Showing posts with label dentistry. Show all posts
Showing posts with label dentistry. Show all posts

Friday, 9 November 2012

Dental problem in sugar disease / dibetes Patient

Diabetes, or as we like to call it - the sweet disease, increases your chances of gum diseases like gingivitis and periodontitis, both being gum diseases. Poor control of blood glucose levels means that your body isn't able to fight off bacteria that invade your gums, causing infections that can lead to the loss of teeth. Another oral problem is dry mouth, which sounds like a minor issue, but can lead to cavities. So in that case, steady control of your glucose levels is the best way to maintain good oral health when you have diabetes.

“Because of this relationship between diabetes and your teeth, it's important to tell your dental hygienist and your dentist that you have diabetes and about any medications you take,” points
  Dr .AmanSingh 
Odontos dental hospital Zirakpur 
.

Startling facts
  • Periodontal (gum) disease is more common in people with diabetes. 1/3rd of diabetics have it.
  • Persons with poorly controlled diabetes are 3 times more likely to have severe periodontitis than those without diabetes.
  • 60% of the people with Diabetes have a dry mouth, gum inflammation (gingivitis and periodontitis), poor healing of oral tissues, plaque & fungal infection and burning mouth and/or tongue. 

Is There a Two-Way Street?

Emerging research also suggests that the relationship between serious gum disease and diabetes is two-way. Not only are people with diabetes more susceptible to serious gum disease, but serious gum disease may have the potential to affect blood glucose control and contribute to the progression of diabetes. Research suggests that people with diabetes are at higher risk for oral health problems, such as gingivitis (an early stage of gum disease) and periodontitis (serious gum disease). People with diabetes are at an increased risk for serious gum disease because they are generally more susceptible to bacterial infection, and have a decreased ability to fight bacteria that invade the gums.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.

Dental Care tips for People With Diabetes

Dental Care tips for People With Diabetes
  • Since people with diabetes are more prone to conditions that may harm their oral health, it's essential to follow good dental care practices and to pay special attention to any changes in your oral health and to seek a prompt dental consultation if such changes occur. Here are some points to consider.
  • Keep your blood sugar as close to normal as possible. 
  • At each dental care visit, tell your dentist about the status of your diabetes. 
  • See your diabetes doctor before scheduling treatment for periodontal disease. 
  • Make sure to give your dentist your diabetes doctor's name and phone number to include on your personal file. This information will then be readily accessible by your dentist should any questions or concerns arise. 
  • Bring your dentist a list of all the names and dosages of all medications you are taking. Your dentist will need to know this information to prescribe medications least likely to interfere with the medications you are already taking if medications are needed. If a major infection is being treated, your insulin dose (for those taking insulin) may need to be adjusted. Check with your doctor. 
  • Postpone non-emergency dental care procedures if your blood sugar is not in good control. However, acute infections, should be treated right away. 
  • Keep in mind that healing may take longer in people with diabetes. Follow your dentist's post-treatment instructions closely. 
  • People with diabetes with orthodontic appliances (such as braces) should contact their orthodontist immediately if a wire or bracket results in a cut to their tongue or mouth. 
*Images Courtesy: Thinkstock/Getty Images/ http://healthmeup.com/news-healthy-living/how-diabetes-the-sweet-disease-affects-dental-health/16225
Article by - Dr .AmanSingh 

Odontos dental hospital Zirakpur 
Sco-1 Near N.k sharma office  ,

Take care and happy Diwali

Tuesday, 6 November 2012

DRUG INTERACTIONS IN DENTISTRY- ODONTOS DENTAl HOSPITAL


DRUG INTERACTIONS IN
DENTISTRY

INDEX
 Pages-
1-2                             Introduction & definition
3                                Antibiotics, Antifungals, antiinfectives
4-7                            Antibiotics/oral contraceptives;antibiotics-   
                                                                             enzyme induction                      
                                                                                                          
7-8                           Antibiotics/Cationic agents
9 -13                       LA & vasoconstrictor interactions
14                           Drugs causing P450 enzyme induction
15-16                     Opioid analgesic interactions
17-18                     Serotonin Syndrome
19-21                    NSAID interactions
22                          References & Conclusion




DEFINITION-
Drug interaction may be defined as a measurable modification (in magnitude and/or duration) of the action of one drug by prior or concomitant administration of another substance, including prescription, non-prescription drugs, food, alcohol, cigarette smoking or diagnostic tests.
The mechanism of drug-drug interactions can be categorized
    into 5 major areas:
Ø Additive or synergistic pharmacological responses
Ø Antagonistic pharmacological responses
Ø Incompatibility
Ø Common pharmacokinetic pathways
Ø Altered defense mechanism of the host
Ø ADDITIVE OR SYNERGISTIC PHARMACOLOGICAL RESPONSE
EXAMPLE:
    When opioid analgesics such as hydrocodine or oxycodine are prescribed for pain and phenothiazine anti-emetics such as promethazine are prescribed for nausea, each causes sedation and will have an additive effect of potentially excessive sedation.
                                                    1                                              

Ø ANTAGONISTIC PHARMACOLOGICAL RESPONSE
 EXAMPLE:
    Patients treated for attention deficit disorder may be more difficult to sedate with benzodiazepines such as midazolam because of the stimulant effects of psychostimulants
Ø INCOMPATIBILITY
 EXAMPLE:
         When the antibiotic vancomycin is administered parenterally through the same intravenous line either before or after the antibiotic ceftazidime, a cephalosporin, a precipitate will be formed which may occlude the line. Thus to avoid this ceftazidime should be administered first and the intravenous line should be flushed before administering vancomycin.
         Tetracycline antibiotics such as doxycycline form insoluble complexes called chelates with divalent cations, such as calcium or magnesium. Therefore, if doxycycline is taken with milk, other dairy products or antacids, a chelate will form and doxycycline will not be absorbed in the GIT but will be excreted. To avoid this tetracyclines should not be administered within 2 hrs of calcium sources.

                                                      2

Ø COMMON PHARMACOKINETIC PATHWAY
  EXAMPLE:
  The drug probenecid was designed to occupy the tubular secretion site for organic acids in the kidney. By administering probenecid to a patient, their kidneys did not tubularly secrete other organic acids such as penicillins, prolonging the length of time that the penicillin stayed in the body.
    ( this drug interaction was utilized to preserve the small supplies   of penicillin antibiotics when treating the wounded during          World War II) 

ANTIBIOTICS, ANTIFUNGALS AND OTHER ANTI-INFECTIVE AGENTS
Antibiotic prophylaxis before treatment for periodontal patients is required in following cases:
Ø Patients at risk of developing endocarditis
Ø Patients with prosthetic cardiac valve
Ø Congenital heart disease
Ø Orthopedic joint replacement
Ø Patients who have received an organ transplant

                                                        3

ANTIBIOTICS 
                    &
           
                 ORAL CONTRACEPTIVES
Mechanism of interaction:
  
  The mechanism in this interaction involves the enterohepatic recycling of the conjugated estrogen excreted in the bile, reactivated by the gastrointestinal flora and reabsorbed as active drug. Because today’s oral contraceptives are low-dose or very low-dose estrogen products, it is theorised that even small decreases in estrogen absorption could render the pill ineffective.

Table: Inhibition of cytochrome P450 enzymes by antibiotics, antifungals
and anti-infectives which increase interacting drug effects
                                              
                                                     4

                                                                                        5
kz



                                                                          6       
Ø The macrolide antibiotic azithromycin does not inhibit hepatic enzymes and is a safe alternative in patients taking these interacting medications.
Ø  Nystatin may be used as an alternative antifungal for mild oral fungal infections in patients who are not immunocompromised, but true therapeutic alternatives do not exist for treatment with azole anti-fungals.
Ø Metronidazole is used to treat the anaerobic component of oral infection with penicillin treating the aerobic component, clindamycin may be used alone as an alternative to treat those mixed infections.
Ø ANTIBIOTICS Vs CATIONIC AGENTS
Ø Several agents can substantially reduce the absorption of fluoroquinolones and tetracyclines thereby causing treatment failure.
Ø Divalent cations (calcium and magnesium) and trivalent cations (aluminum and ferrous sulfate) can form insoluble complexes in the gut if they are taken concurrently with fluoroquinolones thus reducing absorption of fluoroquinolones and tetracyclines by 60-75%.
Ø To avoid this, the fluoroquinolone/tetracycline and cation product should be administered at least two hours apart (preferably four hours apart).
Ø Common products containing divalent or trivalent cations are listed in Table .




                                                               7

TABLE
Common Products Containing Divalent or Trivalent Cations
Aluminum
Alu-Cap, AlternaGel, Amphojel, Basaljel
Aluminum and magnesium combinations
Gelusil, Maalox, Mylanta, Riopan
Calcium
Caltrate, Citracal, Os-Cal, PhosLo, Titralac, Tums
Iron
Feosol, Fergon, Niferex, Nu-Iron, Slow Fe
Magnesium
Almora, Citrate of Magnesia, Mag-Ox 400, Milk of Magnesia, Slow-Mag, Uro-Mag










                                                                      8

LOCAL ANESTHETICS

   The most common time for an emergent or adverse event to occur in a dental office is around the time of the administration of the local anesthetic. Local anesthetics carpules used in dentistry frequently contain a vasoconstrictor in addition to the local anesthetic. The presence of vasoconstrictor provide the greater source for potential drug-drug interactions than does the local anesthetic.
VASOCONSTRICTOR
The vasoconstrictor is present to localise the injection to the site of administration and to decrease bleeding in the area. The two vasoconstrictors commonly used in dentistry are epinephrine and levonordefrin.
Ø Epinephrine stimulates both alpha and beta (both beta-1 and beta-2) adrenergic receptors equally(50/50)
Ø Levonordefrin stimulates alpha receptors 3 times more than beta-1 receptors(75/25).