NAVAL POSTGRADUATE DENTAL SCHOOL BETHESDA, MARYLAND RESIDENCY IN ENDODONTICS CLASSICAL LITERATURE SEMINAR #10a DATE: 12 October 2006 TOPIC: Pharmacology SEMINAR OBJECTIVE: Each resident should synthesize a pharmacologic treatment plan for the control of pain of endodontic origin, anxiety, and infection in endodontic patients. MAIN POINTS: At the conclusion of the seminar, each resident should: MP #1-Describe the mechanism of action of non-steroidal anti-inflammatory drugs. MP #2-Describe the mechanism of action of narcotic analgesics. MP #3-Describe the anti-inflammatory mechanism of action of corticosteroids. MP #4-Describe the indications and contra-indications for the use of analgesics in endodontic practice. MP #5-Describe the indications and contra-indications for the use of antibiotics in endodontic practice. MP #6-Describe the mechanism of action for the antibiotics most commonly used in endodontic practice. MP #7 -Describe a hierarchy of antibiotic use in endodontic practice. GENERAL READINGS: All residents should review and be prepared to discuss the following text and literature references. Hargreaves KM, Keiser K, Byrne BE. Analgesics in Endodontics. In: Cohen S, Hargreaves KM, eds. Pathways of the pulp. 9th ed. St Louis: Mosby, Inc., 2006:665-690. Hargreaves KM, Baumgartner JC. Endodontic therapeutics. In: Walton RE, Torabinejad M, eds. Principles and practice of endodontics. 3rd ed. Philadelphia: W.B. Saunders Company, 2002:533-44. Pallash TJ. Pharmacology for endodontics. In: Ingle JI, Bakland LK, eds. Endodontics. 5th ed. Baltimore: BC Decker Inc, 2002:903-12. Kaufman RL. Mechanisms of antimicrobial resistance. Special Report. NDS Bethesda, MD. November 1997. Colleagues for Excellence. Antibiotics and the treatment of endodontic infections. American Association of Endodontists; Summer 2006. American Dental Association, American Academy of Orthodaepic Surgeons. Antibiotic prophylaxis for dental patients with total joint replacements. J Amer Dent Assoc;134:895-9. American Dental Association. Antibiotic interference with oral contraceptives. JADA 2002;133:880. Bainton R. Interaction between antibiotic therapy and contraceptive medication. Oral Surg Oral Med Oral Pathol 1986;61:453-5. Clifford DB. Treatment of pain with antidepressants. Am Fam Physician 1985;31:181-8. Cunningham CJ, Mullaney TP. Pain control in endodontics. Dent Clin North Am 1992;36:393- 408. Curtis P, Gartman LA. Utilization of ketorolac tromethamine for control of severe odontogenic pain. J Endod 1994;20:457-9. Dionne RA. New approaches to preventing and treating postoperative pain. J Am Dent Assoc 1992;123:27-34. Dionne RA, Gordon SM. Nonsteroidal anti-inflammatory drugs in acute pain. Dent Clin North Am 1994;38:645-68. Dionne R. To tame the pain? Compend Contin Educ Dent 1998;19:426-8,430-1. Ehrich DG, Lundgren JP, Dionne RA, Nicoll BK, Hutter JW. Comparison of triazolam, diazepam, and placebo as outpatient oral premedication for endodontic patients. J Endod 1997;23:181-4. Forbes JA, Kehm CJ, Grodin CD, Beaver WT. Evaluation of ketorolac, ibuprofen, acetaminophen, and an acetaminophen-codeine combination in postoperative oral surgery pain. Pharmacotherapy 1990;10:94S- 105S. Hall EH, Sherman RG, Emmons WW, Naylor GD. Antimicrobial prophylaxis. Dent Clin North Am 1994;38:707-18. Hargreaves KM, Swift JQ, Roszkowski MT, Bowles W, Garry MG, Jackson DL. Pharmacology of peripheral neuropeptide and inflammatory mediator release. Oral Surg Oral Med Oral Pathol 1994;78:503-10. Haas DA, Oral and inhalation conscious sedation. Den Clin North Am 1999;43:341-59. Haas DA. Adverse drug reactions in dental practice – interactions associated with analgesics. Part III. J Am Dent Assoc 1999;130:397-407. Kacso G, Terezhalmy G. Acetylsalicylic acid and acetaminophen. Dent Clin North Am 1994;38:633-44. Harrison JW, Svec TA. The beginning of the endo of the antibiotic era? Part II. Proposed solutions to antibiotic abuse. Quintessence Int 1998;29:223-9. Lynch C, Sinnot J, Holt D, Herold A. Use of antibiotics during pregnancy. Am Fam Physician 1991;43:1365-8. Patten JR, Patten J, Hutchins MO. Adjunct use of dexamethasone in postoperative dental pain control. Compend Contin Educ Dent 1992;13:580-9. Petersen KL, Brennum J, Dahl JB. Experimental evaluation of the analgesic effect of ibuprofen on primary and secondary hyperalgesia. Pain 1997;70:167-74. Roy ML, Narahashi T. Differential properties of tetrodotoxin-sensitive and tetrodotoxin-resistant sodium channels in rat dorsal root ganglion neurons. J Neurosci 1992;12:2104-11. Slavkin HC. Benefit-to-risk ratio: the challenge of antibiotic resistance. J Am Dent Assoc 1997;128:1447- 51. Smith EL. Antibiotics that interfere with bacterial protein synthesis. J Endod 1976;2:339-42. Smith EL. How penicillin works. J Endod 1976;2:149-52. Sokol DJ, Sokol S, Sokol CK. A review of nonintrusive therapies used to deal with anxiety and pain in the dental office. J Am Dent Assoc 1985;110:217-22. Terezhalmy G, Pyle MA. Adverse drug effects. Dent Clin North Am 1994;38:769-84. Torabinejad M, Cymerman JJ, Frankson M, Lemon RR, Maggio JD, Schilder H. Effectiveness of various medications on postoperative pain following complete instrumentation. J Endod 1994;20:345-54. Truelove EL. The chemotherapeutic management of chronic and persistent orofacial pain. Dent Clin North Am 1994;38:669-88. Wynn RL. Tramadol (Ultram) a new kind of analgesic. Gen Dent 1996;44:216-20. Yamamoto K, Fukushima H, Tsuchiya H, Sagawa H. Antimicrobial susceptibilities of eubacterium, peptostreptococcus, and bacteroides isolated from root canals of teeth with periapical pathosis. J Endod 1989;15:112-6. SEMINAR ASSIGNMENTS: All residents should review, prepare abstracts for the assigned articles and be prepared to discuss the following literature references. LCDR SAITO Bartlett JG. Antibiotic-associated diarrhea. N Engl J Med 2002;346:334-9. Brook I, Lewis M, Sandor GKB, Jeffcoat M, Samaranayake LP, Rojas JV. Clindamycin in dentistry: more than just effective prophylaxis for endocarditis? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:550-8. Hersh EV. Adverse drug reactions in dental practice – interactions involving antibiotics. Part II. J Am Dent Assoc 1999;130:236-51. Jerjes W, Jerjes WK, Swinson B, Kumar S, Leeson R, Wood PJ, Kattan M, Hopper C. Midazolam in the reduction of surgical stress: a randomized clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:564-70. LCDR BLANSCET Cooper S. Treating acute pain: do's and don'ts, pros and cons. J Endod 1990;16:85-91. DeRossi SS, Hersh EV. Antibiotics and oral contraceptives. Dent Clin North Am 2002;46:653-64. Dionne RA, Yagiela JA, Cote CJ, Donaldson M, Edwards M, Greenblatt DJ, Haas D, Malviya S, Milgrom, Moore PA, Shampaine G, Silverman M, Williams RL, Wilson S. Balancing efficacy and safety in the use of oral sedation in dental outpatients. J Am Dent Assoc 2006;137:502-13. Goodchild JH, Donaldson M. Calculating and justifying total anxiolytic doses of medications for in-office use. Gen Dent 2006; 54-7. LT JACK Dionne RA. Additive analgesic effects of oxycodone and ibuprofen in the oral surgery model. J Oral Maxillofac Surg 1999;57:673-8. Huber MA, Terezhalmy GT. The use of Cox-2 inhibitors for acute dental pain. J Am Dent Assoc 2006;137:480-7. Nevins A, Verhelle R. Feldman MJ, Berman D. Local prophylactic Benadryl injections in an attempt to reduce postinstrumental pain. J Endod 1994;20:296-8. Phero JC, Becker D. Rational use of analgesic combinations. Dent Clin N Am 2002;46:691-705. LT JOHN Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John’s Wort, Ginseng, Echinacea, Saw Palmetto and Kava. Ann Intern Med 2002;136:42-53. Kardelis AC, Meinberg TA, Sulte HR, Gound TG, Marx DB, Reinhardt RA. Effect of narcotic pain reliever on pulp tests in women. J Endod 2002;28:537-9. Kuriyama T, Karasawa T, Nakagawa K, Yamamoto E, Nakamura S. Bacteriology and antimicrobial susceptibility of gram-positive cocci isolated from pus specimens of orafacial odontogenic infections. Oral Microbiol Immunol 2002;17:132-5. Kuriyama T, Nakagawa K, Karasawa T, Saiki Y, Yamamoto E, Nakamura S. Past administration of b- lactam antibiotics and increase in the emergence of b-lactamase-producing bacteria in patients with orofacial odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:186-92. LT HORAN Gopikrishna V, Parameswaran A. Effectiveness of prophylactic use of rofecoxib in comparison with ibuprofen on postendodontic pain. J Endod 2003;29:62-4. Haas DA. Emergency drugs. Dent Clin N Am 2002;46:815-30. Terezhalmy G, Gagliardi VB. General principles of pharmacology. Dent Clin North Am 1994;38:585-602. Yingling NM, Byrne BE, Hartwell GR. Antibiotic use by members of the American Association of Endodontists in the year 2000: report of a national survey. J Endod 2002;28:396-404. LCDR GNAU Harrison JW, Svec TA. The beginning of the endo of the antibiotic era? Part I. The problem: abuse of the “miracle drugs.” Quintessence Int 1998;29:151-62. Pennisi E. Building a better aspirin. Science 1998;280:1191-2. LT HAWLEY Jeske AH. Selecting new drugs for pain control. Evidenced-based decisions or clinical impressions? JADA 2002;133:1052-6. Moore PA, Gage TW, Hersh EV, Yagiela JA, Haas DA. Adverse drug reactions in dental practice – professional and educational implications. Part I. J Am Dent Assoc 1999;130:47-54. LT CHESLER Kaufman E, Hargreaves K, Dionne R. Comparison of oral triazolam and nitrous oxide with placebo and intravenous diazepam for outpatient premedication. Oral Surg Oral Med Oral Pathol 1993;75:156-64. Moore PA. Adverse drug interactions in dental practice: interactions associated with local anesthetics, sedatives and anxiolytics. Part IV. J Am Dent Assoc 1999;130:541-54. ADDITIONAL READINGS: These references have appeared in past General Readings or as abstracted articles. They are retained in this category for historical purposes and to enhance General Readings. Flath RK, Hicks ML, Dionne RA, Pelleu GB. Pain suppression after pulpectomy with preoperative flurbiprofen. J Endod 1987;13:339-47. Gordon NC, Heller PH. Interactions between fluoxetine and opiate analgesia for postoperative dental pain. Pain 1994;58:85-8. Habib S, Matthews R, Scully C, Levers B, Shepard J. A study of the comparative efficacy of four common analgesics in the control of postsurgical dental pain. Oral Surg Oral Med Oral Pathol 1990;70:559-63. Henderson BN, Triplett RG, Gage TW. Anxiolytic therapy: oral and intravenous sedation. Dent Clin North Am 1994;38:603-18. Menhenick KA, Gutmann JL, Regan JD, Taylor SE, Buschang PH. The efficacy of pain control following nonsurgical root canal treatment using ibuprofen or a combination of ibuprofen and acetaminophen in a randomized, double-blind, placebo-controlled study. Int Endod J 2004;37:531. Narahashi T, Roy ML, Ginsburg KS. Recent advances in the study of mechanism of action of marine neurotoxins. Neurotoxicology 1994;15:545-54. Nikolasjsen L, Hansen CL, Nielsen J, Keller J, Arendt-Nielsen L, Jensen TS. The effect of ketamine on phantom pain: a central neuropathic disorder maintained by peripheral input. Pain 1996;67:69-77. Saxen MA. The clinical pharmacology of ketorolac. Compend Contin Educ Dent 1992;13:504-11. Schwesinger WH, Reynolds JC, Harshaw DH, Frakes LA. Transnasal butorphanol and intramuscular meperidine in the treatment of postoperative pain. Advances in Therapy 1992;9:123-9. Sisk AL, Grover BJ. A comparison of preoperative and postoperative naproxen sodium for suppression of postoperative pain. J Oral Surg 1990;48:674-8. NAVAL POSTGRADUATE DENTAL SCHOOL BETHESDA, MARYLAND RESIDENCY IN ENDODONTICS CLASSICAL LITERATURE SEMINAR #10b DATE: 12 October 2006 TOPIC: Fascial Space Infections of Odontogenic Origin SEMINAR OBJECTIVES: Each resident should: 1) Understand the anatomic relationships between fascia, muscles, and bone in the head and neck in order to predict the possible pathways for the extension of dental infections, and to prevent or recognize potentially life-threatening situations. 2) Understand the most effective means for treating odontogenic infections. MAIN POINTS: At the conclusion of the seminar, each resident should: MP #1 -understand the factors involved in the confinement or localization of dental infections. MP #2 -know the factors involved in the spread of dental infections. MP #3 -know the possible routes for extension of dental infections in the maxilla and mandible. MP #4 -be able to define the boundaries of spaces and potential spaces in the head and neck. MP #5 -know the communication(s) between one anatomical location and another in the head and neck. MP #6 -know the different types of bacteria involved in the spread of odontogenic infections. MP #7 -be able to analyze the potential for the occurrence of life-threatening situations based on anatomic considerations. MP #8 -know the proper treatment and therapeutic regimens for handling odontogenic space infections; I & D, NSRCT, supportive care (antibiotics, etc.). GENERAL READINGS: All residents should review and be prepared to discuss the following text and literature references. Goldberg MH, Topazian RG. Odontogenic infections and deep fascial space infections of dental origin. In: Topazian RG, Goldberg MH, Hupp JR, eds. Oral and maxillofacial infections. 4th ed. Philadelphia: W.B. Saunders Company, 2002:158-187. Hohl TH, Whitacre RJ, Hooley JR, Williams B, eds. A self-instructional guide: diagnosis and treatment of odontogenic infections. Seattle: Stoma Press, Inc., 1983. Montgomery EH. Antibacterial antibiotics. In: Yagiela JA, Neidle EA, Dowd FJ, eds. Pharmacology and therapeutics for dentistry. 4th ed. St. Louis: Mosby-Year Book, Inc., 1998:496-533. Montgomery EH. Principles and mechanisms of antibiotic therapy. In: Yagiela JA, Neidle EA, Dowd FJ, eds. Pharmacology and therapeutics for dentistry. 4th ed. St. Louis: Mosby-Year Book, Inc., 1998:482-95. Peterson LJ. Complex odontogenic infections. In: Peterson LJ, Ellis E, Hupp JR, Tucker MR, eds. Contemporary oral and maxillofacial surgery. 4th ed. St. Louis: Mosby, Inc., 2003:367-79. Peterson LJ. Principles of antibiotic therapy. In: Topazian RG, Goldberg MH, Hupp JR, eds. Oral and maxillofacial infections. 4th ed. Philadelphia: W.B. Saunders Company, 2002:99-111. Peterson LJ. Principles of management and prevention of odontogenic infections. In: Peterson LJ, Ellis E, Hupp JR, Tucker MR, eds. Contemporary oral and maxillofacial surgery. 4th ed. St. Louis: Mosby, Inc., 2003:344-66. Rog R. Odontogenic infections: guidelines for inpatient referrals. Clinical Update, NDS 1989;11:11-12. Barrett AP. Metronidazole in the management of anaerobic neck infection in acute leukemia. Oral Surg Oral Med Oral Pathol 1988;66:287-9. Bonapart IE, Stevens HP, Kerver AJ, Rietveld, AP. Rare complications of an odontogenic abscess: mediastinitis, thoracic empyema, and cardiac tamponade. J Oral Surg 1995;53:610-3. Brennan MT, Runyon MS, Batts JJ, Fox PC, Kent ML, Cox TL, Norton J, Lockart PB. Odontogenic signs and symptoms as predictors of odontogenic infection. A clinical trial. J Am Dent Assoc 2006;137:62-6. Connor JP, Edelson JG. Needle tract infection. J Oral Surg 1988;65:401-3. Egbert GW, Simmons AK, Graham LL. Toxic shock syndrome: odontogenic origin. Oral Surg Oral Med Oral Pathol 1987;63:167-71. Flynn TR. Odontogenic infections. Oral Maxillofac Surg Clin N Amer 1991;3:311-29. Gill Y, Scully C. Orofacial odontogenic infections: review of microbiology and current treatment. Oral Surg Oral Med Oral Pathol 1990;70:155-8. Giunta JL. Comparison of erysipelas and odontogenic cellulitis. J Endod 1987;13:291-4. Grodinsky M. Ludwig’s angina, retropharyngeal abscess and other deep abscesses of the head and neck. JAMA 1940;114:18-22. Hudson JW. Osteomyelitis of the jaws: a 50 year perspective. Int J Oral Surg 1993;51:1294-301. Kitay D, Ferraro N, Sonis S. Lateral pharyngeal space abscess as a consequence of regional anesthesia. J Am Dent Assoc 1991;122:56-9. Krishnan V, Johnson JV, Helfrick JF. Management of maxillofacial infections: a review of 50 cases. J Oral Surg 1993;51:868-74. Li X, Tronstad L, Olsen I. Brain abscesses caused by oral infection. Endod Dent Traumatol 1999;15:95- 101. Loewen RR, Conley SF, Post AC. An atypical pathway of infection in an adolescent with a deep neck space abscess. Pediatr Dent 1995; 17:220-3. Mizuno I, Mizutani H, Ueda M, Kaneda T. Temporal necrotizing infection of dental origin. J Oral Surg 1993;51:79-81. Musgrove BT, Malden NJ. Mediastinitis and pericarditis caused by dental infection. Br J Oral Maxillofac Surg 1989;27:423-8. Rush JR, Sulte HR, Cohen DM, Makkawy H. Course of infection and case outcome in individuals diagnosed with microbial colonies morphologically consistent with Actinomyces species. J Endod 2002;28:613-8. Sakamoto H, Aoki T, Kise Y, Watanabe D, Sasaki J, Isehara, B. Descending necrotizing mediastinitis due to odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:412-9. Taicher S, Garfunkel A, Feinsod M. Reversible cavernous sinus involvement due to minor dental infection. Report of a case. Oral Surg Oral Med Oral Pathol 1978;46:7-9. Young EW, Johnson WT, Lundin R, Kuker C. Evaluation of treatment provided patients hospitalized with orofacial odontogenic infections: a retrospective study. Oral Surg Oral Med Oral Pathol 1985;59:28- 33. Zeitoun IM, Dhanarajani PJ. Cervical cellulitis and mediastinitis caused by odontogenic infections: report of two cases and review of literature. J Oral Surg 1995;53:203-8. SEMINAR ASSIGNMENTS: All residents should review, prepare abstracts for the assigned articles and be prepared to discuss the following literature references. LCDR GUISE ** Prepare a brief written and oral report describing the 1) anatomic location, 2) signs and symptoms, 3) odontogenic origin, 4) patterns of spread and 5) risk to the patient (low, moderate, high). Use the Hohl, Whitacre, Hooley and Williams instructional guide as your main resource. The use of charts, diagrams, and PowerPoint is strongly encouraged for the oral presentation. Dento-Alveolar Ridges Mandibular Buccal Vestibule Body of the Mandible Mental Space Submental Space Sublingual Space Submandibular Space Ludwig's Angina LT GNAU ** Prepare a brief written and oral report describing the 1) anatomic location, 2) signs and symptoms, 3) odontogenic origin, 4) patterns of spread and 5) risk to the patient (low, moderate, high). Use the Hohl, Whitacre, Hooley and Williams instructional guide as your main resource. The use of charts, diagrams, and PowerPoint is strongly encouraged for the oral presentation. Base of the Upper Lip Canine Space Cavernous Sinus Thrombosis Palatal Swelling Periorbital Space LT HAWLEY ** Prepare a brief written and oral report describing the 1) anatomic location, 2) signs and symptoms, 3) odontogenic origin, 4) patterns of spread and 5) risk to the patient (low, moderate, high). Use the Hohl, Whitacre, Hooley and Williams instructional guide as your main resource. The use of charts, diagrams, and PowerPoint is strongly encouraged for the oral presentation. Maxillary Buccal Vestibule Buccal Space Submasseteric Space Deep Temporal Space Superficial Temporal Space Infratemporal Space Parotid Space LT CHESLER ** Prepare a brief written and oral report describing the 1) anatomic location, 2) signs and symptoms, 3) odontogenic origin, 4) patterns of spread and 5) risk to the patient (low, moderate, high). Use the Hohl, Whitacre, Hooley and Williams instructional guide as your main resource. The Grodinsky and Flynn articles will be helpful in the Danger Space report. The use of charts, diagrams, and PowerPoint is strongly encouraged for the oral presentation. Pterygomandibular Space Parapharyngeal Spaces Lateral Pharyngeal Space Retropharyngeal Space Cervical Spaces Peritonsillar Space Danger Space ADDITIONAL READINGS: These references have appeared in past General Readings or as abstracted articles. They are retained in this category for historical purposes and to enhance General Readings. Blomquist IK, Bayer AS. Life threatening deep facial space infections of the head and neck. Infect Dis Clin North Am 1988;2:237-64. Bridgeman A, Wiesenfeld D, Hellyar A, Sheldon W. Major maxillofacial infections. An evaluation of 107 cases. Aust Dent J 1995;40:281-8. Bridgeman A, Wiesenfeld D, Newland S. Anatomical considerations in the diagnosis and management of acute maxillofacial bacterial infections. Aust Dent J 1996;41:238-45. Hanna CB. Cefadroxil in the management of facial cellulitis of odontogenic origin. Oral Surg Oral Med Oral Pathol 1991;71:496-8. Henry CH, Hughes CV, Larned DC. Odontogenic infection of the orbit: report of a case. J Oral Maxillofac Surg 1992;50:172-7. Labriola JD, Mascaro J, Albert B. The microbiologic flora of orofacial abscesses. J Oral Maxillofac Surg 1983;41:711-4. Lindner HH. The anatomy of the fasciae of the face and neck with particular reference to the spread and treatment of intraoral infections (Ludwig's) that have progressed into adjacent fascial spaces. Ann Surg 1986;204:705-14. Moenning JE, Nelson CL, Kohler RB. The microbiology and chemotherapy of odontogenic infections. J Oral Maxillofac Surg 1989;47:976-85. Olson A, MacEdington E, Kulild J, Weller R. Update on antibiotics for the endodontic practice. Compend Contin Educ Dent 1990;11:328-32. Owens B, Schuman N. Ludwig's angina. Gen Dent 1994;42:84-7. Schein B. Microbiologic considerations in selecting a drug for endodontic abscesses. J Endod 1986;12:570-2. Schroeder DC, Sarha ED, Hendrickson DA, Healey KM. Severe infections of the head and neck resulting from gas-forming organisms. J Am Dent Assoc 1987;114:65-8. Schuman NJ, Turner JE. Brain abscess and dentistry: a review of the literature. Quintessence Int 1994;25:411-3. Swift JQ, Gulden WS. Antibiotic therapy – managing odontogenic infections. Dent Clin North Am 2002;46:623-33. Walsh LJ. Serious complications of endodontic infections: some cautionary tales. Aust Dent J 1997;42:156-9.
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