RESUMEN
Background: To examine the feasibility and acceptability of integrating a tele-mentoring component into the identification of oral lesions at the dental clinics of a Federally Qualified Health Center network. Design and Methods: General Practice Residency faculty and residents completed research ethics courses and trained dentists to use intra-oral cameras at chairside to photograph oral lesions of patients at routine dental visits. These images were then uploaded into the patient electronic health records (EHRs) with attendant descriptions and an oral surgeon was notified, who reviewed the charts, placed his observations in the EHR, and communicated his findings via secure e-mail to the involved residents, who in turn contacted their patients regarding follow-up actions. Feasibility was assessed via checklists completed by provider participants and semi-structured interviews. Acceptability was assessed via brief exit interviews completed by patient participants. Results: All 12 of the dentist participants reported that they had successfully provided the tele-mentoring intervention, and that the process (from EHR data entry to interaction with the oral surgeon over findings to patient referral) was clear and straightforward. Of 39 patient participants, most strongly agreed or agreed that the use of an intra-oral camera by their dentists helped them to better understand oral cancer screening (94.9%) and that dentists answered their questions about oral cancer and were able to provide them with resources (94.8%). Conclusions: Findings support further implementation research into adapting tele-mentoring using intra-oral cameras for training dental residents to detect and identify oral lesions and educating patients about oral cancer across settings.
RESUMEN
Adverse reactions to local anesthetics are usually a reaction to epinephrine, vasovagal syncope, or overdose toxicity. Allergic reactions to local anesthetics are often attributed to additives such as metabisulfite or methylparaben. True allergic reactions to amide local anesthetics are extremely rare but have been documented. Patients with true allergy to amide local anesthetics present a challenge to the dental practitioner in providing adequate care with appropriate intraoperative pain management. Often, these patients may be treated under general anesthesia. We report a case of a 43-year-old female patient that presented to NYU Lutheran Medical Center Dental Clinic with a documented history of allergy to amide local anesthetics. This case report reviews the use of 1% diphenhydramine with 1:100,000 epinephrine as an alternative local anesthetic and reviews the relevant literature.