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Biomedical subjects

Arthur H Friedlander

Publications and source records attributed to Arthur H Friedlander.

30 records · Page 2Linked to original sources
PubMed2003

The pathophysiology, medical management and dental implications of fragile X, Rett, and Prader-Willi syndromes.

Fragile X, Rett, and Prader-Willi syndromes are a group of inherited disorders that often present with varying degrees of mental retardation and challenging behaviors. Dentists caring for individuals with these disorders must be familiar with the manifestations of these diseases and their associated features so they can garner the maximum level of cooperation from the patient. They must also be familiar with the medications (anticonvulsants, antihypertensives, antidepressants, antipsychotics, and central nervous system stimulants) used to treat the associated behaviors, because many of these pharmaceuticals cause clinically evident orofacial and systemic reactions, and may precipitate adverse interactions with dental therapeutic agents.

Anticonvulsants↗
PubMed2002

Late-life depression: psychopathology, medical interventions, and dental implications.

BACKGROUND: Late-life depression (LLD) initially occurs after age 65 years and is a major public health concern because the elderly who are at high risk constitute an ever-expanding segment of the population. LLD is a mental illness in which mood, thought content, and behavioral patterns are impaired, causing the individual distress, compromising social function, and impairing self-maintenance skills (eg, bathing, dressing, hygiene). LLD characterized by marked sadness or a loss of interest or pleasure in daily activities and may be accompanied by weight change, sleep disturbance, fatigue, difficulty in concentration, and a high suicide rate. Diagnosis of LLD is sometimes complicated by a denial of mood change and an inability to distinguish symptoms of a concurrent physical illness from those of a depressive etiology. The disorder is most frequently treated with antidepressant medications, and although older individuals have a recovery rate that is comparable with younger adults, they often take longer to recover, have more frequent relapses, and are more sensitive to the side effects of the drugs. CLINICAL IMPLICATIONS: Individuals undergoing treatment for LLD and those whose illness has not been diagnosed or treated often are seen with significant oral disease by the dentist. Dentists need to be cognizant of how to safely and compassionately provide care to those already receiving mental health services. They must also be familiar with the psychiatric symptoms of the disorder to effectuate a timely referral to a physician of those with occult or relapsing disease. LLD is frequently associated with a disinterest in oral hygiene, 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 artificial salivary products, antiseptic mouthwash, daily fluoride mouth rinse, and special precautions in administration of local anesthetics with vasoconstrictors and prescription of analgesics. CONCLUSION: Dentists who invoke appropriate precautions can usually provide a full range of services to individuals with LLD, thereby enhancing patient self-esteem and contributing to the psychotherapeutic aspect of management.

Activities of Daily Living↗
PubMed2002

Carotid calcification on panoramic radiographs: an important marker for vascular risk.

OBJECTIVE: The objective of this study was to determine whether carotid calcifications are harbingers of future vascular events. STUDY DESIGN: Between 1986 and 2000, 71 patients were found to have carotid artery calcifications on routine panoramic films. Medical records were reviewed for vascular risk factors existing before and vascular end points subsequent to the radiographs. RESULTS: The mean age of our patients was 68 years. Sixty-one (86%) had preexisting vascular risk factors, 73% with multiple risk factors. Forty-one end points occurred in 29 patients. The average time to an end point was 2.7 years. The end points included myocardial infarction (8, 11%), stroke (5, 7%), death (11, 15%), revascularization procedures (8, 11%), transient ischemic attack (2, 3%), and angina (7, 10%). Twenty-three patients (34%) had major end points of myocardial infarction, stroke, or death. CONCLUSIONS: Carotid calcifications identified on panoramic radiographs are powerful markers for subsequent vascular events. Patients found to have carotid calcification on panoramic radiographs should be referred for cerebrovascular and cardiovascular evaluation and aggressive management of vascular risk factors.

Aged↗
PubMed2002

The physiology, medical management and oral implications of menopause.

BACKGROUND: Approximately 36 million women in the United States are in the postmenopausal phase of life. The vast majority of these women experienced spontaneous cessation of menses between the ages of 47 and 55 years when the production of estrogen decreased because of an inadequate number of functioning follicles within their ovaries. Fewer women entered menopause after surgical removal of both ovaries. This procedure usually is performed prophylactically to prevent ovarian cancer in conjunction with a hysterectomy, which is required to treat abnormal bleeding, endometriosis or pelvic inflammatory disease. The physiological changes associated with spontaneous or surgical menopause cause some women to experience uncomfortable symptoms such as hot flashes, night sweats and vaginal dryness. In addition, estrogen deprivation arising from menopause in association with age-related factors disproportionately increases the risk of developing cardiovascular disease (that is, myocardial infarct, stroke), osteoporosis, Alzheimer's disease and oral disease. Hormone replacement therapy, or HRT (estrogen or estrogen and progestin), often is prescribed on a short-term basis to alleviate the uncomfortable symptoms associated with estrogen deficiency and on a long-term basis to prevent some of the chronic illnesses common to postmenopausal women. CONCLUSIONS: Dentists who treat women entering menopause need to consider the stressful phase of life their patients are experiencing. Clinical findings of postmenopausal problems on dental examination may include a paucity of saliva, increased dental caries, dysesthesia, taste alterations, atrophic gingivitis, periodontitis and osteoporotic jaws unsuitable for conventional prosthetic devices or dental implants. Panoramic dental radiographs may reveal calcified carotid artery atheromas. CLINICAL IMPLICATIONS: Dentists have an opportunity to refer women who are not under the care of a gynecologist for an evaluation to determine the appropriateness of HRT for its systemic and oral health benefits.

Alzheimer Disease↗
PubMed2002

The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus.

BACKGROUND: People with type 2 diabetes mellitus are disproportionately at risk of experiencing stroke, because hyperglycemia and other risk factors associated with diabetes accelerate development of cervical carotid artery atheromas. Removal of these atheromas may reduce the incidence of stroke. The authors conducted a study to ascertain if those treated without insulin (noninsulin-treated, or NIT) would have a lower prevalence of atheromas on their radiographs and a lower prevalence of risk factors than those treated with insulin (insulin-treated, or IT). METHODS: The authors evaluated the panoramic radiographs and medical records of 46 neurologically asymptomatic men (n = 34) and women (n = 12) (age range 62-77 years, mean age 68.5 years) with type 2 diabetes. They used Fisher exact test to perform a statistical comparison of the prevalence of atherogenic atheromas and risk factors between groups. RESULTS: The radiographs showed that 24 percent of the NIT patients and 36 percent of the IT patients had atheromas; this difference was not statistically significant (P = .52). The groups had similar risk factors--that is, high levels of glycosylated hemoglobin A, or HbA1c; smoking; hypertension; and obesity (P > .05). When compared with the 4 percent atheroma prevalence rate among healthy people of similar age, the rates were significantly higher in both the NIT (P = .02) and IT (P = .0006) patients. CONCLUSION: These results demonstrate that people with type 2 diabetes, irrespective of treatment modality, have high rates of atheromas as visualized on their panoramic radiographs. CLINICAL IMPLICATIONS: Dentists treating patients with type 2 diabetes mellitus must review their panoramic radiographs carefully for evidence of atheroma formation. Patients with atheromatous lesions must be referred to their physicians for further evaluation and treatment, because the modification of atherogenic risk factors and the surgical removal of atheromas in certain people have been shown to reduce the likelihood of stroke.

Aged↗
PubMed2002

The psychopathology, medical management and dental implications of schizophrenia.

BACKGROUND: Schizophrenia is a psychiatric illness characterized by thought disturbances, bizarre behaviors and cognitive impairments that may diminish a person's abilities in the areas of social relations, school or work and self-care. The onset of the disorder typically occurs between the late teens and mid-30s. Advanced dental disease is seen frequently in patients with schizophrenia for several reasons: the disease impairs these patients' ability to plan and perform oral hygiene procedures; some of the antipsychotic medications they take have adverse orofacial effects such as xerostomia; and these patients sometimes have limited access to treatment because of a paucity of financial resources and adequate number of dentists comfortable in providing care. The recent introduction of more effective medications has permitted the majority of patients to receive their psychiatric care from community-based providers rather than in the hospital. Consequently, dentists in the private sector also are being called on more frequently to care for these people. CONCLUSIONS: Dentists cognizant of the signs and symptoms of schizophrenia are likely to feel more secure in treating patients with schizophrenia and more confident when obtaining consultative advice from the patients' psychiatrists. Dentists usually can provide a full range of services to such patients, can enhance these patients' self-esteem and can contribute to the psychotherapeutic aspect of management. CLINICAL IMPLICATIONS: To effectively provide treatment to patients with schizophrenia, dentists must be familiar with the disease process so that they can communicate effectively with the patient, the treating psychiatrist and family members who serve as caregivers. In addition, dental treatment may need to be modified because of the patient's impaired ability to think logically, the local and systemic effects of psychiatric medications, and adverse interactions between these drugs and medications used in dentistry.

Antipsychotic Agents↗
PubMed2002

Bipolar I disorder: psychopathology, medical management and dental implications.

BACKGROUND: The authors review the clinical features, epidemiology, pathophysiology, medical management, dental findings and dental management of patients who have bipolar I disorder, or BD, previously known as manic-depressive disorder. TYPES OF STUDIES REVIEWED: The authors conducted a MEDLINE search for the period 1995 through 2001 using the key terms "bipolar disorder," "epidemiology," "pathophysiology," "treatment" and "dentistry." The articles they selected for further review included those published in English in peer-reviewed journals; they gave preference to articles reporting randomized, controlled trials. RESULTS: BD is a psychiatric illness characterized by extreme mood swings. Mania is accompanied by euphoria, grandiosity, racing thoughts and lack of insight. Depression is characterized by marked sadness or loss of interest or pleasure in daily activities. The unpredictable mood swings can distress the person, can impair social function and quality of life and are associated with a significant increase in the risk for substance abuse and suicide. BD is common in the United States, with a lifetime prevalence rate of 1.6 percent and recurrence rate of more than 50 percent. CLINICAL IMPLICATIONS: The prevalence of dental disease usually is extensive because of poor oral hygiene and medication-induced xerostomia. Preventive dental education, saliva substitutes and anticaries agents are indicated. To avoid adverse drug interactions with the usually prescribed psychiatric medications, special precautions should be taken when administering certain antibiotics, analgesics and sedatives.

Antidepressive Agents↗
PubMed2002

The biology, medical management, and podiatric implications of menopause.

Approximately 36 million women in the United States are in the postmenopausal phase of life, creating unique challenges for the provision of compassionate, comprehensive podiatric medical treatment. Long-term estrogen deprivation arising from menopause in association with age-related factors disproportionately increases the risk of ischemic heart disease, osteoporosis, and concomitant podiatric complications. This article discusses the physiologic basis of menopause, hormone replacement therapy and its effects on osteoporosis, and other podiatric implications of menopause. Podiatric physicians caring for larger numbers of peri- and postmenopausal women must formulate a comprehensive management plan for treating fractures that arise from a combination of estrogen-deprivation osteoporosis and abnormal foot biomechanics.

Cardiovascular Diseases↗
PubMedDate not supplied

Developmental stuttering: manifestations, treatment and dental implications.

Developmental stuttering (DS) is a disturbance in the normal fluency and time patterning of speech resulting in involuntary repetition, prolongation, or cessation of sound. The scientific literature has implicated the lack of strong left cerebral dominance and abnormal levels of the neurotransmitters dopamine and possibly serotonin in regions of the brain controlling the coordination of language processing and motor activity of the vocal apparatus as possible causative factors in DS. Speech-language therapy is the most common form of treatment, but antipsychotic, antidepressant, and anxiolytic medications may be prescribed for some children and adults with persistent stuttering. These medications may cause xerostomia and adversely interact with certain antibiotics, analgesics, and sedatives routinely used in dentistry. Some people who stutter have sensory-motor and tactile-proprioceptive deficits that impede accurate and timely movements of the mandible, lips, and tongue, necessitating protection of the airway by staff during dental care.

Anti-Anxiety Agents↗