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Biomedical subjects

James W Little

Publications and source records attributed to James W Little.

27 records · Page 2Linked to original sources
PubMed2002

Antithrombotic agents: implications in dentistry.

Thrombosis and the complicating emboli that can result are important causes of illness and death. Thrombosis is of greater overall clinical importance in terms of morbidity and mortality than all of the hemorrhagic disorders combined. Agents such as heparin, low-molecular weight heparin, warfarin, aspirin, ticlopidine, clopidogrel, and tirofiban are used to prevent venous or arterial thrombosis. Patients taking these antithrombotic agents may be at risk for excessive bleeding after invasive dental procedures. The current antithrombotic agents used in medicine are reviewed, and the dental management of patients taking these agents is discussed.

Anticoagulants↗
PubMed2002

Deep tendon reflexes: a study of quantitative methods.

OBJECTIVE: The deep tendon reflex (DTR) is routinely used by clinicians to evaluate the nervous system. Depressed and hyperactive DTRs suggest peripheral and central nervous system compromise, respectively. Limitations of DTRs are: qualitative nature of the assessments based upon subjective grading, and limited inter-rater reliability. This preliminary study was undertaken to quantify the tendon tap used by clinicians to elicit DTRs and the reflex response elicited. METHODS: Tendon taps were applied to a force transducer in hypo-, normo-, and hyperreflexic ranges by 2 clinicians, using 3 different tendon hammers (Babinski, Queen Square, and Taylor). Patellar DTRs, measured as joint angle excursion with an electrogoniometer, were compared in hyper- and normoreflexic individuals. RESULTS: Median peak tap force was 1 2.8, 38.0, and 85.2 Newtons (Nt), respectively, for eliciting hyper-, normo-, and hyporeflexic DTRs. Peak tap force was similar in the hyper- and normoreflexic ranges for all 3 hammers; in the hyporeflexic range, peak tap forces with the Taylor hammer were lower. A good distinguishing feature between hyper- and normoreflexic patellar DTRs was briskness, measured as the quotient of knee excursion divided by peak tendon tap force. Knee excursion is a non-linear patellar DTR response, when measured sitting. CONCLUSIONS: Peak tap forces used by clinicians fall into 3 ranges: 0-20 Nt for hyperreflexia, 21-50 Nt for normoreflexia, and >50 Nt for hyporeflexia. The Taylor hammer, with small mass and short handle, has a ceiling effect in the hyporeflexic range. We propose a systematic method for DTR testing.

Central Nervous System Diseases↗
PubMedDate not supplied

Anxiety disorders: dental implications.

Anxiety disorders are the most frequently found psychiatric problem in the general population. The most common anxiety disorders are phobias, panic attack, generalized anxiety disorder, post-traumatic stress disorder and acute stress disorder. Recent terrorist attacks in the U.S. have had a marked impact on the mental health status of individuals directly affected by the attacks as well as those who were far from the scenes of destruction. To provide effective dental care, the dentist must be able to identify anxious patients and deal with their anxiety. This process may involve referring the patient for medical evaluation and treatment of very severe cases of anxiety. In most cases, the dentist can manage the patient by using behavioral and/or pharmacologic means.

Anti-Anxiety Agents↗
PubMedDate not supplied

Special medical concerns in the dental management of older adults.

By the year 2040, older adults will account for approximately 21% of the population of the United States, a significant increase from 1900 (4%) and 1990 (12%). The most rapidly growing segment of the United States population is people aged 85 and older. Currently, 85% of individuals over 65 have one or more chronic illnesses, while 30% have three or more. These individuals and their illnesses account for more than 33% of this country's health care costs.

Aged↗
PubMedDate not supplied

Dental implications of mood disorders.

Mood disorders refers to a heterogenous group of mental conditions characterized by extreme exaggeration and disturbance of mood and affect. This article examines major depression and bipolar disorders and how these disorders can affect a patient's dental care. The drugs used to treat these conditions have significant side effects that dentists should be aware of. In addition, important drug interactions can occur as a result of agents used by the dentist. The dentist should refer patients found with signs and symptoms of mood disorders for medical evaluation and treatment. Depressed patients often have poor oral hygiene due to a lack of interest in self-care. Xerostomia occurs due to depression and the drugs used to treat it. The dentist needs to provide an aggressive preventive dental education program for these patients, including the use of artificial salivary products, mouthwashes, and topical fluoride applications, in addition to the treatment of candidiasis when present.

Antidepressive Agents↗
PubMedDate not supplied

Dental management of patients with Alzheimer's disease.

This article reviews the recent literature regarding the epidemiology, etiology, pathophysiology, diagnosis, and treatment of Alzheimer's disease. The dental management of patients with Alzheimer's disease is discussed in some detail.

Aged↗
PubMedDate not supplied

Methamphetamine abuse and "meth mouth".

Dental management for the patient who abuses drugs is always a challenge. The number of patients abusing methamphetamines appears to be increasing. The dentist needs to be aware of the clinical presentation and medical risks presented by these patients and to attempt to get the patient to seek professional help. Additionally, special attention will be necessary for the high prevalence and severity of oral manifestations including rampant caries, enamel erosion, xerostomia, bruxism, and muscle trismus.

Amphetamine-Related Disorders↗
PubMedDate not supplied

Melanoma: etiology, treatment, and dental implications.

Melanoma is one of the most serious skin cancers. It arises from neural crest-derived melanocytes located in the epidermis or dermis of the skin. Melanoma also can arise from melanocytes located in other regions of the body such as the eye, meninges, digestive tract, mucosal surfaces, or lymph nodes. There are no proven causes of melanoma but the most commonly associated factor is episodic exposure to the sun. Melanoma is a common cancer that has been increasing in incidence for the last 35 years. The median age at the time of diagnosis is 53 years. It is much more common in whites than in people of color. Five-year survival rates for melanoma of the skin have been increasing since 1976. There are four types of melanoma: superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lintiginous melanoma. Clinical signs indicating possible melanoma are asymmetry, border irregularity, color variation, increase in diameter, elevation, ulceration, and bleeding of pigmented lesions. Histopathologic findings (tumor thickness, tumor invasion), surface ulceration, spread to lymph nodes, and distant metastases are used to project patient prognosis. Treatment consists of surgical excision, lymph node dissection, limb perfusion, regional chemotherapy infusion, radiation, intralesional immunotherapy, systemic chemotherapy, and/or interferon-alpha, depending on the staging of the melanoma. Oral melanomas are rare; however, approximately 20% of all melanomas are found in the head and neck region. The role of the dentist is to be alert for changes in pigmented lesions of the oral mucosa and skin of the head and neck. Lesions suspected of melanoma must be biopsied, which usually involves referral of the patient.

Ethnicity↗