The measurement of blood pressure and pulse rate prior to, during and after exodontia was conducted on 60 healthy patients. The aims were to first, investigate the changes in blood pressure and pulse rate, and second, to observe the presence of any clinically significant change over time. Thirty patients attending an Oral Medicine Clinic were used as the control group to allow a comparison to be made between the effects of exodontia and non-invasive treatment. The results suggested that exodontia was the most stressful part of the procedure. Bradycardia during local analgesia was also noted. These changes in the cardiovascular parameters may represent a risk to patients with heart diseases especially those previously undiagnosed. Further, the results indicate the effect stress can have on the cardiovascular system and the importance of eliminating pain and minimizing patient anxiety.
Higher concentration dental local anaesthetics (3% and 4%) have become more available in Australia in recent years. Benefits claimed include a faster onset of anaesthesia and improved success with injections compared to 2% solutions. Recent reports suggest that the higher concentration carries a greater risk of prolonged anaesthesia to the mandibular and particularly the lingual nerves. The literature was reviewed and those studies which demonstrated adverse effects of different concentrations of local anaesthetics were analysed. Recent cases are presented. There is an extensive international literature which confirms increased concentration of local anaesthetic does show an increased risk, by about ·6, of prolonged anaesthesia. Five case reports illustrate the impact of this complication on patients' quality of life. Careful consideration needs to be given before using higher concentration local anaesthetic agents for mandibular and lingual blocks as lower concentration local anaesthetics are safer. If acceptable to individual patients, avoidance of block injections or any local anaesthetic for minor restorative tasks could be encouraged given the severity of the complication. It is safe to use the higher concentration agents for infiltrations away from major nerves.
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An unusual case of root resorption in a mandibular second molar is presented. The literature is reviewed briefly and possible explanations of the pathogenesis are discussed.
The Diploma in Clinical Dentistry (Conscious Sedation and Pain Control) of the Faculty of Dentistry, University of Sydney, is the first dedicated programme devoted to this field in Australia. Its development followed a decision by the Dental Board of New South Wales to require a formal qualification from the University of Sydney before dental practitioners could offer sedation and pain management in practice. The programme is conducted at Westmead Hospital in conjunction with the Department of Anaesthetics, and satisfies the guidelines developed by the Royal Australasian College of Dental Surgeons and the Royal Australasian College of Surgeons. The course is conducted either over one or two years, with block sessions requiring attendance at Westmead Hospital, together with assignments which are completed outside the block sessions. In this way, a dental practitioner enrolled in the programme is able to continue practice. The block sessions need not be completed over one year, but must be completed within two years.
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