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Biomedical subjects

M J Wahl

Publications and source records attributed to M J Wahl.

At least 19 recordsLinked to original sources
PubMed2001

Pain on injection of prilocaine plain vs. lidocaine with epinephrine. A prospective double-blind study.

BACKGROUND: Prilocaine has been described as causing less pain on injection than lidocaine with epinephrine, possibly because of the higher pH of the prilocaine anesthetic solution. METHODS: Three hundred ten consecutively seen patients in a general practice received a total of 334 maxillary buccal infiltration or inferior alveolar block injections, administered under clinical conditions by one of two dentists. Immediately afterward, patients rated the pain from each injection on a six-point scale. Twenty of these patients (in 21 separate appointments) received, and were asked to rate the pain associated with, a second injection of a contralateral tooth. The authors analyzed the pain response by operator, location of injection, patient's age, patient's sex and anesthetic. RESULTS: The difference in perceived pain between lidocaine and prilocaine was not statistically significant. Regardless of the anesthetic used, the perceived pain was usually no more than mild. Of 334 injections, 292 (87 percent) were rated as causing either no pain or mild pain. CONCLUSIONS: Under clinical conditions, there is no statistically significant difference between injection pain associated with prilocaine plain vs. that associated with lidocaine with 1:100,000 epinephrine. CLINICAL IMPLICATIONS: Since there is no significant difference in associated pain on injection between prilocaine plain and lidocaine with 1:100,000 epinephrine, dentists may prefer lidocaine with epinephrine. Since there is less anesthetic in each cartridge of lidocaine, it may require the use of less anesthetic per patient, and the vasoconstrictor can prolong its duration.

Adolescent↗
PubMed2001

Amalgam--resurrection and redemption. Part 2: The medical mythology of anti-amalgam.

Mercury-containing amalgam restorative material has come under attack for its alleged harmful effects on systemic health. A literature search revealed that amalgam restorations release small quantities of mercury but apparently not enough to cause systemic health problems. Mercury from dental amalgam restorations cannot be linked to kidney damage, Alzheimer's disease, multiple sclerosis, other central nervous system diseases, "amalgam disease," mental disorders, damage to the immune system, increases in antibiotic resistance, or harmful reproductive effects. Dentists occupationally exposed to mercury have not been shown to suffer harmful reproductive or other systemic health effects, provided proper mercury hygiene is used. There are legitimate health concerns about alternative restorative materials, including resin composite. According to the latest scientific information available, dental amalgam remains a safe and effective restorative material.

Animals↗
PubMed2000

Myths of dental surgery in patients receiving anticoagulant therapy.

BACKGROUND: Continuous anticoagulant therapy with warfarin is administered to prevent a variety of medical complications, including thromboembolisms and stroke. When patients receiving continuous anticoagulant therapy are scheduled for dental surgery, a decision must be made whether to continue or interrupt the anticoagulant therapy. METHODS: The author reviewed the literature, focusing on dental surgery in patients receiving continuous anticoagulant therapy and in patients whose anticoagulant therapy was withdrawn before they underwent dental procedures. RESULTS: Of more than 950 patients receiving continuous anticoagulant therapy (including many whose anticoagulation levels were well above currently recommended therapeutic levels) who underwent more than 2,400 surgical procedures, only 12 (< 1.3 percent) required more than local measures to control hemorrhage. Only three of these patients (< 0.31 percent) had anticoagulation levels within or below currently recommended therapeutic levels. Of 526 patients who experienced 575 interruptions of continuous anticoagulant therapy, five (0.95 percent) suffered serious embolic complications; four of these patients died. CONCLUSIONS: Serious embolic complications, including death, were three times more likely to occur in patients whose anticoagulant therapy was interrupted than were bleeding complications in patients whose anticoagulant therapy was continued (and whose anticoagulation levels were within or below therapeutic levels). Interrupting therapeutic levels of continuous anticoagulation for dental surgery is not based on scientific fact, but seems to be based on its own mythology. CLINICAL IMPLICATIONS: Dentists should recommend that therapeutic levels of anticoagulation be continued for patients undergoing dental surgery. Practitioners should consult with the patient's physician if necessary to determine his or her level of anticoagulation before performing dental surgery.

Anticoagulants↗
PubMed2000

Demystifying medical complexities.

Although dentists often fear treating medically complex patients, in many cases this fear may be based not on scientific facts but rather on a "mythology" of the dangers of dentistry. Dentistry is a remarkably safe profession, even for most medically complex patients. The myths of endocarditis, artificial joint infections, local anesthetics and vasoconstrictors, dental surgery in anticoagulated patients and patients on antiplatelet drugs, and antibiotic interference with oral contraceptives are discussed. Although dental treatment is not usually a risk factor for endocarditis, practitioners should consult the 1997 American Heart Association statement for recommendations for endocarditis prevention. Most artificial joint patients should not receive antibiotic prophylaxis. Local anesthetics and vasoconstrictors can be used safely in most medically complex patients. Neither continuous anticoagulation nor antiplatelet medications should be withdrawn for dental surgery. Scientific studies have failed to document an interaction between antibiotics used in dentistry and oral contraceptives.

Anesthesia, Dental↗
PubMed2000

The focal infection theory: appraisal and reappraisal.

This paper discusses the past, present, and future of the focal infection theory of disease. A focal infection is a localized or general infection caused by the dissemination of microorganisms or toxic products from a focus of infection. The resurgence of the focal infection theory of disease has been greeted with great enthusiasm in some quarters; however, the present evidence for the relationship of oral microorganisms and systemic disease is very limited due not only to a dearth of prospective studies and a complete lack of interventional studies but also to very significant methodological difficulties associated with the clinical studies that have been performed.

Bacteremia↗
PubMed1999

Drug interactions.

Explore the source record for details and available documents.

Drug Interactions↗
PubMed1996

Altering anticoagulation therapy: a survey of physicians.

Patients who take antithrombotic medications, such as warfarin sodium or aspirin, are more likely than others to experience bleeding problems after some dental treatments. Withdrawing the medication before treatment, however, may place these patients at risk of medical complications. The authors surveyed physicians about the conditions under which such pharmacotherapies should be altered. They not only found a difference of opinion among the respondents, but also learned that many respondents misunderstood the nature of certain dental procedures and the likelihood that those procedures would cause significant postoperative bleeding.

Anticoagulants↗
PubMed1995

Myths of dental-induced prosthetic joint infections.

The overwhelming majority of orthopedists and dentists surveyed recommend antibiotic prophylaxis for dental procedures to prevent late prosthetic joint infection. It is time to stop this practice, which is not based on scientific evidence but rather on "myths" of prosthetic joint infections after dental procedures. The first myth is that there are close similarities between late prosthetic valve endocarditis and late prosthetic joint infection. The second myth is that dental treatment is the probable cause of a large percentage of prosthetic joint infections. The third myth is that results of animal experiments have shown that transient bacteremia due to dental procedures can cause prosthetic joint infections in humans. The fourth myth is that the benefits of antibiotic prophylaxis for patients with prosthetic joints outweigh the risks and costs. The fifth and final myth is that clinicians should recommend antibiotic prophylaxis before dental treatment for patients with prosthetic joints to protect themselves legally.

Animals↗
PubMed1995

Clinical issues in the prevention of dental-induced endocarditis and prosthetic joint infection.

No issue in medicine or dentistry is the subject of more misunderstanding than the prevention of infective endocarditis and late prosthetic joint infections. To resolve some of the confusion, national medical groups have published guidelines for the prevention of these infections, including the use of antibiotic prophylaxis for certain dental procedures and certain at-risk patients. While these guidelines are helpful, there still are clinicians who either do not recommend antibiotics when indicated or recommend antibiotics without indication. An understanding of these issues helps to prevent not only the infections but also the adverse antibiotic effects and associated legal problems. The learning objective of this article is to educate clinicians on the prevention of dental-induced endocarditis and prosthetic joint infections.

American Heart Association↗
PubMed1994

Myths of dental-induced endocarditis.

Although the latest (1990) American Heart Association recommendations for the prevention of bacterial endocarditis are by far the simplest yet, many physicians and dentists still do not comply with them. One of the reasons for this low compliance is that many clinicians rely on "myths" of dental-induced endocarditis prevention. To educate clinicians on endocarditis and its prevention, the myths of dental-induced endocarditis prevention are analyzed. Myth 1: For the most part, physicians and dentists are aware of and comply with American Heart Association guidelines on antibiotic prophylaxis for prevention of infective endocarditis. Myth 2: Most cases of bacterial endocarditis of oral origin are caused by dental procedures. Myth 3: American Heart Association antibiotic regimens give almost total protection against endocarditis after dental procedures. Myth 4: Antibiotics should be administered for any dental procedure that causes bleeding. Myth 5: If a patient was receiving recent antibiotic therapy before the dental procedure, there is no need to change the dose or the antibiotic before the dental procedure. Myth 6: The risk of endocarditis is almost always greater than the risk of antibiotic toxic effects. Myth 7: Parenteral antibiotics before dental procedures are preferable for most patients with high-risk conditions (eg, prosthetic heart valves and previous history of endocarditis). Myth 8: All patients with mitral valve prolapse should routinely receive antibiotic prophylaxis for dental procedures. Myth 9: Clinicians should err on the positive side of antibiotic prophylaxis to prevent lawsuits.

American Heart Association↗