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Biomedical subjects

D A Haas

Publications and source records attributed to D A Haas.

At least 19 recordsLinked to original sources
PubMed2005

Need and demand for sedation or general anesthesia in dentistry: a national survey of the Canadian population.

The aim of this study was to assess the need and demand for sedation or general anesthesia (GA) for dentistry in the Canadian adult population. A national telephone survey of 1101 Canadians found that 9.8% were somewhat afraid of dental treatment, with another 5.5% having a high level of fear. Fear or anxiety was the reason why 7.6% had ever missed, cancelled, or avoided a dental appointment. Of those with high fear, 49.2% had avoided a dental appointment at some point because of fear or anxiety as opposed to only 5.2% from the no or low fear group. Regarding demand, 12.4% were definitely interested in sedation or GA for their dentistry and 42.3% were interested depending on cost. Of those with high fear, 31.1% were definitely interested, with 54.1% interested depending on cost. In a hypothetical situation where endodontics was required because of a severe toothache, 12.7% reported high fear. This decreased to 5.4% if sedation or GA were available. For this procedure, 20.4% were definitely interested in sedation or GA, and another 46.1% were interested depending on cost. The prevalence of, and preference for, sedation or GA was assessed for specific dental procedures. The proportion of the population with a preference for sedation or GA was 7.2% for cleaning, 18% for fillings or crowns, 54.7% for endodontics, 68.2% for periodontal surgery, and 46.5% for extraction. For each procedure, the proportion expressing a preference for sedation or GA was significantly greater than the proportion having received treatment with sedation or GA (P < 0.001). In conclusion, this study demonstrates that there is significant need and demand for sedation and GA in the Canadian adult population.

Adolescent↗
PubMed2001

Local anesthesia does not block mustard-oil-induced temporomandibular inflammation.

UNLABELLED: Temporomandibular joint (TMJ) disorders and rheumatoid arthritis are two conditions in which neurogenic mechanisms may play a critical role. We investigated the neurogenic contribution underlying acute TMJ inflammation by evaluating effects of local anesthetic blockade of afferent innervation on the development of mustard oil (MO)-induced edema in the rat TMJ area. Groups of eight adult male Sprague-Dawley rats were anesthetized by intraperitoneal alpha-chloralose and urethane. A saline injection into the right TMJ followed by MO (1% to 60%) 6 min later elicited dose-dependent edema development (P < 0.05, repeated measures analysis of variance). Lidocaine (5%) or bupivacaine (0.5%) followed by MO (1% or 40%) did not produce edema development different from saline controls (P > 0.05, repeated measures analysis of variance). The failure of local anesthetic blockade to prevent MO-induced edema is not consistent with MO acting through a neurogenic mechanism, as traditionally perceived. IMPLICATIONS: Inflammation found in temporomandibular disorders and rheumatoid arthritis may result from mediators released by pain-sensing neurons. Local anesthesia failed to block simulated neurogenic temporomandibular inflammation in a rat model, suggesting that functional neuronal input may not be necessary for the promotion of inflammation.

Anesthetics, Local↗
PubMed1999

Adverse drug interactions in dental practice. Professional and educational implications.

BACKGROUND: Rapid progress in dental pharmacotherapeutics requires that clinicians constantly update their knowledge of new drugs, drug interactions and useful therapeutic trends. This article is the first in a five-part series based on a 1998 International Association for Dental Research symposium entitled "Adverse Drug Interactions in Dentistry: Separating the Myths From the Facts." The goal of the series is to identify specific adverse drug interactions that are relevant to the therapeutic agents commonly used in general dental practice: analgesics, antibiotics, sedatives, local anesthetics and vasoconstrictors. METHODS: A group of dentist/clinical pharmacologists, with documented expertise in specific areas of dental therapeutics, reviewed the current literature regarding adverse drug interactions in dentistry. This expert panel evaluated the quality of information used to document these drug interactions and assess the severity of these drug reactions with respect to the drugs' use in dental practice. RESULTS: On the basis of the quality and severity of each reported interaction, the authors summarized the clinical importance of these drug interactions using a Significance Rating for Dental Drug Interactions. The participants presented their recommendations at the above-mentioned IADR symposium. CONCLUSIONS: Although thousands of drug interactions are described in the literature, the authors found many to be poorly documented or of minor importance to dental practitioners. For interactions that they determined to be relevant, the participants provided recommendations and precautions for preventing these potential complications. This article discusses the professional impact of drug interactions on dental practice; the classification and documentation of drug interactions; the determination of causality between drug interactions and adverse effects; risk factors; and unique characteristics of dental therapeutics. Subsequent articles will present specific summary recommendations for drug interactions associated with the use of antibiotics, analgesics, sedatives, and local anesthetics and vasoconstrictors. CLINICAL IMPLICATIONS: Although thousands of drug interactions have been reported in the literature, only a few are significantly associated with dental therapeutic agents. Avoiding these drug interactions will prevent potentially severe reactions in dental practice.

Adverse Drug Reaction Reporting Systems↗
PubMed1999

Adverse drug interactions in dental practice: interactions associated with analgesics, Part III in a series.

BACKGROUND: Numerous reports of drug interactions exist, yet not all are valid in or pertinent to dentistry. This article provides an overview of drug interactions with analgesics and identifies those that are clinically relevant. METHODS: The author reviewed reports of drug interactions involving nonsteroidal anti-inflammatory drugs, or NSAIDs (including aspirin), acetaminophen and opioids to determine the interactions' validity and clinical relevance. Consistent with the practice followed in other articles in this series, the author determined the significance of the proposed interaction by gauging its reported severity and the quality of the documentation. RESULTS AND CONCLUSIONS: NSAIDs should not be taken by patients taking high-dose methotrexate, anticoagulants or alcohol. They should be avoided in elderly or renally impaired patients taking digoxin, and avoided over the long term in those taking other NSAIDs. It is possible that NSAIDs should not be given to patients taking lithium, but future studies should be conducted to confirm this. Use of NSAIDs likely is appropriate in the short term with patients taking antihypertensives, unless they have severe congestive heart disease. Aspirin should not be given to patients taking oral hypoglycemics, valproic acid or carbonic anhydrase inhibitors. Acetaminophen may be given in the short term to any patient with a healthy liver, but it should not be given to a patient who has stopped drinking alcohol after chronic intake. Opioids should not be combined with alcohol, and meperidine must be avoided in the patient who has taken monoamine oxidase inhibitors in the previous 14 days. CLINICAL IMPLICATIONS: Drug interactions with analgesics are often reported, but only a small number have clinical relevance in dentistry. Awareness of the significance of these interactions will allow dentists to prescribe analgesics optimally and minimize the potential for adverse reactions.

Acetaminophen↗
PubMed1999

Oral and inhalation conscious sedation.

Many patients can benefit by having dental procedures carried out with conscious sedation administered by the oral or inhalation routes. Dentists who employ these techniques must be familiar with the pharmacology of the agents selected, cognizant of the risks and benefits of the technique employed, and able to manage adverse events that may arise with its use. Careful patient selection and prudent administration of one of the drugs described here is the basis for successful use of these techniques.

Administration, Inhalation↗
PubMed1999

A comparison of certain practice characteristics of dental anesthesiologists in Canada and the United States.

An existing database was used to compare aspects of dental anesthesiology practice of dental anesthesiologists in Canada (n = 32) and the United States (n = 123). Data focusing on percutaneous injuries were obtained through a mailed questionnaire that was returned anonymously. Respondents provided information on the treatment of patients under deep sedation or general anesthesia only. Eighty-one percent of Canadians and 61% of Americans returned the questionnaire. The vast majority (84%) of injuries reported were due to sharps associated with general dentistry compared with those associated with anesthesiology. Canadians were more likely to be operator-anesthetists (P < .01) and to experience a percutaneous injury (P < .01) than US practitioners. American practitioners were more likely to have a greater proportion of the caseload under the age of 20 (P < .02). No other significant differences were observed. These results illustrate a number of unique attributes of the practice of dental anesthesiology in these 2 countries.

Anesthesia, Dental↗
PubMed1999

The occupational risk to dental anesthesiologists of acquiring 3 bloodborne pathogens.

OBJECTIVE: To estimate the occupational risk to dental anesthesiologists of contracting 3 bloodborne pathogens: hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV). METHODS: Through an anonymously returned, mailed questionnaire, dental anesthesiologists in Canada and the United States provided information regarding percutaneous and mucocutaneous contacts with contaminated fluid during the treatment of patients under deep sedation and general anesthesia as well as other general practice information. A mathematical model was applied to determine the occupational risk. RESULTS: Of the 101 (65%) returned questionnaires, 98 reported having treated patients within the previous 6 months. Of these, 41 (42%) had at least one percutaneous accident (89 accidents in total), and the projected mean annual injury rate for dental anesthesiologists overall was 1.82. The most common causes of injury were burs, intraoral needles, and dental instruments. Operator error during use was associated with 31% of reported accidents. Significantly more injuries were reported by those who also reported a mucocutaneous contact and by those working more than 25 hours per week. The projected mean annual number of mucocutaneous exposures was 0.88 for dental anesthesiologists overall. CONCLUSIONS: The calculated annual risk to the average dental anesthesiologist of acquiring HBV (if not immune), HCV, and HIV following percutaneous injury was very low for all infections (HBV the most; HIV the least). The risk of contracting HIV following mucocutaneous contact was extremely low.

Anesthesia, Dental↗
PubMed1998

Radiographic localization of mandibular anesthesia landmarks.

The objective of this study was to assess whether bony landmarks used for the standard inferior alveolar nerve block can be used to accurately determine the position of the mandibular foramen and whether panoramic radiographs are appropriate for this purpose. A total of 11 landmarks from 79 panoramic radiographs and 70 corresponding cases of oblique (45-degree) cephalometric radiographs were examined. Ten measurements of the distance from each landmark to the mandibular foramen, as well as 6 ratios from these distances, were calculated from all radiographs. The results showed that the position of the mandibular foramen was highly individualistic and not consistently related to traditional clinical landmarks. Panoramic radiographs were as good as oblique cephalometric radiographs for the locating of the mandibular foramen. No age or gender correlations were found. It was concluded that the mandibular foramen can be localized in panoramic radiographs but that its relation to bony landmarks is highly variable.

Adolescent↗
PubMed1998

Localized complications from local anesthesia.

The inherent safety of local anesthetics allows practitioners to use them frequently with the confidence that adverse events are rare. Nevertheless, complications can occur. The aim of this article is to briefly review the localized adverse events that may result from local anesthetic administration. Descriptions of each complication will be followed by suggestions for prevention and management. In spite of a dentist's conscientious practice, many of these complications cannot always be prevented.

Anesthesia, Dental↗
PubMed1997

Mortality incidence in outpatient anesthesia for dentistry in Ontario.

Studies determining anesthesia mortality rates in dentistry have been published, yet a similar investigation has never been conducted in Canada. Therefore the objective of this study was to determine the incidence of mortality when general anesthesia or deep sedation was administered by qualified dentists in the province of Ontario. Mortality data were obtained from the years 1973 to 1995 inclusive. The number of general anesthetics and deep sedations administered annually by qualified in dental offices was calculated by surveying all oral and maxillofacial surgeons and dental anesthetists in Ontario in 1990 and 1995. The results provided an estimate of 2,830,000 cases from 1973 to 1995 inclusive. Over this time period there were four deaths associated with cases in which either an oral and maxillofacial surgeon or dental anesthetist administered the general anesthetic or deep sedation, yielding a mortality rate of 1.4 per 1,000,000. This mortality incidence is similar to rates already published for outpatient dentistry.

Adult↗
PubMed1997

Local and systemic therapeutics for the control of endodontic pain.

Endodontic pain is best managed by eliminating the source as completely as possible. When it is determined that drugs are required, judicious use of local anesthetics and nonopioid analgesics can be beneficial and provide the first course of action. When it is determined that the pain will not be managed by these measures alone, the addition of an opioid analgesic may be considered with the understanding that more adverse side effects attend their use.

Analgesics↗
PubMed1997

The efficacy of nonopioid analgesics for postoperative dental pain: a meta-analysis.

The evidence for the efficacy of nonopioid analgesics in the dental pain model was examined by conducting a meta-analysis. Studies were obtained by searching the literature from August 1996 back to 1975 using the terms pain, analgesics, and dentistry. This led to the review of 294 articles, of which 33 studies met the inclusion criteria. Pain scale results were transformed into a common percent scale and converted to N-weighted means with differences in efficacy considered significant using a 95% confidence interval. Collectively, therapeutic doses of the nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used in dentistry were significantly more efficacious than the combination of acetaminophen (600 or 650 mg) with codeine (60 mg). Similarly, specific doses of each of diflunisal, flurbiprofen, ibuprofen, and ketorolac were significantly more efficacious than the commonly used acetaminophen-codeine combination. These quantitative results show that particular NSAIDs may be more efficacious than the acetaminophen-codeine combination for relief of postoperative dental pain.

Acetaminophen↗
PubMed1997

Stability of parenteral midazolam in an oral formulation.

Midazolam is increasingly being used for oral sedation in pediatric dentistry. Unfortunately, it is available only as a parenteral formulation in Canada and the United States. Preparation of the parenteral solution for oral use is not uniform and leads the clinician to question the stability of this drug when used in conjunction with these vehicles. Therefore, the purpose of this study was to investigate the chemical stability of parenteral midazolam as an oral formulation to determine its expiry date. This was evaluated using a validated stability-indicating liquid chromatographic method. Midazolam was diluted in orange-flavored syrup to yield concentrations of 0.35, 0.64, and 1.03 mg/ml and then stored at room temperature. Samples were drawn on each of 9 study days (0, 1, 2, 6, 7, 9, 13, 21, and 102) and chromatographed. On each study day, solutions were inspected visually for changes in color, clarity, and appearance of particulate matter. Midazolam concentrations were considered within acceptable limits if they were not less than 90% of the initial concentration. Over the 102-day study period, there was no significant change in concentration in any of the solutions. On day 102, the remaining midazolam was within 7% of the day zero concentration. Therefore, these formulations of midazolam are stable at room temperature for a period of 102 days and would be suitable for clinical use.

Administration, Oral↗
PubMed1996

A pilot study of the efficacy of oral midazolam for sedation in pediatric dental patients.

Oral midazolam is being used for conscious sedation in dentistry with little documentation assessing its efficacy. In order to accumulate preliminary data, a randomized, double-blind, controlled, crossover, multi-site pilot study was conducted. The objective was to determine if 0.6 mg/kg of oral midazolam was an equally effective or superior means of achieving conscious sedation in the uncooperative pediatric dental patient, compared with a commonly used agent, 50 mg/kg of oral chloral hydrate. Twenty-three children in three clinics who required dentistry with local anesthetic and were determined to exhibit behavior rated as "negative" or "definitely negative" based on the Frankl scale were assessed. They were evaluated with respect to acceptance of medication; initial level of anxiety at each appointment; level of sedation prior to and acceptance of local anesthetic; movement and crying during the procedure; and overall behavior. The results showed that the group randomly assigned to receive midazolam had a significantly greater initial level of anxiety for that appointment (P < 0.02), a finding that could clearly confound further determination of the efficacy of these drugs. Patients given oral midazolam had an increased level of sedation prior to the administration of local anesthetic compared with those given chloral hydrate (P < 0.015). No statistically significant differences were noted in any of the other parameters. The age of the patient was found to have no correlation with the difference in overall behavior (r = -0.09). These preliminary data warrant further clinical trials.

Administration, Oral↗
PubMed1995

Pharmacologic considerations in the management of temporomandibular disorders.

The management of patients with temporomandibular disorders may involve the use of a number of modalities, including pharmacotherapy. This manuscript provides an overview of the pharmacology of agents currently employed for this purpose, with an emphasis on the major drug group used, the non-steroidal anti-inflammatory drugs (NSAIDs). A brief discussion of opioid analgesics, tricyclic antidepressants, muscle relaxants, benzodiazepines, steroids, and local anaesthetics is also included, and guidelines for their use are suggested.

Analgesics, Opioid↗
PubMed1995

Local anesthetic use by dentists in Ontario.

A mail survey to obtain data on the annual use of local anesthetics in dentistry was sent to each of the 6,271 certified dentists in Ontario in 1993. The survey asked dentists to identify the different types and total amounts of local anesthetics used in their practice yearly. A total of 2,426 dentists responded to the survey. Based on extrapolation of the data collected, it is estimated that more than 11,000,000 cartridges of local anesthetic are administered annually by dentists in Ontario. The distribution of use of specific types of local anesthetics and vasoconstrictors was also determined. Lidocaine with 1:100,000 epinephrine accounted for 23.4 per cent of all cartridges used, followed by articaine with 1:200,000 epinephrine (19.9 per cent), articaine with 1:100,000 epinephrine (17.9 per cent), prilocaine with 1:200,000 epinephrine (16.4 per cent), mepivacaine with 1:20,000 levonordefrin (6.4 per cent), and mepivacaine plain (6.3 per cent). Other anesthetics were used to a lesser degree. Further analysis revealed no statistically-significant differences in the use of local anesthetics among dentists who responded to the survey and non-responders. The results of this survey document the current use of local anesthetics in dentistry.

Anesthesia, Dental↗
PubMed1995

A 21 year retrospective study of reports of paresthesia following local anesthetic administration.

A retrospective study of paresthesia following the injection of local anesthetic in dentistry was conducted by examining every report of paresthesia recorded by Ontario's Professional Liability Program from 1973 to 1993, inclusive. Only those cases where surgery was not conducted were considered in this study. The parameters examined included patient age and gender, needle gauge, site of injection, area affected, report of pain or any additional symptoms, and the type of local anesthetic used. From 1973 to 1993, there were 143 reports of paresthesia not associated with surgery. There were no significant differences found with respect to patient age, patient gender, or needle gauge. All reports involved anesthesia of the mandibular arch, with the tongue most frequently reported to be symptomatic, followed by the lip. Pain was reported in 22 per cent of the cases. Paresthesia was reported most often following the injection of articaine and prilocaine. In 1993 alone, there were 14 reports of paresthesia not associated with surgery. This can be projected to an incidence of 1:785,000 injections. Articaine was administered in 10 of these cases or prilocaine in the other four. The observed frequencies of paresthesia following the administration of articaine (p < 0.002) or prilocaine (p < 0.025) were significantly greater than the expected frequencies for these agents, based on the distribution of local anesthetic use in Ontario in 1993. These results are consistent with the suggestion that local anesthetic formulations may have the potential for mild neurotoxicity. Further studies are needed to investigate the mechanisms for this, and to determine whether similar findings would be found elsewhere.

Adult↗