An affirmation of fallibility.
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Biomedical subjects
Publications and source records attributed to Michael Glick.
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BACKGROUND: A substantial proportion of people with risk factors for cardiovascular disease (CVD) are not identified before they develop clinical signs and symptoms. A multidisciplinary approach that includes a cardiovascular screening by oral health care providers can affect the identification of people at risk of experiencing cardiovascular events. METHODS: The authors extracted data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES) and the 2001-2002 NHANES for people aged 40 to 85 years with no reported specific risk factors for coronary heart disease (CHD) and who had not seen a physician in the previous 12 months but had seen a dentist. They used these data to estimate the 10-year Framingham-based risk calculation scores for each subject to determine their global risk of experiencing acute CHD events. RESULTS: Eighteen percent of the male subjects had an increased 10-year global risk of experiencing a CHD event (> 10 percent risk score), 14.3 percent had a moderate, above-average risk score (> 10-< 20 percent), and an additional 4.3 percent had a high risk score (> or = 20 percent). Only one female subject had a risk score greater than 10 percent. When the authors extrapolated these results to the 2000 U.S. census data, they found that among men aged 40 to 85 years without reported risk factors who had not seen a physician but had seen a dentist in the previous 12 months, 332,262 had a greater than 10 to less than 20 percent risk of experiencing a CHD event, and 72,625 had a 20 percent or greater 10-year risk of experiencing a CHD event. CONCLUSION: Dentists can play an important role in identifying people in need of primary prevention strategies for CVD.
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BACKGROUND: Heart murmurs, a common finding in dental patients, are of major concern to dental professionals because certain dental procedures occasionally can induce severe cardiovascular complications. Murmurs may indicate existing heart disease that is a risk factor for infective endocarditis following a dental procedure, as well as more severe heart conditions such as congenital heart disease, atrial fibrillation or congestive heart failure. TYPES OF STUDIES REVIEWED: This review article is based on data published in peer-reviewed journals, including practice guidelines published by major dental and medical professional organizations. RESULTS: Echocardiography is the primary means of evaluating heart murmurs, and all dental professionals should become familiar with major aspects of an echocardiogram. Understanding the medical evaluation and assessment of a heart murmur fosters better communication with other health care professionals and results in improved patient care. CLINICAL IMPLICATIONS: Beyond the need to administer antibiotic prophylaxis, the dentist also needs to address the underlying causes of a patient's heart murmur. By providing dental care to such patients, oral health care providers become part of the patient's overall health care team.
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Lymph node enlargement may be an incidental finding on examination, or may be associated with a patient complaint. It is likely that over half of all patients examined each day may have enlarged lymph nodes in the head and neck region. There are no written guidelines specifying when further evaluation of lymphadenopathy is necessary. With such a high frequency of occurrence, oral health care providers need to be able to determine when lymphadenopathy should be investigated further. Although most cervical lymphadenopathy is the result of a benign infectious etiology, clinicians should search for a precipitating cause and examine other nodal locations to exclude generalized lymphadenopathy. Lymph nodes larger than 1 cm in diameter are generally considered abnormal. Malignancy should be considered when palpable lymph nodes are identified in the supraclavicular region, or when nodes are rock hard, rubbery, or fixed in consistency. Patients with unexplained localized cervical lymphadenopathy presenting with a benign clinical picture should be observed for a 2- to 4-week period. Generalized lymphadenopathy should prompt further clinical investigation. This article reviews common causes of lymphadenopathy, and presents a methodical clinical approach to a patient with cervical lymphadenopathy.
BACKGROUND: In December 2003, the National High Blood Pressure Education Program of the National Heart, Lung, and Blood Institute finalized the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, called JNC 7. OVERVIEW AND CONCLUSIONS: On the basis of new trials and observational studies, and the need for clear and concise guidelines, the JNC implemented changes in blood pressure classification, nomenclature, treatment and prevention in the JNC 7 report. One of the key messages of the report is that systolic blood pressure higher than 140 millimeters of mercury in people older than 50 years of age is a more important risk factor than diastolic blood pressure. Another finding is that people with normal blood pressure at the age of 55 to 65 years have an 80 to 90 percent risk of developing hypertension by the age of 80 to 85 years. CLINICAL IMPLICATIONS: JNC 7 emphasizes that health care professionals besides physicians, including dentists, need to help patients by reinforcing hypertension-related lifestyle modifications, pharmacological therapies and adherence to treatment.
Immunocompromised individuals present a challenge to oral health care providers. As the spectrum of patients with dysfunctional immune responses continues to broaden, practitioners should be able to identify these patients, understand the potential for complications, and manage their dental care safely and effectively. This article reviews various immune deficiencies, addresses complications that may result from an individual's immune status, and discusses dental considerations for these patients.
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BACKGROUND: Cardiovascular disease, or CVD, is associated with a very high rate of morbidity and mortality among people in the United States. Primary and secondary prevention measures will help reduce cardiovascular events and increase the overall health of the patient population. METHODS: The author conducted MEDLINE and Internet searches and reviewed publications from professional organizations for the most up-to-date information on CVD and associated risk factors. RESULTS: More than 450,000 articles and monographs on CVD were published in English between January 1990 and May 2001. Of these, approximately 45,000 discussed CVD and risk factors. The author selected and reviewed more than 550 publications on the basis of their relevance to epidemiology, etiology, and primary and secondary prevention of CVD. CONCLUSIONS: Recent information regarding the pathogenesis and treatment of CVD suggests that oral health care providers can perform screening for risk factors and aid in monitoring of specific conditions that put people at an increased risk of developing and exacerbating existing CVD. Dentists need to take a proactive role in this endeavor. CLINICAL IMPLICATIONS: As with most medical conditions, oral health care providers play an important function as it relates to the overall health of their patients. This article provides a timely update on CVD and the relationship between CVD and its risk factors, and offers suggestions for oral health care providers as to when they should interact with patients and patients' primary health care providers to possibly reduce the mortality and morbidity of CVD.
BACKGROUND: The thyroid gland and its hormones play an important role in the regulation of growth, development and metabolic functions of the body. Thyroid diseases include a group of conditions that can affect the delivery of dental care. LITERATURE REVIEWED: The authors conducted a MEDLINE search of the medical and dental literature concerning thyroid disease and its management published between 1980 and 2000. The authors found eight published articles concerning this topic in the dental literature; a few of the articles specifically addressed thyroid disease and dental care. They reviewed the medical literature within the scope of provision of dental care. CONCLUSIONS: The oral health care professional can play a role in the screening of dental patients who have undiagnosed thyroid disease. In addition, to treat patients who have thyroid disease, a thorough understanding of the many related pathological conditions, as well as the signs and symptoms that can occur, is needed. Specific dental treatment protocols for these patients are not found in the medicodental literature published between 1980 and 2000. CLINICAL IMPLICATIONS: As part of a health care team, the dentist plays an important role in detecting thyroid abnormalities. Modifications of dental care must be considered when treating patients who have thyroid disease.