Methemoglobinemia and Dentistry: A Potentially Lethal Combination

This post is intended to be a refresher on the causes, complications, and treatment of Methemoglobinemia –which can occur because of certain medications in dentistry.

Methemoglobinemia is “A condition in which a higher-than-normal amount of methemoglobin is found in the blood. Methemoglobin is a form of hemoglobin that cannot carry oxygen.”1 Essentially, methemoglobin is still Hemoglobin, but it has a different form of Iron which inhibits the molecule from holding onto Oxygen. If the Hemoglobin cannot hold onto Oxygen the way it is intended to, oxygen is not delivered to the tissues as needed.

What happens if the tissues and organs do not get the oxygen they need? Anyone who is not getting the oxygen they need will have: gray or blue-colored skin, lips, and nail beds; shortness of breath; fatigue; confusion; headache; lightheadedness; and fast heart rate. Methemoglobinemia can be fatal in anyone with breathing issues, heart disease, or in the elderly/infants2.

What Causes Methemoglobinemia?

The condition can be caused by certain drugs, chemicals, foods, or acquired genetically3. In Dentistry specifically, Topical Benzocaine.

Dental Implications:

In 2018, the FDA produced the statement that said “oral drug products containing benzocaine should not be used to treat infants and children younger than 2 years. We are also warning that benzocaine oral drug products should only be used in adults and children 2 years and older if they contain certain warnings on the drug label.” The article goes on to say that these topical benzocaine products should definitely not be used for treating oral pains such as toothaches and sore gums in teething children as it will not produce the desired effect and will wash away in the mouth.

So if after administering a Topical benzocaine product in the dental chair, be alert for any of the signs listed above. If symptoms do start to arise, contact and get the patient to an emergency medical center immediately for treatment which can be reversible. These signs and symptoms may arise minutes to hours after application of the Topical Benzocaine4. Can also occur with over the counter Benzocaine products like the one above.

TL:DR–If after administering Topical Benzocaine at home or in the dental chair and the patient begins to feel funny: seek medical attention immediately

  1. NCI Dictionary of Cancer terms. National Cancer Institute. (n.d.). Retrieved May 23, 2022, from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/methemoglobinemia 
  2. Center for Drug Evaluation and Research. (n.d.). FDA acts on OTC benzocaine oral products and RX Local anesthetics. U.S. Food and Drug Administration. Retrieved May 24, 2022, from https://www.fda.gov/drugs/drug-safety-and-availability/risk-serious-and-potentially-fatal-blood-disorder-prompts-fda-action-oral-over-counter-benzocaine 
  3. NCI Dictionary of Cancer terms. National Cancer Institute. (n.d.). Retrieved May 24, 2022, from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/methemoglobinemia 
  4. Center for Drug Evaluation and Research. (n.d.). FDA acts on OTC benzocaine oral products and RX Local anesthetics. U.S. Food and Drug Administration. Retrieved May 24, 2022, from https://www.fda.gov/drugs/drug-safety-and-availability/risk-serious-and-potentially-fatal-blood-disorder-prompts-fda-action-oral-over-counter-benzocaine 

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The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.

Busting Wives Tales: Crushed Aspirin for a Toothache

Aspirin is a Non-Steroirdal Anti-Inflammatory or NSAID, commonly used for everyday aches and pains. Some people are also prescribed this drug to manage the risk of heart attack. So besides taking this over-the-counter drug for cardiovascular reasons, it might make sense to take it for a toothache.

For some reason the myth of crushing up Aspirin, then rubbing the powder on and around the tooth has hung around for too long. What can happen if you rub crushed Aspirin on a toothache is a chemical burn on the gums around the tooth.

If you do allow the crushed Aspirin to remain on the gums, you will notice something similar to the lesion below with some pain to boot. The reaction will be similar to a sunburn on the outside of you skin, and more discomfort will probably result.

Chemical Burn from Crushed Aspirin (Neville et al., 2003)

Discontinuation of the crushed Aspirin and time is the only method of healing for these burns.

A proven method for reduction of pain if you are experiencing a toothache is the combination of Tylenol and Ibuprofen, along with getting in to see your dentist as soon as possible to take care of the sour tooth. So if you want to avoid a toothache, and a chemical burn, see your dentist before the toothache begins and don’t crush up the Aspirin.

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Neville, B. W., Damm, D. D., & White, D. K. (2003). Color atlas of clinical oral pathology. BC Decker. 

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The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.

2022 Dental Assistant Recognition Week Interviews

In Honor of National Dental Assistant week, I decided to interview a couple of my awesome dental assistants. Without them, my job would be 1000% more harder and a lot less fun. This post contains good information on the not so obvious parts of Assisting!

Preemptive thanks to @paige.westermann and @traylee1245 for a) being great assistants and b) allowing me to interview them

  1. How long have you been working as a Dental Assistant?
    • Tracy: Just shy of a year
    • Paige: A year and a half
  2. Did you attend any formal Dental Assisting schooling? And do you think it is beneficial to go to Dental Assisting School?
    • Tracy: No previous Assisting school, and from what I have learned so far it is a waste of time
    • Paige: I did a year of assisting school and it was 100% a waste of time
  3. What are your Favorite Procedures to assist with?
    • Tracy: I like assisting with extractions and doing quadrants of composite fillings
    • Paige: …Referral appointments lol
  4. What has been the most Eye-Opening part of assisting?
    • Tracy: I did not realize how important your oral health is to your overall health
    • Paige: Dealing with patients who, for lack of a better term, are not that joyful to deal with
  5. What part of Dentistry do you Like the Most?
    • Tracy: That is hard to say, because I like pretty much everything we do
    • Paige: Ditto
  6. Is it difficult to switch and assist different doctors in the office?
    • Tracy: Yes, only because doctors have different tempos at which they work
    • Paige: Hard to tell, I have only assisted for one dentist
  7. What is something that you didn’t know about dentistry that you think everyone should know?
    • Tracy: I was never taught how to floss correctly, and now that I see the correct way, it is so much easier!
    • Paige: Along the same lines, but for brushing and how important it really is.
  8. What can your dentist do to help make your job easier/more enjoyable?
    • Paige: Know when to be serious, but also be able to not take everything so seriously. I like it when the Doc is able to loosen up a little and joke around
    • Tracy: I enjoy when the dentist explains/teaches to me the thought process behind why/how we do procedures
  9. What Grinds your Gears the most during assisting?
    • Tracy: When patients try to blame the dentist, and does not take responsibility for not taking care of their teeth…
    • Paige: When patients don’t cooperate with what we’re asking them to do…
  10. If there was one thing you could change about your job, what would it be?
    • Tracy: I would love to be able to do more things such as the expanded functions of fillings etc.
    • Paige: I would never do a perio chart again
  11. Last but not least, Give me your best patient interaction story?
    • Tracy: The most funny thing is when patients tell us about trying to adjust their dentures at home with power tools
    • Paige: I had a patient tell me he drinks 12 Mountain Dews a day…….

Again, a big thank you to my assistants and to all assistants out there on National Dental Assistant week!

What to do Before a Patient Starts Cancer Treatments

This guide can be useful for patients who will be undergoing radiation to the head/neck area, beginning to take myelosuppresive drugs, or going to begin chemotherapy.

  1. Step one involves getting the patient in for examination at least a month before treatment begins. Coordination with the Oncologist is helpful here to determine where the proposed radiation field will be.
    • This examination should involve a few things
      • Identification of any teeth with cavities, periodontal disease, or endodontic lesions
      • Identification and elimination of any sources of oral trauma–from partials/dentures, braces, etc
      • Patient education on foods/drinks to avoid to reduce cavity risk.
  2. Once all of the patient information has been gathered, treatment of any invasive procedures need to be completed at least 14 days before starting cancer treatments
    • Extractions of questionable teeth in areas with heavy radiation
    • Root Canals of any teeth with endodontic issues that will be saved
    • SRPs
    • Prosthetic surgeries need to be completed
    • IMPORTANT: Do not commence any invasive procedures until contacting the patient’s oncologist if the cancer is Hematologic in nature.
  3. Cavity and Oral Irritation Prevention:
    • Treat caries and gingival inflammation
    • Instructing patients to use a more heavy-duty fluoride toothpaste, or fluoride trays
    • Saliva inducers or supplements to fend off xerostomia
    • Setting up more frequent Hygiene recalls from every 6 months to every 2-3 months
    • Again, making sure no prostheses are rubbing irregularly on the soft tissues
  4. Advice for Patients:
    • They should still be brushing and flossing, but use a soft or very soft bristled toothbrush.
    • If the brushing hurts, warm the brush up in warm water first
    • Lightly brush after every meal
    • Avoid Mouthwashes with alcohol in them
    • Join support groups with individuals who are also going through what they are.

Be sure to get in touch with your local Oncologist who may need your help in treat patients before starting cancer/immunosuppressive therapies.

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  1. National Institute of Dental and Craniofacial Research. (n.d.). Dental Provider’s Oncology Pocket Guide. .S. Department of HealtH anD HUman ServiceS national institutes of Health. Retrieved March 2, 2022, from https://www.nidcr.nih.gov/sites/default/files/2017-09/oncology-guide-dental-provider_0.pdf 

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The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.

Check the Lips!

Importance of Evaluating the Outer Lips for Actinic Keratosis: A.K.A Actinic Cheilosis, Solar Keratosis of the lips, Farmer’s Lip and Sailor’s Lip. Potentially unremarkable lesions with consequences.

Have you ever noticed little scaly plaques on someone’s face, neck, top of their head, or lips? Commonly mistaken for chapped lips, Actinic Cheilosis are 1-2 millimeter or larger plaques on the outer surface of the lips. Usually grey-brown in color and scaly around the borders of the lesion, there can also be a blurring of the vermilion border of the lip.

(Neville et al., 2016)

Actinic Keratoses are Premalignant lesions that can transform into Squamous Cell Carcinoma

Risk Factors for Actinic Cheilosis and Keratosis include: Older age, usually greater than 40-45. Living and working in a Higher UV indexed location for prolonged periods of time. Red/Blonde hair with fairer skin. History of Skin Cancer. Outdoor occupations with long exposures to sun. Immune Deficiencies. There is also an increase in risk when a larger number of lesions are noted, long-standing lesions, or lesions on individuals who are not protecting themselves from the elements.

Diagnosis involves ideally catching the lesions early, then biopsy to be sent to lab to determine histology and diagnose. There is a 2.5x increase in malignant transformation in these lesions, but the onset can take years.

Treatment can involve Excision, cryotherapy, or topical drug therapy depending on stage caught.

Preventive Measures: Limit your UV exposure as much as possible — Hats that cover surface of lips and face. Wear SPF 30 broad spectrum sunscreen. Lip Balm with SPF with frequent reapplications. Limit sun time1.

Be on the lookout for suspicious lesions and feel free to contact a Dermatologist if questions arise

(Neville et al., 2016)

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  1. Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2016). Oral and maxillofacial pathology. Elsevier. 

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The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.

Dry Mouth Relief

If you, someone you know, or one of your patients is suffering from dry mouth; here is a list of options for potential relief options to try. This is not an exhaustive list, and if you are suffering from dry mouth you should consult with your dentist or physician to determine underlying conditions. Some of these products are not necessarily for dry mouth, but do help protect the teeth from the damaging effects of dry mouth. Of course remember to drink lot’s of water throughout the day for dry mouth! Lastly, this list is in no particular order.

Gels:

  1. XyliGel from OraCoat: This gel contains 153mg of Xylitol per serving, which is a 1mL squeeze of the product. OraCoat also has XyliMelts, containing Xylitol and instructions include using before bed, or anytime dry mouth occurs. These products can be found online or in many different retail locations.
  2. Biotene OralBalance Gel: Coming from a company known for its dry mouth products, the OralBalance gel claims to provide relief for up to 4 hours. Also contains Xylitol and can be found online and at many retail stores.
  3. GC Dry Mouth Gel: The first of a couple GC products on this post, this product claims to provide a protective coat around the teeth and oral tissues. Simple application and safe to swallow.

Mouth Rinses:

  1. Biotene Dry Mouth Oral Rinse: Another product in Biotene’s lineup, contains moisturizing ingredients and has Xylitol as well. Product description notes that it can be used up to five times per day to help relieve symptoms.
  2. Oral-B Dry Mouth Oral Rinse Mouthwash: Oral-B has a lot of products that claim to work well for dry mouth. One of the main active ingredients in this product is Sodium Hyaluronate which is commonly used as a lubricant safe for the human body.
  3. SmartMouth Dry Mouth Activated Oral Rinse: Marketed for those with dry mouth and bad breath, this product uses a patented zinc ion formulation to fight bad breath. Also available in stores or online.
  4. ACT Dry Mouth Mouthwash with Xylitol: This mouthwash has multiple ingredients that may be beneficial for people with dry mouth. Xylitol, Fluoride and the lubricating ingredients may all help to benefit teeth in those suffering from dry mouth.
  5. CloSYS: A different take on the usual dry mouth game, CloSYS uses fluoride which is good for teeth and stabilized chlorine dioxide which is a water purifying agent that helps with bad breath.

Mints and Gum:

  1. Elevate Oral Care Epic Xylitol Gum: Both of the products in this category are used to help stimulate salivary flow to combat dry mouth.
  2. Elevate Oral Care Epic Xylitol Mints: They also both contain Xylitol, an ingredient you have seen listed elsewhere in this post which has cavity bacteria-fighting capabilities.

Toothpastes:

  1. Biotene Fluoride Toothpaste: On paper, just another toothpaste that you can use containing fluoride. But this toothpaste is also SLS free, which is a common irritant to some people.

Prescription needed Products:

  1. SalivaMax from Forward Science: This is a supersaturated solution of calcium phosphate rinse. Commonly prescribed for patients with radiation treatment, severe xerostomia, or mucositis post cancer. Mix the packets with 1mL of water and swish.
  2. Pilocarpine: Commonly prescribed for patients with Sjögren’s Sjogren’s Syndrome and radiation induced destruction of salivary glands, this medication helps the body produce extra saliva. There are common side-effects and interactions with other drugs, so consult with a dental professional before usage.
  3. Prevident 5000: There are multiple variations of this Colgate product. It has a high content of sodium fluoride, which is important for those with dry mouth to help protect teeth from the low pH environment(acidic).
  4. GC America MI Paste and MI Paste Plus: Not necessarily a toothpaste, but it is to be used after brushing around teeth and gums that are at risk of caries/have sensitivity/feel dry, because of dry mouth. Contains Casein Phosphopeptide-Amorphous Calcium Phosphate which comes from milk, so confirm any milk allergies or vegan preferences before usage.

Summary:

All of these products listed above could potentially help relieve dry mouth symptoms/ help reduce cavities in those who do have dry mouth. However, it is still important to discuss symptoms with your dentist to rule out any underlying conditions or allergies to any of the products listed above before trying them. Of course avoiding things like alcohol, tobacco, caffeine, and spicy foods can help to relieve dry mouth as well.

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The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.

What The Dentist Sees in Your X-rays

A series of photos below will walk you through the progression of some cavities, and what we are looking out for after your most common X-rays.

This is an X-ray of someone without radiographically visible cavities. But you can see an impacted 3rd molars (wisdom tooth) in the bottom right corner hanging out and chilling.
Dentists will focus onto the areas that are circled, you can appreciate the darker areas in the hard outer enamel. These dark spots start off as triangular in shape as the cavity is working its way through the hard outer enamel.
Here we can see more triangular shaped cavities in the outer Enamel. The circle with the star, and the lower left circle shows a cavity that has broken through the hard outer enamel. Once this break through the hard outer Enamel occurs, the cavity is in the soft inner Dentin where it can run rampant.
The circled area here depicts the cavity that has decimated the soft inner Dentin of the tooth and has found its way into the pulp/nerve/blood supply to the tooth. A Root Canal will be needed to save this tooth.

Now you know what to look for at your next cleaning and exam appointment with your dentist when they swing that monitor or film with your x-rays on them. This is not an exhaustive list of x-rays a dentist might need of your teeth, but these are some of the most common. Read through some of our previous posts to learn more about cavities at www.teethandchiefs.com.

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The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.

What Are These White Spots On My Child’s Teeth?

Those are white spot lesions! Let’s talk a bit about why they happen and what we can do about them.

What Are White Spot Lesions (WSLs)?

White spot lesions are simply areas of decalcification of our enamel. Before we have a true cavity (a cavity results from decay entering the inner layer of our tooth, dentin, past the outer enamel layer), the enamel becomes decalcified. This results in a chalky-white appearance. White spot lesions are a common occurrence around the brackets of traditional fixed braces, but also may appear on your teeth throughout your life. A study has found that these ‘lesions’ can appear rapidly, up to four weeks after initiating orthodontic treatment in the presence of poor oral hygiene¹. With this in mind, let’s look more into studies about white spot lesions.

What Causes These Lesions?

Like mentioned above, these lesions are commonly associated with orthodontic treatment (but this isn’t their only cause!). When orthodontic treatment is started, the bacteria of the oral cavity is changed. One of those bacteria, S. mutans, is a major factor in the formation of cavities and was found to be increased in those who initiate orthodontic treatment². WSL’s are like ‘starter cavities,’ so it makes sense that they would be seen more in those with patients with a large microflora of S. mutans. The common areas that they appear are around the brackets (or under), as well as along the gingiva towards the top of teeth. Just because you don’t have braces doesn’t mean you can’t get these lesions, though – WSL’s are simply areas of decalcification and anything that promotes poor oral hygiene can contribute to them.

One study found that the key characteristics between developing WSL’s are the surface characteristics of the teeth, the saliva flow of the patient, as well as the distance of brackets from the gingiva in those who have orthodontics³.

Microbiology GIFs - Get the best GIF on GIPHY

So What Do We Do About Them?

The easiest thing to do is prevent. That means brushing your teeth twice a day with a fluoridated toothpaste, as well as watching your diet for carbohydrates (which the bacteria that contribute to cavities feed off of). Don’t fret, though, if you find yourself with these lesions. There are methods to make your teeth appear like their natural selves again.

The first method is to remineralize the teeth with repeated applications of fluoride. This can be jump-started by fluoride varnishes at your dentist, and continued with maintenance at home with fluoridated toothpastes. Next, an abrasive may be used to ‘rub away’ the lesion using a fine grit material and acidic substance. Finally, a new method of resin-infiltration has been proposed and is regularly used in dental offices today – this method involves injecting a tooth-colored filling material into the tooth to bring back its natural look. Not all dentists provide these services, though, and remineralization is generally the first and least-invasive method for these lesions.

Bonus: Eat cheese! On food that prevents cavities: ‘the most protective properties against caries formation was the one (cheese) that involves the greatest amount of casein phosphoproteins and calcium phosphate in its content³.’

Cheese GIFs | Tenor

To Summarize:

  • White spot lesions are common and a result of demineralization of enamel
  • WSL’s are more common in those with poor oral hygiene and fixed orthodontics
  • There are numerous ways to combat WSL’s and it begins with prevention

References:

¹Khoroushi, M., & Kachuie, M. (2017). Prevention and Treatment of White Spot Lesions in Orthodontic Patients. Contemporary clinical dentistry8(1), 11–19. https://doi.org/10.4103/ccd.ccd_216_17

²Shukla, C., Maurya, R. K., Singh, V., & Tijare, M. (2016). Evaluation of changes in Streptococcus mutans colonies in microflora of the Indian population with fixed orthodontics appliances. Dental research journal13(4), 309–314. https://doi.org/10.4103/1735-3327.187876

³Temel SS, Kaya B (2019) Diagnosis, Prevention and Treatment of White Spot Lesions Related to Orthodontics. Int J Oral Dent Health 5:085. doi.org/10.23937/2469-5734/1510085

Liability Statement:

The medical advice given in this blog should only be utilized by a medical professional who has received a medical degree. I am not responsible for the medical advice given in this blog and each case should be reviewed extensively with sources outside my blog. This blog is for education purposes only and is not meant as a substitute for an academic institution.

Debate Settled? The Best Toothbrush: Oscillating vs. Sonic Electric Toothbrushes

What is an Oscillating Electric toothbrush? What is a Sonic Electric toothbrush? Which is better?

From the International Journal of Dental Hygiene, a winner has been nominated as to which Electric toothbrush does a better job at removing plaque–The Oscillating Electric Toothbrush.

Sonic Toothbrush: An example of this is the Sonicare Electric toothbrush – longer, more traditional head with bristles that vibrate at tens of thousands of strokes a minute.

Oscillating Toothbrush: An example of this type of toothbrush would be Oral-B’s electric lineup – with a circular head that rotates and vibrates with a self-proclaimed 48,800 movements per minute .

From a previous post, https://teethandchiefs.com/2021/01/31/doc-what-kind-of-toothbrush-should-i-be-using/ – we know that all things being even an Electric Toothbrush removes more plaque than manual toothbrushes. But now with full peer-review it appears the true winner is the Oscillating Type of electric toothbrushes1.

Per our usual statement here on Teeth and Chiefs, any toothbrush that gets you to brush with the soft-prickly side is the toothbrush for you. But for pure argument-sake it appears we have a winner, also I like the smaller circular head of the oscillators.

  1. Thomassen, T. M. J. A., Van der Weijden, F. A., & Slot, D. E. (2021). The efficacy of powered toothbrushes :‐a systematic review and Network Meta‐analysis‐. International Journal of Dental Hygiene. https://doi.org/10.1111/idh.12563 

Treating Medically Complex Patients with Dental Infections

A refresher on some of the conditions, pharmaceutical treatments, and host defenses that can complicate treatment:

Part 1- Determine the severity of the infection e.g. How is the patient feeling? How quickly did the infection start? Is there any trismus, dyspnea, dysphagia, malaise? If the infection arose quickly and/or shows signs listed above, the infection may be severe and immediate action or referral to an Oral Surgeon may be required.

Part 2- Determine Patient’s host Defense Mechanisms: There are many different metabolic diseases or dysfunctions that can contribute to more severe infections e.g. Uncontrolled diabetes type I or II, End Stage Renal Disease, Severe Alcoholism, and malnutrition. There are also Immune System-Suppressing Diseases that can lower white cell functioning and allow infections to spread faster e.g. HIV/AIDS, Leukemias and Lymphomas or other congenital or acquired immunologic diseases.

Part 3- Is the patient taking any Pharmaceuticals that decrease host defenses to infections? Certain drugs can lower white cell counts to low levels, with this the host defenses are severely compromised potentially allowing infections to run rampant. Patients commonly receive immunosuppressive drugs for things like 1. organ transplants, 2. cancer chemotherapeutics, and 3. autoimmune diseases. These drugs commonly fall under the the categories of Cyclosporine, Corticosteroids, Tacrolimus, and Azathioprine. Some of these drugs can affect the patient for years after ending therapy.

Summary:

Quick and efficient action for patients presenting with any of the conditions listed above are important. Reminder that if the patient has difficulty breathing, swallowing, opening, elevated temperature, severe malaise, need for General Anesthesia, or compromised host defenses, it may be time to refer to your neighborly Oral Surgeon.

Pharmaceutical Refresh: Other common names for drugs listed above for attention.

  1. Cyclosporine: Sandimmune, Neoral, Gengraf
  2. Tacrolimus: Envarsus XR, Astagraf XL, Protopic
  3. Azathioprine: Azasan

Reference:

Hupp, J. R., III, E. E., & Tucker, M. R. (2019). Contemporary Oral and maxillofacial surgery. Elsevier. 

The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.