We All Get Older (Hopefully!) Is It Our Age, Our Genes, or Something Else? Do Telomeres "Tell It All"?.

As healthcare professionals, we deal daily with "aging"'factors relating to our patients' dental treatment planning (and to ourselves). We are all are expressions of our DNA-the long molecules in our cells' nuclei that contain our genes which determine how proteins will be made to express who we are. Although genetics can be a confusing subject to understand, when trying to understand DNA, perhaps consider that you Do Not Abandon learning some of the basics of genetics. In today's evolving world of medical science, there is a major focus on genetics and genomics; analyzing one's genetic makeup to help in diagnosing and managing disease, and prescribing of medications (pharmacogenetics/pharmacogenomics). One aspect of interest is what we call "aging" or getting older, an expression of cellular "senescence"-most of our cells are programmed to commit suicide (apoptosis) over time. So we get wrinkles, our stomach sags and our hair goes gray. As described below, a normal physiologic process takes place at the end of your chromosomes to protect them. Over many years, this process can no longer protect your chromosomes and the cells die. However, if normal processes are not functioning correctly, the chromosomes continue to reproduce-if this is a cancer cell, the lack of cell suicide allows tumors to grow.

Viruses--Virulent, eVasive, Vicious. Often our enemies, at times our friends.

This overview is intended as a baseline understanding of viral biology, pathology and developing medical therapeutic regimens using viral vectors. The dental clinician is encouraged to pursue further information as patients present with viral related illness or are undergoing emerging therapies.

Itchy Lip-Swollen Tongue Swollen Lip It's not Always an Allergy to Dental Materials; Angioederna- Possibly Life Threatening! You Might See This in Your Practice.

When providing dental treatment, the dental clinician (DC) is expected to be knowledgeable in recognition and emergency management of an allergic response. Common manifestations of localized allergic responses can present as a rash or hives (urticaria), running of the nose, and swelling of the lips, eyes, face, respiratory and gastrointestinal mucosa. More critically, there is the potential for breathing difficulties from laryngeal swelling. Airway obstruction can be potentially life threatening.' Anaphylactic shock can be another serious reaction. Although most of these allergic responses can be minimal and managed with an antihistamine (diphenhydramine), more serious allergic reactions (marked breathing difficulty, anaphylaxis) may require the use of an intramuscular injection of epinephrine. This case report describes a patient who had what appeared to be a common allergic response to some aspect of dental materials or treatment but was subsequently diagnosed with an allergic condition known as angioedema (AE) that had the potential to be non-responsive to dental office emergency medications. AE may be due to the more common histamine generated process as described below. However, if the patient's AE is due to alternate pathophysiology, the DC may not be able to manage breathing difficulties due to airway swelling, which could be rapidly fatal.

Blood clots. Good when you're bleeding; bad when you're not bleeding hypercoagulability and thrombophilia--overview and case report.

A critical and recurrent situation faced by the dental clinician (DC) is that of providing care to patients who may be at risk for excessive bleeding during care or post-operatively. Bleeding disorders may be due to congenital and/or acquired conditions affecting platelets and/or the coagulation process. Less often, the DC may be providing care to a patient who has an excessive clotting disorder. This paper will provide a brief overview the pathophysiology of these disorders and treatment considerations for these patients. The focus is to provide some background information for the DC so as to be better informed if a patient does present with a particular thrombotic problem. Specific details of each disorder can vessel be assessed on an individual basis pending the diagnostic category and the patient's therapy. A clinical case report will be presented.

New antiplatelet and anticoagulant drugs. Considerations for dental patient management.

A recent occurrence in dental practice is the noting of new "blood thinners" when the clinician is reviewing a patient's medical history and medications. "Doc, I take Pradaxa or Effient or Xarelto" etc. After many years of the widespread use of aspirin and Coumadin there has appeared a new generation of medications focused on reducing thromboembolic events in patients at risk. This trend has been driven by a need for drugs providing better drug efficacy based on patient biologic processing of the medications and the frequency and cost factors associated with the monitoring the degree of anticoagulation. Guidelines for assessing bleeding risk and managing patients on these new medications in dental practice are not yet defined and are empirically based on medical practitioner experience. This paper will review these new medications and will discuss current considerations for dental patient care. (Note that not all new antiplatelet and anticoagulant medications will be reviewed in this paper.)

Case report: Patient with acute dental pain has cardiac valve replacement--INR 3.8. What to do? What not to do?

Cardiovascular medicine treatments now include an increasing number of cardiac valve replacements; approximately 60,000 patients may undergo heart valve replacement per year. Dentists will be seeing an increasing number of patients who have undergone this surgical intervention. This paper will overview the types of valve replacements and suggested patient management in the dental setting. A case report of one such patient and the treatment provided is presented.

Seizure disorders. Update on medical management for the dental clinician. A pacemaker for the brain.

There have been many papers reviewing the dental office assessment and management of the patient with a seizure disorder. This paper will discuss two updated medical management issues which may impact dental office care of the seizure patient. The focus will on the use of a pacemaker-like device connected to the vagus nerve as part of seizure control. Also presented is a Food and Drug Administration (FDA) update on the increasingly recognized medical side effects of antiseizure (antiepileptic) medications which may impact a dentist's interaction with a patient.

Seizure disorders. Update on medical management for the dental clinician. A pacemaker for the brain.

There have been many papers reviewing the dental office assessment and management of the patient with a seizure disorder. This paper will discuss two updated medical management issues which may impact dental office care of the seizure patient. The focus will on the use of a pacemaker-like device connected to the vagus nerve as part of seizure control. Also presented is an FDA update on the increasingly recognized medical side effects of antiseizure (antiepileptic) medications which may impact a dentist's interaction with a patient.

Dental management for head and neck cancer patients undergoing radiation therapy: comprehensive patient based planning--a case report.

Medical management of the head and neck cancer patient (HNCP) most often will include radiation therapy to the head and neck region. HNCPs with malignant disease require judicious dental treatment planning prior to radiation therapy (RT) and/or chemotherapy. RT can result in a multitude of adverse effects, both reversible and irreversible. We report a case of a patient with squamous cell carcinoma of the throat above the larynx (supraglottic), who did not adhere to dental treatment recommendations for both pre- and post radiation dental management. The focus of this case report is to create awareness within the clinician that, in addition to evaluating the patient for the disease related issues that may affect the oral cavity and dentition, a total management plan should include factors beyond the structural oral problems related to the cancer. Final treatment plans for the HNCP should include medical assessment of past dental history, oral hygiene, potential compliance, or lack of, to dental care recommendations, the emotional state of the patient, socio-economic status of the patient (lifestyle, cost of care), future quality of life, the medical and/or life prognosis of the patient.

Factor V Leiden--dental patient management for a rare bleeding disorder: a case report.

In today's complex healthcare environment, there is an increasing incidence of patients with serious medical issues who may present for dental care. Excessive post-operative bleeding is always a concern of the dentist. It is essential that the contemporary oral healthcare provider be familiar with: 1. The basics of bleeding and coagulation; 2. the medications that can affect these processes; 3. published guidelines which provide the framework for patient evaluation and management; and 4. adjunctive procedures necessary to control post-treatment bleeding.

Case report: Glanzmann thrombasthenia. Dental patient management for a rare platelet disorder.

With today's medically complex population of ambulatory patients, it is essential that the dental clinician possess a working knowledge of those medical issues that may impact a practice. This is most critical in those patients who present with a bleeding risk. Acquiring a thorough history with necessary medical information and possessing a basic knowledge of bleeding disorders will guide the clinician in deciding whether to treat or to make an appropriate referral.