs involved with the use of antibiotics can be significant as well. This article reviews the current status of secondary antibiotic prophylaxis use in dentistry.

Efficacy of antibiotic prophylactic regimens for the prevention of bacterial endocarditis of oral origin.

Despite the controversy about the risk of individuals developing bacterial endocarditis of oral origin, numerous Expert Committees in different countries continue to publish prophylactic regimens for the prevention of bacterial endocarditis secondary to dental procedures. In this paper, we analyze the efficacy of antibiotic prophylaxis in the prevention of bacteremia following dental manipulations and in the prevention of bacterial endocarditis (in both animal models and human studies). Antibiotic prophylaxis guidelines remain consensus-based, and there is scientific evidence of the efficacy of amoxicillin in the prevention of bacteremia following dental procedures, although the results reported do not confirm the efficacy of other recommended antibiotics. The majority of studies on experimental models of bacterial endocarditis have verified the efficacy of antibiotics administered after the induction of bacteremia, confirming the efficacy of antibiotic prophylaxis in later stages in the development of bacterial endocarditis. There is no scientific evidence that prophylaxis with penicillin is effective in reducing bacterial endocarditis secondary to dental procedures in patients considered to be "at risk". It has been suggested that there is a high risk of severe allergic reactions secondary to prophylactically administered penicillins, but, in reality, very few cases have been reported in the literature. It has been demonstrated that antibiotic prophylaxis could contribute to the development of bacterial resistance, but only after the administration of several consecutive doses. Future research on bacterial endocarditis prophylactic protocols should involve the re-evaluation of the time and route of administration of antibiotic prophylaxis, and a search for alternative antimicrobials.

An audit of paediatric dental treatments carried out under general anaesthesia in a sample of Spanish patients.

OBJECTIVE: To evaluate the success and failure rates of the clinical procedures carried out under general anaesthesia in disabled or medically comprised and healthy children. BASIC RESEARCH DESIGN: Retrospective study included 47 patients who received dental treatment under general anaesthesia, grouped according to whether they were disabled or medically compromised (group A, n = 16) or not (group B, n = 31), and subgrouped according to whether they were under or over 6 years of age. RESULTS: Mean duration of anaesthesia was 2 hours and 25 minutes, with a range of 1 to 4 hours. The percentage of children followed up was 87%. The procedures performed were: 105 preformed metal crowns, 142 restorations, 85 pulpotomies and 166 extractions. The success rate was 93% for preformed metal crowns, 96% for pulpotomies and 90% for restorations. CONCLUSIONS: General anaesthesia is necessary in some children, but should be complemented with a preventive programme, behavioural remodelling and a follow-up schedule to avoid having to repeat the use of general anaesthesia.

Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group.

BACKGROUND: The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis, which were last published in 1997. METHODS AND RESULTS: A writing group appointed by the AHA for their expertise in prevention and treatment of infective endocarditis (IE) with liaison members representing the American Dental Association, the Infectious Diseases Society of America and the American Academy of Pediatrics. The writing group reviewed input from national and international experts on IE. The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and IE; in vitro susceptibility data of the most common microorganisms, which cause IE; results of prophylactic studies in animal models of experimental endocarditis; and retrospective and prospective studies of prevention of IE. MEDLINE database searches from 1950 through 2006 were done for English language articles using the following search terms: endocarditis, infective endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental, gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental surgery, pathogenesis, vaccine, immunization and bacteremia. The reference lists of the identified articles were also searched. The writing group also searched the AHA online library. The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used. The article subsequently was reviewed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee. CONCLUSIONS: The major changes in the updated recommendations include the following. (1) The committee concluded that only an extremely small number of cases of IE might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 percent effective. (2) IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from IE. (3) For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of IE. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when IE prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.

Protocols for treating patients with end-stage renal disease: a survey of undergraduate dental programs.

RATIONALE/BACKGROUND: Approximately 14% of Americans are living with chronic kidney disease (CKD). The prevalence of end-stage renal disease (ESRD), the result of progressing CKD continues to rise by 21,000 per year. There are no updated, evidence-based antibiotic prophylaxis guidelines for patients with renal disease undergoing dental treatment. The most recent was a scientific statement from the American Heart Association (AHA) in 2003. Presented in three parts, the goal of the first part of this study is to determine the current protocol being used to treat renal patients at U.S. dental schools. METHODS AND MATERIALS: A 21 multiple-choice question survey was e-mailed to 58 clinic deans of accredited dental schools in the United States regarding renal treatment protocol details including antibiotic prophylaxis. RESULTS: Fifty-two percent of programs report having no established renal patient treatment protocol. For programs with a protocol, when using prophylactic antibiotics, 54% followed AHA protocol, whereas 62% used a modified protocol. CONCLUSION: There is a lack of consistent, established protocols among undergraduate dental programs. It is suggested that evidence-based guidelines for the safe treatment of patients be developed.

Protocols for treating patients with end-stage renal disease: a survey of AEGD/GPR dental residencies.

RATIONALE/BACKGROUND: Approximately 14% of Americans are living with chronic kidney disease (CKD). The prevalence of end stage renal disease (ESRD), the result of progressing CKD continues to rise by 21,000 per year.Currently the only antibiotic prophylaxis guidelines for patients with end-stage renal disease undergoing dental treatment were published by the AHA in 2003. Presented in three parts, the first part of this study found no consistent protocols amongst U.S. dental schools. The goal of the second part of the project was to determine the current protocol being used to treat ESRD patients at accredited U.S. AEGD and GPR programs. METHODS AND MATERIALS: A 20 multiple choice question survey was e-mailed to 262 directors of AEGDs and GPRs within the United States regarding renal treatment protocol details and antibiotic prophylaxis for patients with renal disease. RESULTS: 34% of respondents reported having an established renal treatment protocol. For programs with a protocol, 65.5% of programs reported following AHA guidelines. CONCLUSION: There is a lack of consistent, established protocols amongst U.S. AEGD and GPR programs. It is suggested that updated and evidence based guidelines for the safe treatment of patients be developed.

[Standards, Options and Recommendations (SOR) for good practices in dentistry for head and neck cancer patients. Federation of the French Cancer Centres (FNCLCC)]. / Standards, Options et Recommandations pour une bonne pratique odontologiques en cancérologie.

CONTEXT: The Standards, Options and Recommendations (SOR), initiated in 1993, is a collaborative project between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcomes for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary experts group, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines for dentistry and oral hygiene in head and neck cancer patients. METHODS: Data have been identified by literature search using Medline (up to January 1999) and personal reference lists. The main end points considered were risk factors for treatment related late effects, safety and quality of life, efficacy of dental preventative measures and treatment. Once the guidelines were defined, the document was submitted to reviewers for peer review and to the medical committees of the 20 French Cancer Centres for review and agreement. RESULTS: The key recommendations are: 1) before receiving radiotherapy, surgery and chemotherapy for head and neck cancer, patients must benefit from a multidisciplinary approach including dental evaluation; 2) the patients must be informed of precautions and educated about oral hygiene; 3) after radiotherapy, the most important dental late effect to prevent is radionecrosis, in accordance with the oral and dental state, the dentist may propose conservation or extraction of teeth, fluoridation and regular follow-up; 4) during chemotherapy, the principal complications are mucositis, haemorrhage and infection risk; 5) after surgery, the dentist may propose prosthetic measures with the aim functional, aesthetic and psychological benefit; 6) in the particular case of children, treatment and prevention are the same as for adults but the follow-up is specific because of the dental development.

Management of dental patients on warfarin therapy in a primary care setting.

The surgical management of patients on anticoagulant therapy is often poorly understood in all fields of medicine (not just dentistry). Until now there has been no uniform approach to managing these patients and much of the advice routinely given by medical practitioners and haematologists has fallen behind the recent evidence. Many medical conditions from atrial fibrillation to prosthetic heart valves predispose patients to venous thrombosis and pulmonary embolism (Table 1). In order to prevent these complications, these patients are normally placed on an anticoagulant. By far the most common one in use is Warfarin, which is a derivative of 4 hydroxycoumarin.