Hypersensitivity to the constituents of dental amalgam is uncommon. When it occurs it typically manifests itself as a lichenoid reaction involving a delayed, type IV, cell-mediated hypersensitivity response. Rarely, a more acute and generalised response can occur involving both the oral mucosa and skin. We describe two cases that illustrate the presentation and management of these two types of reaction.
Miconazole oral gel is frequently prescribed for the treatment of oral Candidal infections. Its ability to be systemically absorbed and interact with other drugs has previously been recorded but is not universally known. As a reminder, a further case of derangement of anticoagulation following concomitant use of warfarin and miconazole is reported. Other potential drug interactions of miconazole and fluconazole are highlighted.
The aim of this study was to develop, and assess the inter-observer reliability of an instrument for evaluating dental students' communication skills. Methods used were process-tracking of interactions between experienced practitioners and patients, development of the instrument and its simultaneous use by two researchers observing 43 third year dental students prior to communication skills training. The results found that the instrument was appropriate for the purpose for which it was designed, and was easy to utilise. There were no significant differences between observers' total scores. Item-specific weighted kappa scores showed almost perfect agreement between observers for all but four of the 31 items. The lowest interobserver weighted kappa score was for the measurement of eye contact (k = 0.60). In conclusion, assessment of communication skills is now a necessity in the undergraduate curriculum. Preliminary analysis of an instrument of communication skills in the dental surgery indicates that it may be possible to do this reliably.
Objective To examine the current practice of antifungal prescribing by GDPs in the United Kingdom. Design A postal questionnaire circulated to a random selection of 400 dentists. Outcome measures The questionnaires were analysed and the responses expressed as absolute and relative frequencies. Results Responses to the questionnaire were received from 297 (74.3%) GDPs. Nystatin was the most popular choice of antifungal agent that GDPs would use, followed by miconazole, amphotericin B and fluconazole. The likelihood of use of miconazole was positively linked to recent date of graduation. Lack of knowledge regarding contraindications and problems with azole antibiotics was found in a significant minority of practitioners (36%). Conclusions The present study indicates that azole antifungal agents (especially miconazole) are becoming more widely used by GDPs, but that knowledge regarding potential problems with their use is suboptimal. Nystatin remains the most popular choice of antifungal agent.Much attention has been focused on the prescribing of antibiotics recently. Such interest has largely examined antibacterial prescribing but there has been less work examining antifungal prescribing. Given that there is increasing evidence of Candida species becoming resistant to some antifungal agents, particularly the azole group, 1 it is timely to examine the current prescribing habits in general dental practice.Lewis et al. 2 investigated the prescribing of antibiotics by general dental practitioners (GDPs) in the United Kingdom in 1987. Since that study, newer azole antifungals, namely fluconazole, have become available in general dental practice. However, the azoles, unlike the polyene antifungals, are absorbed from the gastrointestinal tract and thus have the potential for interactions with other drugs. They also have the potential to be hepatotoxic. Over the last few years four antifungal drugs in a number of formulations, have been available for GDPs to prescribe under NHS regulations. 3 Nysatin is available as pastilles, suspension and ointment for extra-oral use on the skin, while amphotericin is only available in lozenges and suspension for intra-oral use. Miconazole is available as an oral gel as well as an ointment and cream (combined with 1% hydrocortisone) for use on the skin. Fluconazole capsules and suspension are available for oral/systemic use.The aim of the present study was to establish the types and formulations of antifungal agents prescribed by a cross section of general dental practitioners during 1999/2000. We wanted to examine if prescribing habits were influenced by the time since graduation and the possession of postgraduate qualifications. Also, we wished to examine the awareness of practitioners regarding contraindications to, and problems with azole antifungals.
MATERIALS AND METHODSThe postal addresses of dental practitioners were obtained from the 1999 UK Dental Register. An initial total of 400 practitioners were selected by choosing every 74th entry in the register. Each of these dentists ...
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