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Biomedical subjects

S P Zusman

Publications and source records attributed to S P Zusman.

At least 19 recordsLinked to original sources
PubMed2003

Oral health and treatment needs of institutionalized chronic psychiatric patients in Israel.

The aim of the study was to examine the oral health and treatment needs of chronically hospitalized psychiatric patients in Israel. Ten percent of the patients hospitalized for more than 2 years in the 18 psychiatric institutions in Israel were selected at random. The dental status (DMF-T index) was calculated, demographic and medical data were retrieved from the files. Of the 431 patients examined (250 men, 181 women, average age 54 years) 312 patients had only partial natural dentition. The average DMF-T score was 26.74 (out of 32), one of the highest in the literature. The caries component accounted for 2.3% of the DMF-T, the missing teeth component 72% and the restored teeth component 5%. There was an adverse correlation between age and caries and between duration of hospitalization and number of teeth. The average number of carious and missing teeth was higher than in the healthy population. No all-edentulous patients had dentures. These findings confirm the urgent need for an intervention program to improve dental health care in high-risk, difficult-to-treat, psychiatric chronic inpatients.

Adolescent↗
PubMed2002

[Emergencies evolving from local anesthesia].

Local anesthesia is without doubt the most frequently used drug in dentistry and in medicine. In spite of records of safety set by using these drugs, there is evidence to adverse reactions ranging from 2.5%-11%. Most of the reactions originate from the autonomic system. A recent, well-planned study indicates that adverse reactions are highly correlated to the medical status of the patient: the higher the medical risk, the greater the chance to experience an adverse reaction. This study also found that adverse reactions highly correlated to the concentration of adrenalin. Another recent study found a direct relationship between adverse reactions and the level of anxiety experienced by the patient and to the dental procedure. Most of the reactions in this study occurred either immediately at injection time and within 2 hours following the injection. Since the beginning of last century, vasoconstrictors have been added to local anesthesia solutions in order to reduce toxicity and prologue activity of the LA. However, today it is commonly agreed that this addition to local anesthesia should not be administered to cardiac patients especially those suffering from refractory dysrhythmias, angina pectoris, post myocardial infarction (6 months) and uncontrolled hypertension. Other contraindications to vasoconstrictors are endocrine disorders such as hyperthyroidism, hyperfunction of the medullary adrenal (pheochromocytoma) and uncontrolled diabetes mellitus. Cross reactivity of local anesthetic solutions can occur with MAO inhibitors, non specific beta adrenergic blockers, tricyclic antidepressants, phenothiazides and cocaine abusers. Noradrenaline added to local anesthetics as a vasoconstrictor has been described as a trigger to a great increase in blood pressure and therefore has been forbidden for use in many countries. This paper describes 4 cases of severe complications following the injections of local anesthesia of which three ended in fatality.

Anesthesia, Dental↗
PubMed2002

[Syncope in the dental environment].

Syncope or Fainting is, by far, the most common emergency situation in the dental practice. Syncope is defined as an abrupt, transient, short term loss of consciousness and postural tone, followed by spontaneous and complete recovery. The pathophysiology of syncope consists of a sudden cessation or decrease in cerebral perfusion. Differential diagnosis of these medical conditions is of paramount importance in uncovering unrecognized systemic diseases. The dental team plays an important role in the process of establishing the correct diagnosis by its ability to recognize and document all the clinical symptoms and signs evident at the time of fainting. The dental surgeon is expected to be familiar with the various etiologies of syncope and should be able to differentiate between them. This article provides the essentials of the diagnostic procedure and an approach to the evaluation of the unconscious patient.

Dental Care↗
PubMed2002

[Respiratory distress].

Dental treatment is usually conducted in the oral cavity and in very close proximity to the upper respiratory airway. The possibility of unintentionally compromising this airway is high in the dental environment. The accumulation of fluid (water or blood) near to the upper respiratory airway or the loosening of teeth fragmentations and fallen dental instruments can occur. Also, some of the drugs prescribed in the dental practice are central nervous system depressants and some are direct respiratory drive depressors. For this reason, awareness of the respiratory status of the dental patient is of paramount importance. This article focuses on several of the more common causes of respiratory distress, including airway obstruction, hyperventilation, asthma, bronchospasm, pulmonary edema, pulmonary embolism and cardiac insufficiency. The common denominator to all these conditions described here is that in most instances the patient is conscious. Therefore, on the one hand, valuable information can be retrieved from the patient making diagnosis easier than when the patient is unconscious. On the other hand, the conscious patient is under extreme apprehension and stress under such situations. Respiratory depression which occurs during conscious sedation or following narcotic analgesic medication will not be dealt with in this article. Advanced pain and anxiety control techniques such as conscious sedation and general anesthesia should be confined only to operators who undergo special extended training.

Central Nervous System Depressants↗
PubMed2002

[Chest pains in the dental environment].

Chest pain does not necessarily indicate cardiac disease. The most common causes of acute chest pain encountered in dental situations include hyperventilation, pulmonary embolism, angina pectoris and myocardial infarction. Stress and fear often cause rapid breathing or hyperventilation. This usually occurs in young adults and although the hyperventilating patient often complains of chest pain, this is rarely a manifestation of cardiac disease. Pulmonary embolism usually indicates the occlusion of a pulmonary artery causing severe chest pain. The primary clinical manifestation of angina pectoris is chest pain. Although most instances of anginal pain are easily terminated, the dentist must always consider the possibility that the supposed anginal attack is actually a sign of acute myocardial infarction (AMI). AMI is a clinical syndrome caused by a deficient coronary arterial blood supply to a region of myocardium that results in cellular death. There is a high incidence of mortality among AMI with death often occurring within 2 hours of the onset of signs and symptoms. The initial clinical manifestations of all types of chest pain can be similar. Therefore the dentist must develop proficiency in constituting a differential diagnosis and an efficient management protocol. As in most medical situations prevention is the most powerful tool. However, if chest pains do occur, measures such as airway management, oxygen supplementation, coronary artery dilation, analgesis and in extreme cases, cardiopulmonary resuscitation and evacuation to the emergency room, may be necessary.

Adult↗
PubMed2002

[Allergy-related emergencies].

Allergic reactions can develop to any of the drugs or materials commonly used in dentistry. They exhibit a broad range of clinical signs and symptoms ranging from mild, delayed reactions to immediate and life-threatening reactions developing within seconds. Allergies usually manifest themselves in reactions that are related to histamine release in one of three ways: skin reactions, respiratory problems and anaphylaxis. Anaphylaxis is the most critical allergic reaction in the dental environment. Measures such as airway management, oxygen supplementation, antihistamine, adrenaline and corticosteroid medication, cardiopulmonary resuscitation and evacuation to the emergency room, may be necessary.

Dental Materials↗
PubMed2002

[The potential dangers of endocrinal disorders].

The symptoms of most endocrine system diseases are usually clearly recognizable and most of the times are accompanied by a rich medical history. Many general practitioners are reluctant to treat such cases and prefer to refer these patients to specialists who are trained in management of the medically compromised thus increasing the chances of dental treatment without complications. However, sometimes endocrinal diseases develop slowly and their clinical manifestations are hidden or subclinical in nature. In these cases, neither the patient nor the dentist are aware of the condition and there is the potential of life threatening, emergency situations in what at first seem as simple, straightforward dental procedures. Therefore, the dentist must be able to recognize the clinical problem, differentiate between the different symptoms and initiate the proper management protocol. The most unstable endocrinal disorders that should be treated with great care are diabetes mellitus, mainly hypoglycemia, hyperthyroidism and adrenal insufficiency. The general practitioner dentist can treat patients suffering from these disorders providing the disease is well controlled and balanced and that the dental treatment is not very traumatic.

Adrenal Insufficiency↗
PubMed2002

[Legal and ethical considerations of emergencies in the dental office].

The dentist has the ethical and legal responsibility to anticipate emergency situations in correlation with the patient's medical status. He has the obligation to do all in his power to prevent emergencies from happening and to be prepared to manage any emergency that might occur. This article also discusses the importance of monitoring and documentation.

Dental Care for Chronically Ill↗
PubMed2002

[Saliva secretion and oral health in a hospitalized geriatric population in Israel].

Saliva secretion decreases with age, although not regarded as caused solely by age. The decrease is associated among others, with diseases and medications. The aim of the study was to assess saliva secretion, dentition and oral pathologies in a hospitalized geriatric population in a genera hospital. The secretion was measured by 2 methods: saliva collection at rest and sugar cube test. 125 patients agreed to participate, with an average age of 75. They had an average of 6 diagnoses, and took 6 medications. They had 6 teeth in average, with 52% edentulous. Salivary excretion was found to be 15% low according to the saliva secretion and According to the sugar cube test, 20% suffer from xerostomia. However, no statistically significant correlations were found to age, medications, diagnoses, or number of teeth. The study population was hospitalised for short term in a general hospital, and quickly returned to the community. Therefore, we can conclude that salivary excretion is low in the geriatric population in the community, especially among those who suffer from illnesses, who need short terms hospitalization. The health care personnel should be aware of this situation and recommend saliva substitutes and stimulants.

Age Factors↗
PubMed2001

[Patient satisfaction, quality indicators and utilization of dental services in Israel].

Lack of dental data induced JDC-Brookdale Institute to undertake a wide scope research in the general population. The present paper is part of this research and its main objective is to pinpoint differences in accessibility, availability and quality of services by service type. The sampling basis was the Israeli population over 22 years of age. Data was gathered by telephone interviews during March-May 1998. In Kupot Holim clinics, the proportion of people reporting presence of auxiliary personnel (RDH, DSA, etc.) was highest as well as those reporting that the dentist explained their problem and the treatment. In the Kupot clinics, the waiting time to receive an appointment is longest, while in public clinics the waiting time in the clinic is the longest. However, the waiting time in the Kupot clinic till treatment is received is shortest. The findings show that satisfaction with dentists attitude (81%), order and cleanliness in the Kupot clinics (90%) is highest, compared to private (79% and 78% accordingly) and public (55% and 46% accordingly) clinics. When overall satisfaction with the dentist was requested, highest proportion that gave 'very good mark was in private and kibbutz clinics (63% and 67% accordingly), compared to kupot clinics (49%) public clinics (55%) and to company/commercial clinics (43%). It is pertinent to mention that price is regarded as high among patients of kupot clinics than in private clinics. The findings of the research imply that in a competitive market, such as the dental market, providers that want to survive have to adjust their practices to the patients expectations. This means providing more explanations of their medical problem and its treatment. Waiting time in public clinics should be shortened, and furthermore, geographical distribution should be improved.

Adult↗
PubMed1999

Immediate complications of local anesthetic administered to 1,007 consecutive patients.

BACKGROUND: Probably the most common procedure in dentistry is the administration of local anesthetic, or LA. Immediate complications of LA administration include positive blood aspiration, blanching of the tissue and burning sensation on impingement of the nerve. Because studies about the immediate complications of LA administration were conducted before 1980, more recent data regarding this procedure are needed. MATERIALS AND METHODS: In this prospective study, an experienced dentist administered, 2,528 LA injections to 1,007 consecutive patients with 1-inch 27-gauge needles, using a solution of 2 percent lidocaine and 1:100,000 nordefrine hydrochloride. RESULTS: The authors observed positive blood aspiration in 73 injections (2.9 percent) without any further complications. The most severe immediate complication-syncope-occurred only in one case. In 63 injections (2.5 percent), the dentist touched the nerve, and the patient reported feeling an electric current sensation (40 times with inferior alveolar nerve blocks, 18 times with lingual nerve blocks, four times with mental nerve blocks and one time with a second injection to the same site) without any further complications. CONCLUSIONS: The results confirm that LA injections that are properly carried out appear to be safer today than they were in the past. CLINICAL IMPLICATIONS: LA is a safe procedure when the appropriate technique is used. It is even safer when an inferior alveolar nerve block is administered.

Adolescent↗
PubMed1999

The prevalence and treatment of dental caries among Israeli permanent force military personnel.

A survey was conducted to determine dental caries prevalence and treatment among 1,095 25- to 44-year-old permanent force Israeli military personnel. Caries experience, by decayed, missing, and filled permanent teeth (DMFT), was 11.66, with an average of 1.37 untreated caries, 2.40 extracted teeth, and 7.90 treated teeth. Caries was positively associated with age (p < 0.001). Females demonstrated statistically higher DMFT levels than males (p = 0.009). Negative associations were detected for education levels and untreated and extracted components (p < 0.001), and a positive association was detected for the treated caries component (p < 0.001). Permanent military personnel treated by private dentists exhibited 17.6% untreated caries, compared with 9.4% among personnel treated in the army. Officers had lower levels of untreated caries (8.6%) than others (13.3%). Among the present population, 77% had attended a dental clinic in the preceding 2 years. Permanent force personnel are offered free, comprehensive, and accessible dental treatment. The data emphasize a need for further dental health education.

Adult↗
PubMed1995

Changes in caries prevalence in Ashkelon, Israel, children 1980-1994.

During the 14 years from 1980 to 1994, a marked reduction in caries prevalence was noted in Ashkelon. In the 7-year-old age group, the percentage of caries free children increased from 21 per cent to 29 per cent and the dmft dropped from 3.5 to 2.7. In the 13-year-old group there was also a marked improvement. The percentage of caries free children increased by 16 per cent (from 30 per cent to 35 per cent) with a marked reduction in the DMFT, from 2.3 to 1.9. The DT component halved from 1.8 to 0.9, with a marked rise in the FT component from 0.4 to 1.1. There is less decay and much less untreated dental decay in Ashkelon today than in 1980.

Adolescent↗
PubMed1994

Planning oral health care for the elderly in Israel for the years 2000 and 2025.

The methodology and conclusions of this workshop are reported here because the problems requiring solution are not unique to Israel. They will increasingly have wide geographical and political application. The population of Israel since its establishment in 1948 has increased about sixfold. The numbers of the elderly (65+) have increased about tenfold. The current situation must be examined and estimates obtained for the next ten years. Only thus can the system be enabled to cope with the problem as it develops. The chosen method was a carefully preplanned, multisectorial workshop. Recommendations were discussed, amended and finalised. The recommendations of the workshop included: Baseline national data is urgently required. Guidelines are required for selecting specific target populations to which priority should be given. The current favourable situation of adequate oral health manpower in Israel makes it possible to encourage providers of oral health care towards treatment for the elderly. It is essential that the appropriate health authorities allocate sufficient funds for the following urgent purposes: the conduct of a national survey of the elderly population; the establishment of oral health units on a trial basis in some selected hospitals; support institutions of higher education to facilitate training in geriatric dentistry. CONCLUSIONS. The workshop was multidisciplinary because it was necessary to include all the expertise and experience available as vital elements of the policy making process. This type of workshop was found to be an effective tool for planning oral health services.

Aged↗
PubMed1994

Pharmacists as members of the healthcare team in Israel: sectoral differences.

OBJECTIVE: To examine the sectoral differences among Israeli pharmacists regarding their perception of actual versus desired contact with other members of the healthcare team, and measures necessary to achieve a closer working relationship among members. DESIGN, SETTING, AND PARTICIPANTS: Pharmacists from private, community, and hospital sectors (n = 145) completed a survey that assessed their respective views of the current and future roles of the pharmacist as a member of the healthcare team. MAIN OUTCOME MEASURES: Common to pharmacists in all three sectors is their aspiration for greater cooperation among members of the healthcare team, especially with physicians. Intersectoral differences were found in their attitude toward their role in the healthcare team: hospital pharmacists would like a better relationship with patients, private pharmacists would like closer ties with physicians, and community pharmacists would like better teamwork with the nurse. No sectoral differences were seen in how pharmacists see themselves as members of the clinical healthcare team. Only 12 percent believe they have adequate knowledge to advise on clinical pharmacotherapy. To perform this function, they indicated that more training in pharmacotherapy would be needed (98.6 percent of respondents), as well as joint courses with medical students (84.2 percent), and a modification of their internship period requiring them to work in each of the different practice sectors (73.4 percent). No sectoral differences were observed regarding the benefits of a more active role of the pharmacist in the healthcare team. CONCLUSIONS: One possible explanation for Israeli pharmacists' low professional self-image, despite the rewards of the profession, is that they lack the necessary clinical knowledge that would enable them to take a more active role in the healthcare team. Pharmacists' job satisfaction may improve if a more active advisory role in the healthcare team can be achieved.

Adult↗
PubMed1993

Cost evaluation of two methods of post tooth extraction hemostasis in patients on anticoagulant therapy.

The classical management of patients on oral anticoagulant therapy included hospitalisation, cessation of the anticoagulant agent, and extraction of teeth when the prothrombine levels rise. This method was substituted in the High Risk Dental Clinic at Barzilai Medical Center in Ashkelon by use of a tissue sealant (Tisseel) which does not need hospitalisation nor cessation of the anticoagulant therapy. In comparing the last 23 sessions employing the former method to the first 23 sessions using the new method there were significant differences in the cost effectiveness for the health system, provider, insurer and patient. Despite the fact that from the health system point of view the new method is much more cost effective, there is no financial incentive for the provider (hospital) nor awareness on the part of the insurer (General Sick Fund) to embrace it and 'market' it.

Ambulatory Care↗
PubMed1992

Dental caries and its determinants among recent immigrants from rural Ethiopia.

Adults (35-45 yr old) and children (5 and 12 yr old) recently arrived in Israel from rural areas in Ethiopia were examined. Caries levels were low: e.g. DMFT = 0.31 among 12-yr-olds, and 1.27 amongst adults. The 5-yr-olds were 86.8% caries-free, while 12-yr-olds were 81.8% and adults 54% caries-free respectively. According to interview data, the diet in Ethiopia had been based on local agricultural products and was almost sugar-free. The mean total count of salivary bacteria, as determined on blood agar, was 3.4 x 10(8); mean count of Streptococcus viridans, on mitis salivarius, was 6.7 x 10(7); and mean count of S. mutans, as determined on mitis salivarius with bacitracin, was 1.7 x 10(7). These levels were all high and were not significantly different from a control group of 20 Israelis. The mean number of lactobacilli, on Rogosa agar, was 2.75 x 10(4), which was significantly higher than among the controls (3.6 x 10(3). Salivary pH levels were generally similar between the Ethiopian group and the controls. Salivary flow was significantly higher for the Ethiopians (1.93 ml/min) than for controls (1.16 ml/min). Low levels of caries in this population can be attributed to an almost sugar-free diet and high salivary flow, but not to the composition of oral microflora.

Adult↗