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Medical Emergencies in the Dental Practice

In Dental Emergencies on July 25, 2013 by Dr Gregory Lloyds Tagged:

 emergencies dental practiceThe aim of  Lloyds Dental Practice Emergencies Research (LDPER) website is to assist the dentist in the prevention and treatment of emergencies that may occur in the surgery.

The emergencies may be due to medical disease in the patient or to problems with drugs and drug therapy.  A careful medical and dental history may prevent an emergency as may alert the dentist to a particular problem and allow the choice of the most appropriate treatment for the patient.  Its value cannot be overemphasised.

Further information may be obtained by consulting the patient’s practitioner. This is advisable whenever the patient appears to have medical problem.

If complications are anticipated, it may be advisable to admit the patient to hospital for dental treatment (for more info go to www.dentistcronulla.net.au). The Oxygen Therapy Sections of this website will deal with the various emergencies that may occur in the dental surgery. Oxygen therapy and basic life support techniques, together with other aspects of treatment, are described.

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Diseases That May Affect the Management of the Dental Patient

In Dental Patient Diseases on July 23, 2013 by Dr Gregory Lloyds

dental infection managementAlthough the majority of patients attending dentist Sutherland,for dental treatment are healthy, everyone is subject to minor acute infections such as the common cold and influenza. While such infections normally settle within a few days, others, particularly in the more elderly patient, may get worse or be followed by complications. It is therefore unwise to subject any patient with an acute infection to the extra stress of an elective operation; these should normally be deferred until the patient has recovered. Attendance at the dental surgery should also be discouraged, in order to prevent the spread of infection to other dental patients and staff.

A number of dental patients will have sub-acute or chronic disease affecting the various organs and systems of the body. In some, the disease will be symptomless and patient unaware of it; in others, as a result of treatment, the patient may feel completely fit and have little or no limitation of activity: he or she is able to work, take an active part in sport and lead a normal life. While patients in the second group are likely to tolerate operations well, it is particularly important to take a careful history as the drugs with which they may be being treated may seriously affect the course of their dental treatment, and place them particularly ‘at risk’ while undergoing operative procedures.

There remains a third group of patients who, in the presence of severe disease and despite treatment, have progressive restriction placed on their activity. These ‘decompensated’ patients, who are often unable to work, are operative risks, and while every attempt should be made to treat and control their disease before surgery, it may be necessary after consultation with the patient’s physician to decide that the risk of an elective operation is unwarranted.

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Balustrade Contractors Dental Insurance Guide

In Balustrade Contractors on November 4, 2014 by Dr Gregory Lloyds Tagged:

Maybe you have dreamed your Contractor company was to the verge of collapse due to a multimillion dollar suit? Actually, it is a nightmare scenario any independent contractor could face due to alleged neglect or alternative liability claims.

There is undoubtedly that contractors, particularly those face more costly and possibly larger litigation prices than most companies. Being a real balustrade contractor means that you must be concerned about suits do for your work, workers work and work of your subcontractors. Have you got your contracts designed to offer indemnification arrangements, hold harmless and require the subcontractor to add you to their own policy as an additional insured? Can you get a certification of insurance out of every subcontractor before every occupation starts? These changes that are simple could save you 1000s of dollars if there’s a claim or damage.

Over time we’ve found claims and many litigations in the construction industry. We’d a claim lately where a contractor was working in a Pasadena, Maryland house to set up a fresh HVAC system in the cellar. The contractor counseled the home owner to stay from the cellar, since the electricity was turned off and needed to leave the work website uncompleted as well as the job had not been done. Later that evening, the homeowner that was ready went downstairs to see how things were advancing. In his effort to "check things out" he tripped over the contractors tool box that has been left in the ground. His ankle broke and injured his back, causing many weeks and him a long-term back injury. The contractor was sued by the homeowner for pain and suffering and his medical bills.

How often have you ever left occupation websites without things advising customer to avoid and done? Could this scenario occur for you?

But on a scale that is small, you run a number of other dangers, including workers compensation claims, vandalism and damage, property theft, as well as the regular issues that any company can experience, like vehicle mishaps and company dislocation.

Any among these has the capacity reverse years of effort and to sabotage your company. However, from these fiscal risks with customized contractors insurance, it is possible to safeguard yourself with the aid of specialized specialists such as the team at Huff Insurance.

We provide for contractors with purpose built packages that could include protection for lots of companies rely to the service:

  • Commercial auto insurance
  • Workers compensation insurance
  • General contractual liability, company liability insurance and excess indebtedness
  • Company Owners Policies (BOP’s) and Bundles are accessible
  • Indemnification on neighboring sites on site or for damage
  • Property insurance coverage
  • Stuff in warehousing, shipping and transit
  • Specific risks related to your company – roofing, demolition, building, environmental contracting
  • Bonds (Performance Bonds, Rating Bonds, Bid Bonds etc)

We are able to design Contractor Insurance strategy that is custom for these kinds (and many more):

  • Baluster Contractor
  • Artisan Contractor
  • Electrical Contractor,
  • HVAC Contractor
  • General Contractor
  • Paving Contractor
  • Landscape Contractor
  • Construction Contractor
    All Contractors of any kind!

Huff Insurance, a Sure Choice Independent Insurance Agent, is where to visit remember to have the appropriate Contracotor Insurance Protection!

With Huff Insurance working for you, you do not need to stress, although there really are plenty of items to think about. With experience and our expertise, we will assist you be sure to have the proper insurance protection in the proper cost for the company and to understand your unique needs.

We provides guidance and national insurance and certification regulations, offer advice on handling risk and possibly help you save cash through reductions that are available.

Do not let the roof fall in on your company dreams through contractors insurance that is substandard. Complete our Free Contractor Insurance Estimate Form with this page now to learn how you can be protected by us!

At Huff Insurance in Pasadena Maryland we realize that you want certifications immediately, most certifications are completed whil

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The psychology of dental patient care:

In Psychiatric Disease on November 3, 2014 by Dr Gregory Lloyds Tagged:

To introduce some posts concerning the psychology of the dentist-patient relationship, Elinor Parker, Associate Editor considers their relevance to the dental healthcare professional that is practising

Introduction
Those facets of patient management that matter most to patients have yet to be covered at adequate depth or nicely. This show, characterised by the ‘Commonsense Strategy’, the name of the initial part, aims to redress that.

The series’ principal topic is the fact that ‘dental medical care is a two-man endeavour’, not a thing that one man does to another. It provides a framework as well as practical strategies to underpin them. The writer ‘s own experience in practice and her expertise informs this strategy.

Baby Steps or Giant Strides?

Frequently used techniques include:

  • Using non-threatening language (and body language)
  • interactive approaches based on tell-show-do techniques (direct interaction)
  • Organized time (taking regular rests)
  • positive reinforcing stimulus (making positive opinions)
  • Rehearsals and desensitisation will also be often used, both in formal and in informal manners.

    What all these approaches have in common is that they are based on action and rapport. They are geared toward trust and building confidence. They are around putting you in control.

    By going slow and taking baby steps, lots of people find that they gain confidence rather quickly and make giant strides! watch this www.youtube.com/watch?v=iWis-ZPuL-Q

Regular vignettes, many using the enchanting immediacy of verbatim transcription, exemplify the inner workings and effects of numerous psychological principles this website. . Clear expositions of the theories balance these. Some technical terms are utilized, and described, because to obtain information in a different area it’s important to find a way use its terminology and to comprehend the’s theories.

The show deals together with the healthcare professional, or ‘oppositions’ to dental hygiene, and demonstrates that there are some with obstacles. As in other areas of the dentist-patient relationship, an equality is proposed. So a dentist’s pressure may mirrors a patient’s anxiety; worries about fee amounts could be reciprocal; both people may be operated on by time pressures. Significant attention is paid on dental professionals to the truth of undue pressure as well as the chance for reducing this by the strategies indicated.

Systems are offered by the writer for running successful interviews, for recognising avoidance behaviors as well as for distinguishing between just concerned and phobic patients. The patient summarizes the COURSE framework (Context, Listening, Acknowledgement,Strategy, Outline) extensively utilized in medicine for successful communicating. The patient reminds readers of the classic ‘Tell-Show-Do’ approach.

The chain additionally points out that whilst dentists consider dental symptoms patients experience those symptoms within their particular societal and emotional circumstance. Comprehending this enables more powerful help. A teenager who starts to resist the ‘well-being directed’ conduct of cleaning to keep gum health, may react to the ‘health related’ advantage of fresh breath. It is a good example of a ‘commonsense’ approach, but exemplifies and conceptualises why and the way that it works. Subscribers of the show will not become unable to determine other uses described that may apply for their particular day-to-day practice.

The writer examines the three-man treatment alliance when a young child is the patient that has to be invented. The occurrence is described in which stress will generate behavior feature. Knowledge with this helps it be more easy for the professional to make a proper reply. The result of beliefs and the parent’s own anxieties should be taken into consideration. That is debated in the post entitled ‘The Case for the Mom in the Operation’.

One post varies lay and professional perspectives. Patients vary broadly in translating the existence of oral symptoms to gain access to care into activity. Lay and professional perspectives are generally most extensive in defining the importance of treatment. Comprehending this mismatch is important in the event the unmet oral health needs of these who merely attend within an emergency must be supplied.

It’s been extensively found that unsatisfactory results are produced by just giving health guidance. The claim is created for using the motivational interviewing technique although clear regarding the restraints that time and fee amounts may impose upon professionals. This can be combined using the ‘Phases of Change’ model which identifies periods of preparation or contemplation to act. While making it clear that some means of supplying advice is important, this section looks at how patients can form a powerful and equality-established alliance for change using their dental professionals.

Through the entire show the writer reveals knowledge of the risk of’ burnout’ in dentists that are overstressed. The long-term advantage of the string may be treatment alliances with patients who’ve become responsible for their particular dental well-being through less filled and more rewarding encounters for both parties.

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Australian Dental Hospitals

In Dental Hospitals on December 2, 2013 by Dr Gregory Lloyds

If superficiallyAustralian dental hospitals could be described as a cottage industry of over 1100 separate facilities with nearly 100 000 beds dotted over the continent, closer scrutiny might suggest otherwise. Their apparently random distribution, sometimes long distances from each other, at other times a street apart, the variations in ownership and control, the great differences in size and in function, might all suggest an inchoate industry totally lacking the benefits to be derived from concentrated large-scale operation, centralized control, national planning, and orderly distribution. Yet such a judgement, while containing significant elements of truth, would be at the same time a distorted representation of the industry. For all that its origins lie in a ‘nationalized’ system of hospital care at the time of white settlement, admittedly for practical rather than ideological reasons, today’s Australian dental hospital industry is pluralist in nature and represents the interests of a disparate series of groups. As might be surmised, one of the features of such a system is a certain degree of confusion when the question of categorization arises with the outcome depending largely on who is making the judgement and the criteria being used. The broad picture is set out below, notwithstanding definitional niceties.

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Drugs Which May Precipitate Emergencies in Dental Practice

In Drugs in Dental Practice on September 26, 2013 by Dr Gregory Lloyds

drugs in dental practiceThe most frequently used drugs in dentistry are local anaesthetics, either plain or in combination with a vasoconstrictor. Their side effects are likely to be the cause of many of the emergencies encountered by dentists. Certain precautions should always be taken when they are used. Below are listed the toxic manifestations of each agent, but it should be remembered that some of the effects of the base will be masked by the vasoconstrictor.

In practice it would seem that the commonest side effects seen are those due to adrenaline or nor-adrenaline. If the warning signs associate: with these toxic effects are not appreciated and administration ceased, there I is a high risk that the patient will collapse.

Adverse and toxic effects are determined by:

  1. Concentration and volume of solution.
  2. Rate of injection.
  3. Toxicity of agent.
  4. Presence or absence of vasoconstrictors.
  5. Physical status of the patient and his or her current drug therapy.

The major cause of systemic reactions is a high blood level of local anaesthetic base or vasoconstrictor. The aim must be to use the smallest volume of lowest concentration to achieve satisfactory anaesthesia.

In order to avoid these effects, the following precautions should be taken:

Patient History

An adequate patient history should be taken. Certain diseases or the concurrent use of some drugs accentuate the undesirable side effects of adrenaline or nor-adrenaline.

Their use is absolutely contra-indicated in the following conditions:

1. Sensitivity to catecholamines.
2. Thyrotoxicosis  – Their use is also contra-indicated where the patient is receiving the following drugs:
2.1. Sympathomimetic agents
2.2. Tricyclic antidepressant drugs, MAOI inhibitors.
2.3. Certain general anaesthetic agents (halothane, chloroform, trichlorethylene).

In these conditions felypressin (octapressin) is a safe alternative vasoconstrictor to adrenaline and nor-adrenaline, and may be used in circumstances where adverse reaction to these drugs is anticipated. Felypressin is the vasoconstrictor of choice should one be required in patients with cardiovascular disease and hypertension.

Aspiration Prior to Injection

Aspiration should always be performed prior to injection of any local anaesthetic solution. The toxic effect of both local anaesthetic and vasoconstrictor are increased where they are injected intravenously, so aspiration should always be performed prior to injection.

Inadvertent intravenous injection may occur not only with mandibular and maxillary block injections, but also in infiltration of both facial and palatal sites. An adequate aspirating syringe with a needle no finer than 26 gauge should be used for all injections and at least 2 seconds should be allowed for the aspiration.

Rate of Injection

Injections should be undertaken slowly, ideally at the rate of 1 mL per 30 seconds, to minimise possible toxic effects. Patients in the Sutherland Shire should be monitored for toxic effects which may occur occasionally at relatively low doses in susceptible persons.

Dose

Local Anaesthetic  – The maximum dose of local anaesthetic base should be calculated from the weight of the patient particularly in infants and children. The maximum dose will depend on whether the local anaesthetic is plain or has vasoconstrictor added, as the latter will lessen the rate of absorption of the base.

Catecholamines - Clinically effective vasoconstriction for dental anaesthesia can be obtained with concentration in the range of 1:300 000 (3.3 ug/mL) adrenaline to 1:100 000 (10.0 ug/mL), and in order to minimise toxic effects the lowest effective concentration should be used. Where adrenaline is used a concentration of 1:80 000 (12.5 ug/mL) should not be exceeded and where nor-adrenaline is used a maximum of1:50 000 (20.0 ug/mL) is suggested.

Sedatives, Hypnotics and Analgesics

Sedative – A drug which allays apprehension, but does not produce analgesia.
Hypnotic – A drug which induces sleep, but does not produce analgesia.
Analgesic – A drug which reduces the patient’s perception of pain.
The response to hypnotic drugs is dose dependent and many hypnotics given in small doses will act as sedatives. Long-continued use of depressant drugs produces tolerance to the psychic effects of sedative drugs. Caution is always needed because metabolic disturbances or drug interaction may lead to depression of respiration which may, in turn, permit respiratory obstruction and respiratory failure as well as circulatory depression. As well as the specific sedatives and hypnotics, all tranquillisers, some antihypertensive drugs, antidepressant and antihistamines may have sedation as a side effect.

Pain Relief

Unless pain is first controlled by analgesics or narcotics, the administration of sedatives will cause restlessness.

Pain may be controlled by:

  1. Analgesic drugs.
  2. Narcotics, which may induce sleep as well as relieve pain.
  3. General anaesthesia, which implies freedom from pain, produced by rendering the patient unconscious. Analgesics may be administered orally, by injection or by inhalation. They may be divided into two groups:
    1. Mild analgesics which act peripherally.
    2. Potent analgesics which exert a depressing action on the central nervous system.

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Allergies in Dentistry

In Allergies on September 19, 2013 by Dr Gregory Lloyds

Manifestations : Allergic reaction or ‘collapse’ following administration of drugs, especially penicillin.
Drug Therapy : Antihistamines, corticosteroids.
Dangers : Anaphylaxis.

allergies in dentistrySometimes the body responds to the entry of a foreign substance by the formation of a specific antibody. This antibody circulates in the blood and lodges in various organs. When the response is controlled and to the patient’s benefit, it is called immunization and the antibody neutralizes the foreign substance. A small number of people form an unusual antibody that produces undesirable effects while the foreign substance is in the process of naturalization. These people are allergic or hypersensitive and the undesirable effects are called allergy.
Anaphylaxis is the acute allergic reaction which usually follows the administration of a drug by injection; in its most severe form it is life threatening.
The signs of an acute allergic reaction are:

  1. Itching and prickling sensations and the appearance of hives, weals and blotches.
  2. An asthma-like attack with wheezing and cyanosis.
  3. A serious fall of blood pressure, called anaphylactic shock.
  4. Unconsciousness and cardiorespiratory arrest.
  5. Swelling of the mouth, tongue and throat.

Anaphylaxis may appear in seconds or minutes depending on the rate of absorption of the drug from the site of injection. Serum sickness is the delayed allergic reaction. It occurs days or weeks after the injection and it consists of fever, rashes, painful joints and swelling of the lymph glands. Serum sickness is not a life-threatening reaction.

Unfortunately the term allergy is often used loosely to cover any undesirable reaction to a drug. However, in practice, toxic effects, side effects and idiosyncrasy are more frequent. The pharmacological actions of a drug other than those for which it is administered are called side effects. For example, pethidine is used to relieve pain but it also depresses respiration and causes nausea; the latter are side effects. Some patients get exaggerated pharmacological reactions and they are said to have idiosyncrasy, e.g. prolonged, severe vomiting after pethidine. Toxic effects occur when a drug enters the bloodstream in a high concentration as the result of overdosage or inadvertent intravenous injection, e.g. unconsciousness and respiratory arrest after an injection of pethidine.

Patients sometimes say that they ‘collapsed’ during an operation or an anesthetic. It is essential to find out the exact cause by contacting the surgeon or the anesthetist personally. A history of eczema, hay fever and asthma is a warning that the patient has an allergic diathesis. Specific questions should be asked about reactions to drugs, particularly antibiotics, barbiturates and narcotics. Patients must not be exposed to a drug if a past allergic reaction is suspected – alternative medication is always available. Test doses are unreliable and dangerous and it is impossible to suppress allergic responses with certainty by pre-treatment with corticosteroids or antihistamines.

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Managing the Patient with Musculo-Skeletal Disease

In Musculo-Skeletal on September 11, 2013 by Dr Gregory Lloyds

Manifestations  : Paralysis or weakness of muscles. Deformity and rigidity of joints.
Drug Therapy : Corticosteroids for rheumatoid arthritis.
Dangers  : If affecting the chest, throat or mouth.

dental patients respiratoryDiseases of the musculo-skeletal system are unlikely to influence the course of surgery unless they affect the chest, throat and mouth. In these vital areas, paralysis, deformity or rigidity may cause serious respiratory difficulty. Fortunately this is rare, but it may be encountered in myasthenia gravis, the muscular dystrophies and advanced ankylosing spondylitis.

In some of the rarer myopathies – usually, but not invariably, those associated with a family history – malignant hyperpyrexia may follow general anaesthesia.

Corticosteroids are used in the treatment of rheumatoid arthritis.

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Liver Disease and Dental Management

In Dental Patient Diseases, Liver Disease on September 6, 2013 by Dr Gregory Lloyds Tagged:

Manifestations  : Cirrhosis, disorders of hydration and coagulation.
Drug Therapy  : Diuretics, corticosteroids.
Dangers  : Hepatitis B. Reduced ability to detoxify sedatives, narcotics, local anaesthetics.

patients with liver diseaseChronic disease of the liver is called cirrhosis. The commonest cause is the prolonged, excessive intake of alcohol but it occasionally follows longstanding hepatitis. In decompensated cirrhosis, fluid accumulates in the abdomen and in dependent parts of the body. The patient complains of weakness, abdominal discomfort and puffy ankles. In acute liver disease the skin and eyes are jaundiced.

Intensive treatment of cirrhosis with diuretics can lead to dehydration and a tendency to syncope. A severely damaged liver fails to synthesise coagulation factors normally and this leads to a bleeding tendency; also, it fails to detoxify many drugs, including sedatives, narcotics and some local anaesthetics, but this is not usually a problem in dental practice.

Some patients with liver disease carry the virus of hepatitis B and some may be having treatment with corticosteroids.

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