May L BeiBDSMDSPHD Edward ChinMan Lo BDSMDSPHD ChunHung Chu BDSMDSPHD Silver Diamine Fluoride Colorless Alkaline Fluoride Ions Silver Ions 38 Solution Uses Managing Caries in Children ID: 1039053
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3. Clinical Use of Silver Diamine Fluoride In Dental TreatmentMay L. Bei,BDS,MDS,PHD; Edward Chin-Man Lo BDS,MDS,PHD, Chun-Hung Chu, BDS,MDS,PHD
4. Silver Diamine FluorideColorlessAlkalineFluoride IonsSilver Ions38% Solution
5. UsesManaging Caries in ChildrenManaging Root Caries in the ElderlyDesensitizing TeethCaries control/Off Label Use
6. Ammonia and Silver combine to form the Diamine-Silver IonMore Stable than Silver FluorideSilver Ions are BacteriocidalFluoride Ions promote remineralization
7. Development of a squamous layer on the exposed dentin, plugging the dentinal tubules. (Hydrodynamic theory of dentin hypersensitivity).Increase resistance to acid dissolution and enzymatic digestion by bacterial proteases. Inhibits the proteins; matrix metalloproteinase, cathepsins and bacterial collagenases.Act against bacteria in lesion by breaking membranes, denaturing proteins and inhibiting DNA replication.“Zombie Effect” – when bacteria killed by silver ions are added to living bacteria, the silver is re-activated so that effectively the dead bacterial kill the living bacteria.Increases in mineral density and hardness by formation of hydroxyapatite and fluorapatite along with presence of silver chloride and metallic silver.
8. Low CostEasy to UseBlack StainMetallic TasteGingival and Mucosal IrritationMay cause Fluorosis in Large Doses
9. Does not stain sound enamelMany studies show no need for caries removal
10. Plastic-lined cover for counter, plastic-lined bib for patientStandard PPE for provider and patientOne drop of SDF into the deep end of a plastic dappen dishRemove bulk saliva with saliva ejectorIsolate tongue and cheek from affected teeth with gauze or cotton rollsApply petroleum jelly with cotton applicator around lip and gingivaDry affected tooth surfaces with triple syringe or dry with cottonBend microbrush, immerse into SDF, remove excess on side of dappen dishApply directly onto the affected tooth surfaces with microbrushAllow SDF to absorb for up to 1minute if reasonable, then remove excess with gauze or cotton roll.Rinse with waterPlace gloves, cotton and microbrushes into plastic waste bags
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12. No consensus on frequency of applicationOnce a week for three weeks (this study) for caries controlEffective after 1 application for desensitivity
13. Managing Patients Using Novel Oral Anticoagulants(NOAs) in Dentistry; A Discussion Paper on Clinical ImplicationsConstantinides, Rizzo,Pascalzo,Maglione
14. PurposeTo discuss how to approach patients on NOAs before, during and after treatment
15. NOAsPradxa (Dabigatran Etexilate)Xarelto (Rivaroxaban)Eliquis (Apixaban)
16. AdvantagesAntagonists at very specific steps of coagulationProvide stable anticoagulation at a fixed doseNo need to monitor with lab exams
17. AdvantagesNo INRRapid OnsetRapidly reach peak concentrationWide therapeutic marginLow drug to drug interactionsNo significant food interactions
18. MethodsReviewed Literature through 2012
19. PradaxaDirect Thrombin InhibitorBinds to Thrombin and prevents Fibrinogen/Fibrin
20. Re-Ly18,113 PatientsLower rates of stroke and embolism than WarfarinNo MonitoringHas a reversal agent (Idarucizumab)
21. Dental ConsiderationsDTI similar to Warfarin with INR of 2-3Vitamin K antagonists with INR less than 3No direct interaction with NSAIDs
22. Modification of TxRenal FunctionComplexity and length of ProcedurePatient Dependent Factors (age, aspirin)
23. XareltoFactor Xa InhibitorIndicated for Use in Hip and Knee Rplacement SurgeryPrevention of Cerebrovascular complications in non-valvular A-FibDVT
24. Rocket- AF Study14,236 patientsSignificant decrease in stroke and embolism compared to Warfarin
25. Dental ConsiderationsNo need to discontinue for simple extractions in patients with normal Renal functionNo need to discontinue for routine procedures
26. EliquisFactor Xa InhibitorSame Indications as Xarelto
27. Aristotle Study9260 PatientsPeak Plasma Levels in 1-3 hours12 Hour ½ LifeExcreted almost totally in Bile
28. SummaryNo need to discontinue for routine proceduresConsider if over 5 extractions or surgery over 45 minutes
29. Articaine Buccal Infiltration Vs Lidocaine Inferior Block- A Review of the LiteratureG. Bartlett and J. Mansoor
30. PurposeCompare the effectiveness of Articaine buccal infiltrations and Lidocaine Blocks in mandibular Molars
31. ArticaineDerived from thiphene not benzeneMore lipid solubleMore potent, faster onset
32. MethodsLiterature Review27 Studies
33. MethodsCompared 4% Articaine Infiltration vs 2% Lidocaine IAN blockPermanent teeth onlyAdults onlyMandibular Molars onlySuccess = pulpal anesthesia
34. Only 2 studies met these criteriaRandomized double-blind studies
35. ResultsSuccess rate of 56-70% for BlocksSuccess rate of 65-70% for infiltrations
36. ConclusionNo significant difference
37. Management of Patients with Cardiovascular Implantable Electronic Devices in Dental, Oral, and Maxillofacial SurgeryJames Tom, DDS
38. Review Article3 Million patients with Pacemakers or Implantable Cardioverter Defibrillators250,000 new patients annuallyElectromagnetic Interference
39. Current RecommendationsConsultation with physician if within 30 days or if any change in medical historyConsultation for any sedation/general anesthesia
40. ElectrosurgeryIf using electrosugery, keep electrode dispersal pads as far away from CIED as possible and keep exposure times short
41. Minimal EMI from:Apex LocatorsLight Curing UnitsHandpiecesPiezoelectric Dental ScalersLasers
42. Very little EMI from Dental ImagingNo effect from local anesthesia