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Biomedical subjects

A H Friedlander

Publications and source records attributed to A H Friedlander.

At least 37 records · Page 2Linked to original sources
PubMed1994

Panoramic dental radiography as an aid in detecting patients at risk for stroke.

PURPOSE: Atherosclerotic lesions in the region of the bifurcation of the common carotid artery and in the internal carotid artery are the most common cause of stroke. On occasion these lesions are calcified and visible on a panoramic dental radiograph. METHODS: Six subjects receiving outpatient dental treatment and denying a history of previous transient ischemic attacks or stroke had bilateral calcified carotid arterial lesions noted on their routine panoramic dental radiograph. RESULTS: Electronic thermography (ET) demonstrated that these patients had significant temperature differences bilaterally between their medial supraorbital region and the ipsilateral remainder of their forehead when compared with control subjects. These findings are consistent with the presence of calcified stenotic intraluminal plaques altering blood flow, tissue perfusion, and skin temperature readings. The presence of stenotic plaques was verified by Doppler spectral analysis and imaging. CONCLUSION: ET of the face, currently considered an investigational procedure, demonstrates promise as an ancillary imaging system capable of confirming the diagnosis of patients at risk of stroke. Such individuals should be referred to an appropriate physician for consideration of medications and/or surgical removal of the plaque. In selected individuals, these are safe and relatively reliable methods of preventing stroke.

Aged↗
PubMed1994

Pathogenesis and prevention of native valve infective endocarditis in elderly dental patients.

Elderly dental patients are at risk of developing infective endocarditis. Increased longevity is associated with an increased prevalence of cardiac valvular disease and impairment of the immune system. Aortic stenosis commonly occurs in persons between 60 and 75 years of age. Degenerative calcification of the mitral valve ring leading to valve incompetency often develops in those over age 70 years. Men over the age of 60 years with mitral valve prolapse and systolic hypertension are at risk of infective endocarditis because the excessive haemodynamic load placed upon the abnormal valve causes extensive stretching of cusps and loss of valve surface endothelium. Dental procedures, that result in mucosal or gingival bleeding (most notably dental extractions, periodontal probing, scaling and surgery, endodontics and restorative procedures which extend below the gingival line), frequently produce a bacteraemia. Anaerobic strains of bacteria are isolated twice as frequently as aerobic strains. Antibiotic prophylaxis decreases the level of bacteraemia, prevents adherence of bacteria to the damaged valvular epithelium and suppresses the growth of those microbes that manage to adhere to the valve. The standard prophylactic regimen consists of amoxicillin 3g 1 hour before the dental procedure, then 1.5g 6 hours after the initial dose. Erythromycin is a good alternative for penicillin-allergic patients. Topical chlorhexidine 5 minutes before initiating dental therapy reduces the bacterial inoculum and the likelihood of endocarditis.

Aged↗
PubMed1992

Dental treatment of patients with Gilles de la Tourette's syndrome.

Gilles de la Tourette's syndrome, a familial neurologic disorder with onset in early life, is characterized by chronic intermittent motor and vocal tics. Many of the orofacial tics and compulsive behaviors seen in this disorder may cause destructive oral lesions. The medications used in treating the syndrome may adversely interact with dental therapeutic agents, frequently cause hyposalivation associated with the development of dental caries and periodontal disease, and may produce tardive dyskinesia with buccolingual choreiform movements. The oral signs and symptoms associated with the syndrome are reviewed, and modifications in dental treatment on the basis of the patient's behavioral alterations, and current drug therapy are suggested.

Bruxism↗
PubMed1992

Pseudocysts of the mandibular condyle.

The panoramic radiographs of 507 consecutive patients receiving comprehensive dental treatment were evaluated for the presence of radiolucencies in the mandibular condyles. Nine patients met the study criteria. Five patients had bilateral and four patients had unilateral circumscribed radiolucencies in the anterior aspect of the condyle. Computerized tomography confirmed that these radiolucencies were age-related anatomic variants that were accentuated and distorted during panoramic radiography.

Adult↗
PubMed1991

Dental management of the patient with major depression.

Major depression is a psychiatric disorder in which mood, thought content, and behavioral patterns are impaired for long periods of time. It is a common disorder, with an increasing prevalence among young adults. It may be associated with a disinterest in performing appropriate preventive oral hygiene techniques, a cariogenic diet, diminished salivary flow, rampant dental decay, advanced periodontal disease, and oral dysesthesias. Many medications used to treat the disease magnify the xerostomia and increase the incidence of dental disease. Appropriate dental management necessitates a vigorous preventive dental education program, the use of saliva substitutes and anticaries agents containing fluoride, and special precautions when prescribing or administering analgesics and local anesthetics.

Anesthesia, Dental↗
PubMed1990

Polymyalgia rheumatica and temporal arteritis.

Polymyalgia rheumatica and temporal arteritis are separate but overlapping rheumatic diseases commonly seen among elderly persons. Polymyalgia rheumatica is characterized by upper body and trunk myalgias/arthralgias and an elevation in erythrocyte sedimentation rate. In about half of patients, temporal arteritis begins after polymyalgia rheumatica. Temporal arteritis is a systemic granulomatous disease that predominantly affects branches of the carotid artery. Claudication of the muscles of mastication and a painful burning tongue may develop during temporal arteritis or be the initial presenting symptoms. Recognition that these orofacial manifestations may be part of the disease process is mandatory because one third of patients with untreated temporal arteritis may go blind.

Aged↗
PubMed1990

Pathogenesis, management, and prevention of infective endocarditis in the elderly dental patient.

Aortic stenosis and mitral valve insufficiency are common precipitating causes of infectious endocarditis in older persons. These degenerative cardiac valvular lesions may result from an exaggerated calcification process seen in association with aging. Mitral valve prolapse, especially when noted in an older man, may predispose the person to infectious endocarditis. Infectious endocarditis is harder to diagnosis and treat in older persons, and about half of patients die of the disease or its complications. Prophylactic antibiotics must be prescribed for patients with degenerative cardiac or atherosclerotic valvular defects having dental procedures likely to produce a bacteremia.

Aged↗
PubMed1989

Mental nerve neuropathy: a symptom of Waldenström's macroglobulinemia.

The uncontrolled production of immunoglobulins in Waldenström's macroglobulinemia, a neoplastic plasma cell disorder, results in hyperviscosity of blood and multisystem organ derangement. Previously reported orofacial manifestations have been limited to osteolytic lesions of the jaw, ulcerations of the mucosa and tongue, gingival bleeding, and enlargement of salivary and lacrimal glands. Mental nerve anesthesia resulting from IgM deposition on the myelin sheath is a previously unreported early warning sign of advancing disease. Its occurrence heralds the need for aggressive medical management.

Adult↗
PubMed1989

Temporal lobe epilepsy: its association with psychiatric impairment and appropriate dental management.

Temporal lobe seizures are manifested by aberrant experiences, automatic behavior, or both. In addition, approximately 40% of the patients who have had the disease for more than 15 years exhibit significant personality disorders, mood changes, or psychoses in the periods between seizures (interictal phase). Recognition that these characterologic manifestations are components of the underlying neurologic disorder allows for a more rational approach to the provision of dental care.

Dental Care for Persons with Disabilities↗
PubMed1988

A diagnosis of AIDS: understanding the psychosocial impact.

Acquired immunodeficiency syndrome (AIDS) was discovered in 1981. It is now estimated that 1.5 million persons have become infected and that, by the year 1991, there will be 270,000 cases of the disease and 179,000 associated deaths. An extraordinary aspect of the AIDS epidemic is the high level of fear manifested by large numbers of people, in a manner disproportionate to the objective threat. AIDS has been referred to in the press as the greatest public health problem in America today. While dental journals are replete with studies enumerating the oral manifestations, and appropriate infection control guidelines, the psychosocial aspects of AIDS have generally been confined to media reports. Appropriate dental management of patients at high risk for the development of AIDS/AIDS-related complex requires a complete understanding of the psychosocial environment confronting these persons.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Consent for dental therapy in severely ill patients.

Delirium, dementia, or depression is frequently seen in association with severe medical illness. Usually transient, it is precipitated by the stress of systemic illness and the medications used to treat the underlying disease. Unrecognized, it may invalidate the informed consent required for the provision of emergency dental care services.

Delirium↗
PubMed1988

Dental management of the cocaine addict.

Addiction to cocaine is a growing problem in the United States. The detrimental physiologic aspects of addiction require that certain precautions be observed during dental care to avoid a morbid reaction or a possible fatality. The adverse psychological and social aspects of addiction must also be understood by the dentist in order to properly manage this troubled group of patients.

Cocaine↗
PubMed1988

Painless swelling of the lower lip.

A characteristic example of a mucocele has been presented. Clinicians should be aware that even though these lesions have a distinctive clinical appearance and react biologically in a fairly characteristic manner, they must be differentiated from benign and malignant neoplasms that appear and react clinically similar to mucous retention phenomenons. Microscopic examination of tissue from the lesion is the only definitive method to make this differentiation.

Diagnosis, Differential↗