The Doctor's Channel - Dentistry

Pre-op smoking cessation improves head and neck surgery outcomes

2009-06-18T13:40:26+01:00

NEW YORK (Reuters Health) - Even a short period of 4 to 8 weeks of smoking cessation prior to surgery to treat upper aerodigestive tract squamous cell carcinoma improves wound healing, according to a review of the literature. If the patient stays tobacco-free, the risk of cancer recurrence is substantially reduced.

However, full cessation is required -- simply reducing the quantity of cigarettes smoked per day is of little benefit, Dr. Richard O. Wein from Tufts Medical Center, Boston, reports in the June Archives of Otolaryngology—Head and Neck Surgery.

Studies within the field of otolaryngology of the impact of smoking cessation on surgical outcomes are few and contradictory, Dr. Wein points out. For his review, he drew on studies of smokers operated on for non-otolaryngology conditions as well as for head and neck tumors.

The “bottom line,” he says, is that “although conflicting reports exist within the literature concerning the impact of short-term smoking cessation, it should be noted that the sheer number of articles reporting the negative impact of continued tobacco use on postoperative pulmonary function and wound healing far outweighs those minimizing this impact.”

Furthermore, multiple studies indicate increased risk of recurrence or the development of a second cancer in patients who continue to smoke after their index cancers are diagnosed. One study, for example, found that 40% of patients who kept smoking after being treated definitively for a malignant oral cavity tumor had a recurrence or developed a second malignant lesion.

Overall costs of care, the author notes, are considerable compared with those of individuals with an adequate period of preoperative cessation.

Unfortunately, patients with a diagnosis of a head and neck cancer usually don’t have the luxury of taking 2 months to stop smoking before surgery is imperative, Dr. Wein notes.

“In these scenarios,” he concludes, “although the impact of short-term (less than 2 weeks) preoperative smoking cessation on the immediate post-operative course may be modest, the long-term cardiopulmonary benefits and the potential decrease in the development of future smoking-related neoplasia with sustained cessation are undeniable.”

Reference:
Arch Otolaryngol Head Neck Surg 2009;135:597-601.

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Proper oral hygiene may cut risk of pneumonia in critically ill patients

2009-06-08T14:07:24+01:00

NEW YORK (Reuters Health) – New research shows that oropharyngeal cleansing with chlorhexidine solution is no better than a control solution of potassium permanganate in preventing nosocomial pneumonia in critically ill patients. However, the regular maintenance of “meticulous” oral hygiene does provide a benefit, the findings suggest.

There is clear evidence that oral cleansing with chlorhexidine can help stave off nosocomial pneumonia after heart surgery, Dr. Dilip R. Karnad, from Seth GS Medical College, Mumbai, and colleagues note. By contrast, the benefit of this intervention in critically ill patients is unclear.

The current study, reported in the May issue of Chest, featured 512 patients who were randomized to receive twice-daily oropharyngeal cleansing with 0.2% chlorhexidine or with the control solution.

The rate of nosocomial pneumonia during the ICU stay was 7.1% in the chlorhexidine group, not significantly lower than the 7.7% rate seen in the control group.

The median day of development of pneumonia was identical in each group: 5.0 days. Likewise, the chlorhexidine and control groups had similar median ICU stays (5.0 vs. 6.0 days) and mortality rates (34.8% vs. 28.3%).

Despite these null findings, oropharyngeal cleansing did seem to be beneficial. During the study, the nosocomial pneumonia rate was 7.4%, whereas the rate in the 3 months before and following the study was 21.7% (p < 0.001; RR = 0.34).

“Meticulous oral cleansing seems to decrease the risk of the development of pneumonia regardless of the content of the solution used for this purpose,” the authors write.

“More studies using a higher concentration of chlorhexidine are required to establish the role of routine antiseptic oral cleansing in ICU patients,” they add.

Reference:
Chest 2009;135:1150-1156.

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International Foundation for Oral Design

2009-05-28T18:25:14+01:00

Jason J. Kim, CDT, Master Ceramist, Oral Design Member, Clinical Assistant Professor at New York University College of Dentistry, discusses the International Foundation for Oral Design and its role in sharing information amongst colleagues worldwide to ultimately improve techniques and practice.

References and Resources:
Oral Design International.

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Dental Aesthetics

1970-01-01T01:00:00+01:00

Jason J. Kim, CDT, Master Ceramist, Oral Design Member, Clinical Assistant Professor at New York University College of Dentistry, discusses the importance in today's dentistry of ceramic design concept in restructuring teeth.

His ?Blueprint for Predictable Aesthetics? and ?Restorative Space Management? approaches have been instrumental in ensuring predictable and consistent results through a standardized operating procedure.

Jason J. Kim is the Founder and President of JK Dental Laboratory Services, Inc, and is President of the Oral Design Center in New York.

For more information on Jason Kim, please visit:
JK Dental Laboratory Services

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Using Zirconia in Dental Ceramics

2009-05-13T11:59:39+01:00

Jason J. Kim, CDT, discusses building first class ceramic dental preparations with zirconia. His “Blueprint for Predictable Aesthetics” and “Restorative Space Management” approaches have been instrumental in ensuring predictable and consistent results through a standardized operating procedure.

Jason J. Kim is the Founder and President of JK Dental Laboratory Services, Inc, and is President of the Oral Design Center in New York.

For more information on Jason Kim, please visit:
JK Dental Laboratory Services

Views: 1485
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GENTLEray

2009-04-07T16:37:23+01:00

Scott Hammond of KaVo Dental, describes the new GENTLEray laser with built-in features such as micropulse technology, which helps the healing process.

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Rotadent prescription toothbrush

2009-03-18T17:48:12+00:00

Missy Cornell of Zila Pharmaceuticals describes the Rotadent prescription microfilament toothbrush, which was designed by dental hygienists and is particularly useful for orthodontic patients.

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Increase Patient Education with Telephone on Hold

2009-03-18T14:59:42+00:00

Justin Ginsberg discusses a customized on-hold telephone marketing service for dental and other offices, which provides the caller with some patient education as well as marketing material while they are waiting.

Telephoneonhold.com

Smileonhold.com

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DIAGNOdent Caries Detector

2009-03-18T14:14:22+00:00

Scott Hammond of KaVo Dental, discusses the DIAGNOdent Caries Detector device, which is designed to find early dental decay before it is detectable on an x-ray or with a sharp explorer. It uses a low-powered, two-way laser to measure the fluorescence of bacteria.

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Waterlase Dentistry

2009-03-18T13:47:35+00:00

Howard S. Golan, DDS, a dentist in private practice in Long Island, NY, discusses the relatively new technique of waterlase dentistry, which uses water and laser energy to cut teeth. This technique is painless and currently used by around 3-4% of dentists in the US.

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