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Clinical problem solving in dentistry by E W Odell

25 February 2017 adminDentistry

By E W Odell

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Sample text

History of complaint She first noticed the dry mouth about 4 or 5 years ago though it may have been present for longer. At first it was only an intermittent problem but over the last 3 years or so the dryness has become constant. Recently the mouth has become sore as well as dry. Medical history The patient describes herself as generally fit and well but has had to attend her medical practitioner for poor circulation in her fingers. They blanch rapidly in the cold and are painful on rewarming. She has also used artificial tears for dry eyes for the last 2 years but takes no other medication.

Stimulate residual salivary flow using chewing gum (sugar-free). — Consider using pilocarpine in severe cases (though side-effects and an appropriate dosing regimen can be problematic). • Prevent and treat dental caries — Avoid sweets or overuse of citrus fruit to stimulate salivary flow. — Appropriate dietary analysis, preventive advice and fluoride treatment. — Treat caries. • Consider using saliva substitutes though these are generally unsatisfactory and not liked by patients. — Carboxymethyl-cellulose and similar starch-based liquids.

In practice this is most likely to affect patients under general anaesthesia or sedation. However, individuals with Down’s syndrome also have poor muscle tone so that the joint is not fully stable even when conscious. Simply ensuring head support, including lateral support, is sufficient. 2 Categories of learning difficulty Learning difficulty/ disability Indicative IQ Effects Mild 50–70 Most can lead normal lives but may need assistance in handling difficult situations Moderate 35–49 Need to use simple language when talking.

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