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Biomedical subjects

Arthur H Jeske

Publications and source records attributed to Arthur H Jeske.

14 recordsLinked to original sources
PubMed2006

Migraine drug therapy: dental implications.

Triptan drugs continue to constitute the major pharmacotherapeutic interventional agents for migraine therapy. Interactions of dental drugs with migraine medications are limited, but their seriousness dictates that dentists be aware of the use of ergot alkaloids, triptans, or other migraine drugs. While many migraine sufferers avoid dental therapy dur ing migraine attacks, the practitioner who is treating a patient who has taken migraine medications must carefully monitor the cardiovascular status of the patient, which may affect the use of vasoconstrictors. Macrolide antibiotics and azole antifungals represent additional drug groups that are prescribed by dentists but which may potentiate the adverse effects of migraine drugs. Migraine patients prefer agents that offer rapid onset of relief and total relief within a couple hours of drug administration; they also prefer therapy that prevents recurrences and does not require "rescue" medications, and, of course, a lack of adverse effects and interactions with other medications. Currently, no single drug or class of drugs offers this ideal combination of actions in all patients.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Drug therapy for smoking cessation: evidence-based considerations for dentistry.

Meta analyses and systematic reviews reported to date provide substantial scientific support for certain forms of pharmacotherapy in smoking cessation. Less information is available on pharmacotherapy for intervention in other forms of tobacco abuse (i.e., spit tobacco). Prior to recommendation or prescription of nicotine replacements and/or prescription of bupropion, the dentist must recognize that drug therapy alone is not appropriate to assist patients in smoking cessation. However, when combined with appropriate behavioral interventions and a demonstrated willingness of the patient to quit tobacco use, drug therapy is a valuable adjunctive service.

Antidepressive Agents, Second-Generation↗
PubMed2005

Prescription opioid abuse: dental perspectives.

Drug abuse and diversion of controlled substances prescribed by dentists will continue to be an important issue in the overall management of dental pain, and must be recognized by the dentist. If suggested guidelines, regulations, and laws are observed, the associated problems for the dentist and the entire dental team and their patients can be minimized. Pain control is an essential service and duty for dentists, and the appropriate selection and use of analgesics affords this service with the best safety and efficacy.

Analgesics, Opioid↗
PubMed2004

Noninvasive assessment of diffusion hypoxia following administration of nitrous oxide-oxygen.

The phenomenon of diffusion hypoxia is commonly believed to occur unless nitrous oxide-oxygen inhalation sedation is followed by "washout" with 100% oxygen for 5 minutes upon termination of the flow of nitrous oxide. When systematically studied, however, this phenomenon generally appears to be unfounded. The present study evaluated the effect of breathing room air instead of 100% oxygen in healthy (ASA 1) human volunteers following administration of sedative concentrations of nitrous oxide. The occurrence of hypoxia was determined objectively, using pulse oximetry and a standardized psychomotor skills test (Trieger test). Diffusion hypoxia was not observed using these criteria.

Air↗
PubMed2003

Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment.

BACKGROUND: There is a widespread belief among dental practitioners and physicians that oral anticoagulation therapy in which patients receive drugs such as warfarin sodium must be discontinued before dental treatment to prevent serious hemorrhagic complications, especially during and after surgical procedures. OVERVIEW: The authors examine the scientific basis for properly managing the dosage of anticoagulants for dental patients who are receiving anticoagulation therapy. The authors review the appropriate laboratory test values to which dentists should refer when evaluating for dental treatment patients who are receiving anticoagulation therapy. The authors also review clinical studies, published within the past five years, that focus on the frequency and degree of hemorrhagic and related complications among dental patients who are receiving anticoagulation therapy orally to prevent thromboembolic events. CONCLUSIONS AND CLINICAL IMPLICATIONS: The scientific literature does not support routine discontinuation of oral anticoagulation therapy for dental patients. Use of warfarin sodium as it relates to dental or oral surgical procedures has been well-studied. Some dental studies of antiplatelet therapy are consistent with the findings in warfarin sodium studies. Dental therapy for patients with medical conditions requiring anticoagulation or antiplatelet therapy must provide for potential excess bleeding. Routine discontinuation of these drugs before dental care, however, can place these patients at unnecessary medical risk. The coagulation status--based on the International Normalized Ratio--of patients who are taking these medications must be evaluated before invasive dental procedures are performed. Any changes in anticoagulant therapy must be undertaken in collaboration with the patient's prescribing physician.

Administration, Oral↗
PubMed2003

Dental local anesthetics: alternative delivery methods.

BACKGROUND: The authors review four techniques for producing block and topical anesthesia that have been advocated as alternatives to conventional methods. The objective of this review is to examine the basis for each method's application in dentistry, including scientific studies where available. TYPES OF STUDIES REVIEWED: The authors reviewed both historical (1912 and 1923) and more recent (1977 to present) reports relating to specific local anesthetic delivery systems. While this article is not a comprehensive literature review, the clinical reports and double-blind scientific reports from peer-reviewed publications are specific to the various attributes of the delivery systems being described. In addition, the authors identify any claims lacking scientific validity. RESULTS: Several alternative local anesthetic delivery systems are clinically effective in producing local anesthesia. Potential adverse effects and complications do, however, differ from one technology to another, depending on the mechanical characteristics of the particular system. Finally, all of the alternative local anesthetic delivery systems represent additional costs when compared with those of conventional applications, and cost-effectiveness is an important factor to be considered when implementing these systems in a dental practice. CLINICAL IMPLICATIONS: Alternative local anesthetic delivery systems may offer some advantages over conventional techniques in certain situations, although the costs may outweigh the advantages in certain cases.

Administration, Topical↗
PubMed2003

The key to profound local anesthesia: neuroanatomy.

BACKGROUND: To achieve profound dental local anesthesia, it is necessary for the dentist to have a thorough knowledge of the details of sensory innervation to the maxilla and mandible. Since the early 1970s, dentistry has experienced a resurgence of interest in the neuroanatomical basis of local anesthesia, resulting in numerous scientific reports on the subject. OVERVIEW: Current studies afford a more detailed knowledge of the branching of various divisions of the trigeminal nerve, the great sensory nerve of the head region. In this article, the authors provide an update of the peripheral distribution of the trigeminal nerve to enhance induction of safe and effective dental local anesthesia. CONCLUSIONS AND PRACTICAL IMPLICATIONS: An understanding of the potential variations in innervation should help the dentist improve his or her ability to induce profound local anesthesia.

Anesthesia, Dental↗
PubMed2003

Avoiding complications in local anesthesia induction: anatomical considerations.

BACKGROUND: Dentists administer thousands of local anesthetic injections every day with few reports of serious complications. However, misjudging the anatomy involved during local anesthetic administration can result not only in inadequate or incomplete anesthesia, but in other complications such as paresthesia, bleeding or hematoma formation, or in serious systemic complications. OVERVIEW: The authors discuss anatomical considerations that dentists should keep in mind when administering local anesthetic injections. In particular, they discuss ways in which dentists can minimize the risk of nerve or vascular injury, as well as systemic complications. CONCLUSIONS AND CLINICAL IMPLICATIONS: Even the most experienced practitioner can benefit from a periodic review of the anatomy associated with local anesthesia. This article offers dentists the opportunity to consider needle placement with regard to location of nerves, blood vessels and glands, and to review injection protocols that can minimize the risk of complications.

Anesthesia, Dental↗
PubMed2003

Local anesthetics: special considerations in endodontics.

Local anesthetics are essential for successful endodontic treatment, and their pharmacologic characteristics have special implications for the treatment of painful, chronically-inflamed or necrotic teeth. Their dosages must be limited to prevent toxicity, which may be enhanced by the coadministration of sedative agents or drugs which affect hepatic drug metabolism. Endodontic patients with established central and peripheral sensitization represent special challenges for pain control, since morphogenetic changes resulting from neurogenic inflammation can render pain fibers more resistant to local anesthesia. The use of vasconstrictors with conventional and alternative injection techniques, e.g., intraosseous injections, are necessary to prolong the duration of action of local anesthesia but can place patients with cardiovascular disease at some risk. An appreciation of all of these aspects of local anesthesia in endodontics will better prepare the operator for predictably safe and effective patient care.

Amides↗
PubMed2003

Local anesthetics: special considerations in endodontics.

Local anesthetics are essential for successful endodontic treatment, and their pharmacologic characteristics have special implications for the treatment of painful, chronically-inflamed or necrotic teeth. Their dosages must be limited to prevent toxicity, which may be enhanced by the coadministration of sedative agents or drugs which affect hepatic drug metabolism. Endodontic patients with established central and peripheral sensitization represent special challenges for pain control, since morphogenetic changes resulting from neurogenic inflammation can render pain fibers more resistant to local anesthesia. The use of vasconstrictors with conventional and alternative injection techniques, e.g., intraosseous injections, are necessary to prolong the duration of action of local anesthesia but can place patients with cardiovascular disease at some risk. An appreciation of all of these aspects of local anesthesia in endodontics will better prepare the operator for predictably safe and effective patient care.

Anesthetics, Local↗
PubMed2002

Selecting new drugs for pain control: evidence-based decisions or clinical impressions?

BACKGROUND: Selecting drugs for pain control in dentistry should be based on scientific research rather than clinical impressions. This article highlights the scientific attributes of analgesic medications that make them practical for treating postoperative dental pain. METHODS: This article is based on a review of the general characteristics of double-blind, controlled clinical studies compared with clinical observation in dental practice. The literature reviewed included all recent published clinical studies in refereed journals pertinent to the use of rofecoxib, a selective cyclo-oxygenase-2, or COX-2, inhibitor, in treating postoperative dental pain. The author focuses on some pharmacokinetic parameters of this agent as they compare with those of nonselective COX-2 inhibitors used to control dental pain. (The other selective COX-2 inhibitors, celecoxib and valdecoxib, do not carry label indications for short-term management of postoperative pain.) RESULTS: The findings of this literature review show that the COX-2-selective inhibitor rofecoxib is no more effective than conventional, nonselective, nonsteroidal anti-inflammatory drugs, or NSAIDs, for the relief of postoperative dental pain. Rofecoxib does, however, have the disadvantage of requiring rescue medication from a different class of drugs in a significant number of patients. CONCLUSIONS: The currently available COX-2-selective inhibitors do not replace conventional NSAIDs for the short-term treatment of postoperative dental pain. However, they are useful for treating chronic pain conditions because they produce fewer adverse effects when taken long-term than do conventional NSAIDs. CLINICAL IMPLICATIONS: Selecting drugs for the short-term relief of postoperative dental pain should be based on a careful assessment of all relevant pharmacological characteristics of a given agent, especially those related to maximum dosage, duration of action and efficacy.

Acute Disease↗