Perspectives on Menagement of Dental Pain

Eliminacija boli kod stomatoloŠkih pacijenata veoma je važna. Učinkovito ukloniti bol zahtijeva da se razumiju temeljni mehanizmi boli. Promijenjeno je tradicionalno shvaćanje kako je bol rezultat aktivnosti određenog niza događaja koji počinju u perifernim nociceptorima. Kompleksniji pogled razmatra i plastičnost prijenosnoga puta te opisuje kako proces počinje stimulusom i dovodi do pojave osjetilnog i emocionalnog odgovora. Ova suvremena koncepcija pomaže kliničarima da bolje rješavaju bol. Na primjer, mehanizmi u podlozi primarne hiperalgezije upućuju na bolje uklanjanje boli uporabom više lijekova. Slično tomu, fenomen pojačavanja boli, u kojem periferni stimulus može biti pojačan i do 20 puta, doveo je do razvoja nove koncepcije analgezije i razumijevanja važnosti vremenskoga rasporeda doza analgetika, ali i potrage za novim sredstvima koja mogu središnje blokirati senzibilizaciju. Broj analgetika na raspolaganju stomatolozima je velik, ali jednostavni protokoli, temeljeni na najboljim kliničkim dokazima, mogu osigurati jednostavne smjernice. Izbor analgetika uvelike će ovisiti o jakosti boli koji opisuje ili očekuje pacijent, uzimajući u obzir pacijentovo opće zdravlje. Paracetamol, nesteroidni antiinflamatorni lijekovi i kodein korisni su za većinu stomatoloških pacijenata. Doziranje i vremenski raspored uzimanja lijekova također su važni, ali važne su i informacije dostupne pacijentu. Na primjer, znanje o tome kako pacijentova prijeoperativna anksioznost može pojačati poslijeoperativnu bol naglašava važnost prijeoperativnog uklanjanja anksioznosti jednostavnim sredstvima, kao što su priladne informacije.Menagement of pain in dental patients is important. Effective menagement of pain requires an understanding of basic pain mechanisms. The traditional view that pain could be adequately described as resulting from the acrivity in a dedicated pathway originating in peripheral nociceptors has changed. Now a more complex view takes into account the plasticity of the conduction pathways and describes a process that starts with a stimulus and leads to both a sensory and emotional response. This contemporary understanding of pain systems helps clinicians manage pain better. For example, the mechanisms underlying primary hyperalgesia suggest ways to provide optimum pain relief by using a multi-drug approach. Similary, the phenomenon of wind-up, whereby peripheral input may be simplifield as much as twenty times, has lead to the concept of preemptive analgesia and an understanding of the importance of timing analgesic dosing, and the search of novel agents that may block central sensibilisation. The choice of analgesics available to dentists to proscribe or recommend is vast but simple protocols based on best clinical evidence can provide straightforward guidance. Analgesic choice will depend largely on the pain intensity reported or anticipated but will also take into account the patients gneral health. Paracetamol, NSAIDs and codeine are useful for ambulatory dental patients. The dosage and timing of drug administration are important but so too is the information made available to the patient. For example, an understanding of how a patients preoperative anxiety may also exaggerate their postoperative pain emphasises the importance of preoperative menagement of anxiety by simple means as providing appropriate information

The COVID-19 pandemic and dentistry: the clinical, legal and economic consequences - part 1: clinical

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus which causes COVID-19, is highly contagious. Dentistry is a high-risk profession for occupational virus transmission because of the close proximity of the operator to the patient during treatment and the procedural generation of aerosols. The impact on the provision of dental care has been profound, with routine care restricted or paused for a period around the world. There have been adverse consequences for dental education and clinical research. Emergency and urgent care provisions have generally proceeded. However, even when a patient's condition is deemed urgent, access to the appropriate care may not have been possible due to lack of the recommended personal protective equipment. The common dental diseases of caries and periodontitis usually present with signs and symptoms after some advancement, hence the recommended regular dental examination so that these may be diagnosed early by a professional with suitable lighting, instruments and radiography. Conditions such as oral cancer similarly present in their early stages without symptoms. Many countries introduced telephone and video consultations for patients with symptoms but much disease has gone undiagnosed and without management. It is difficult to ascertain the full effect of the disruption to dental services, education and research but it is likely to be substantial. The immediate future will focus on return to routine care provision with likely longer-term permanent changes

COVID-19, domestic violence and abuse, and urgent dental and oral and maxillofacial surgery care.

Household isolation measures to reduce coronavirus transmission during the COVID-19 pandemic have resulted in increased risk of domestic violence and abuse (DVA). DVA physical injury most frequently involves the face. Dentists, dental care professionals, oral surgeons and oral and maxillofacial surgeons all have a critical part to play in identifying patients experiencing DVA, who present with dental and facial injury, and in making referrals to specialist agencies. This paper describes how to ask questions about DVA sensitively and how to make an appropriate referral. Early intervention and referral to a DVA advocate can prevent an abusive situation becoming worse with more intense violence. It can save lives

Visual neglect after right posterior cerebral artery infarction

This article has been made available through the Brunel Open Access Publishing Fund and is available from the specified link - Copyright © 2006 BMJ Publishing Group.Objectives: To investigate the characteristics and neuroanatomical correlates of visual neglect after right-sided posterior cerebral artery (PCA) infarction.Methods: 15 patients with acute PCA strokes were screened for the presence of neglect on a comprehensive battery of cognitive tests. Extra tests of visual perception were also carried out on six patients. To establish which areas were critically associated with neglect, the lesions of patients with and without neglect were compared.Results: Neglect of varying severity was documented in 8 patients. In addition, higher-order visual perception was impaired in 5 of the 6 patients. Neglect was critically associated with damage to an area of white matter in the occipital lobe corresponding to a white matter tract connecting the parahippocampal gyrus with the angular gyrus of the parietal lobe. Lesions of the thalamus or splenium of the corpus callosum did not appear necessary or sufficient to cause neglect, but may mediate its severity in these patients.Conclusions: PCA stroke can result in visual neglect. Interruption of the white matter fibres connecting the parahippocampal gyrus to the angular gyrus may be important in determining whether a patient will manifest neglect

Assessing sedation need and managing referred dentally anxious patients:is there a role for the Index of Sedation Need?

Aim: To conduct an exploratory investigation of public dental service (PDS) practitioners' planned sedation modality using a structural equation modelling approach, in order to identify the explanatory value of using the Index of Sedation Need (IOSN), or its component parts, to predict sedation modality in patients referred with dental anxiety. Methods: A convenience sample of patients referred to the PDS for dental anxiety management was invited to take part. The IOSN was completed for each patient (patient dental anxiety, medical and behavioural indicators and dental treatment complexity) as well as the American Society of Anesthesiologists Physical Status Classification System and the Case Mix Tool. The practitioners completed details of their planned sedation modality and identified normative dental treatment need. The data were entered onto an SPSS v21 database and subjected to frequency distributions, t-tests, correlation analysis and exploratory partial structural equation modelling (SEM). Results: Ninety-five percent of patients were ranked as MDAS 3 or 4, indicating high dental anxiety; 69% had a medical condition, which might impact on dental treatment and 82% had a dental treatment need, which was classified as intermediate/complex according to the IOSN. Eighty-eight percent of the patients in accordance with the IOSN required sedation: 62% of patients were assessed as requiring intravenous sedation. The IOSN discriminated between patients who were assessed as requiring more complex sedation modalities and had a greater normative treatment need. The SEM showed that the patient dental anxiety (P <0.02) and dental treatment complexity (P <0.02) predicted planned sedation modality. Functional morbidity was less strong, as a predictor, and was significant at the ten percent level. Conclusions: The IOSN is a useful and valid assessment of sedation need and predicted sedation modality for patients referred with high dental anxiety states and secondly, that component parts of the IOSN add explanatory value in practitioners' choice of planned sedation modality

Mitigating Gender Bias in Machine Learning Data Sets

Artificial Intelligence has the capacity to amplify and perpetuate societal biases and presents profound ethical implications for society. Gender bias has been identified in the context of employment advertising and recruitment tools, due to their reliance on underlying language processing and recommendation algorithms. Attempts to address such issues have involved testing learned associations, integrating concepts of fairness to machine learning and performing more rigorous analysis of training data. Mitigating bias when algorithms are trained on textual data is particularly challenging given the complex way gender ideology is embedded in language. This paper proposes a framework for the identification of gender bias in training data for machine learning.The work draws upon gender theory and sociolinguistics to systematically indicate levels of bias in textual training data and associated neural word embedding models, thus highlighting pathways for both removing bias from training data and critically assessing its impact.Comment: 10 pages, 5 figures, 5 Tables, Presented as Bias2020 workshop (as part of the ECIR Conference) - http://bias.disim.univaq.i

Results of an international survey on the investigation and endovascular management of cerebral vasospasm and delayed cerebral ischemia

Background: Delayed cerebral ischemia (DCI) is a major cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage. Endovascular management of this condition offers a new hope in preventing adverse outcome; however, a uniform standard of practice is lacking owing to a paucity of clinical trials. We conducted an international survey on the use of investigative and endovascular techniques in the treatment of DCI to assess the variability of current practice. Methods: Neurovascular neurosurgeons and neuroradiologists were contacted through professional societies from America, United Kingdom, Europe, and Australasia. Members were invited to complete a 13-item questionnaire regarding screening techniques, first-line and second-line therapies in endovascular intervention, and the role of angioplasty. Answers were compared using χ2 testing for nonparametric data. Results: Data from 344 respondents from 32 countries were analyzed: 167 non-United States and 177 U.S. respondents. More than half of all clinicians had 10+ years of experience in units with a mixture of higher and lower case volumes. Daily transcranial Doppler ultrasonography was the most commonly used screening technique by both U.S. (70%) and non-U.S. (53%) practitioners. Verapamil was the most common first-line therapy in the United States, whereas nimodipine was most popular in non-U.S. countries. Angioplasty was performed by 83% of non-U.S. and 91% of U.S. clinicians in the treatment of vasospasm; however, more U.S. clinicians reported using angioplasty for distal vasospasm. Conclusions: Treatment practices for DCI vary considerably, with the greatest variability in the choice of agent for intra-arterial therapy. Our data demonstrate the wide variation of approaches in use at present. However, without further clinical trials and development of a uniform standard of best practice, variability in treatment and outcome for DCI is likely to continue