Gregori M. Kurtzman, DDS, MAGD, FPFA, FACD, FADI, DICOI, DADIA
Justin D. Moody, DDS, DABOI, DICOI
Lisa Moler (Publisher)
Mali Schantz-Feld, MA, CDE (Managing Editor)
Tag team customer service
This year marks the 40th anniversary of Clifton Oral and Maxillofacial Surgery PA, and our commitment to customer service has never been greater. Patients are consumers in the truest sense of the word. They view dentistry as a service that can be provided in many different offices. And as such, they intend to be satisfied with the entire interaction. From the moment they contact the office for the first appointment, they are starting to form an opinion of the office. By the time they have met the doctor, they may have already formed an opinion about the quality of the office and the type of care they will receive.
In our practice, the staff is fully aware that their interactions with the patients before and once they arrive in the office are of the utmost importance. Assuming everything goes well, now it is time for the doctor to enter the picture. Assuming that the patients are “normal,” they are fearful, generally uneducated on the procedure that will be done, and have real concerns about the cost and possible pain. Now the doctor must establish a relationship, review their medical history, explain the patient’s condition, give a treatment plan and options, and answer any questions the patient may have. All of this must be done in a relatively short period of time. The manner and quality in which all of these above-mentioned tasks are achieved will either convince the patient to have the treatment with this doctor or seek treatment elsewhere.
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ISSN number 2372-9058
In addition to the way in which the staff handles themselves, taking time to explain things to the patient, not rushing through the four steps above, and truly showing that you care for the patient is essential to establishing excellent customer service. In our office, we are champions of customer service and provide quality care in a compassionate environment. From the moment the patient first speaks to the initial staff member to the ultimate goodbye at the final postoperative visit, our patients know that, although they don’t want to be in our office, they have come to a special place and have received quality care. The doctors routinely receive unsolicited compliments about our staff. And we ask every patient to write a review. Why? Because Google is where patients look for information. This is where they can hear other patient’s stories and understand what others think of the doctors and staff. This information will allow the patient to decide whether or not to call the office and make that first appointment!
I mentioned above that we are champions of customer service and quality oral surgery care. Now I can support this by mentioning that we have surpassed our 1000th Google review with a 4.9 rating. We are extremely proud of this achievement. For more than a decade, Dr. Lindsay Scoggins has embraced this mission. She embodies the goal noted above of providing superb customer service and quality care in a compassionate environment. Leadership in the office starts from above, and Dr. Scoggins sets the tone for this daily. Shortly you will hear her life, journey, and thoughts. I’m sure you will agree that she is an outstanding provider in all aspects. And if you need more proof, take a moment to read her Google reviews! Dr. Glenn Gorab
Glenn N. Gorab, DMD, is the founder of Clifton Oral & Maxillofacial Surgery in New Jersey. He received his dental degree from Fairleigh Dickinson University and pursued his general practice residency and oral and maxillofacial surgery residency at Jersey City Medical Center. He is board certified by the American Board of Oral and Maxillofacial Surgery and is an active attending at St. Mary’s General Hospital in Passaic, New Jersey. He is a member of the American Dental Association, New Jersey Dental Association, Passaic County Dental Association, American Association of Oral and Maxillofacial Surgeons, New Jersey Society of Oral and Maxillofacial Surgeons, and American Society of Dental Anesthesiology.
Dr. Glenn Gorab
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Dr. William J. Maloney provides guidance on modifications that may be needed in the treatment of special needs patients
TAG Dental
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A fresh beginning and a grateful heart
American Poet T.S. Eliot wrote, “Every moment is a fresh beginning.” These words have become my North Star — my entire journey with MedMark has been a tapestry of transformative new beginnings, each one more meaningful than the last.
Lisa Moler Founder, MedMark Media
Looking back on these incredible 21 years, my heart is full thinking about how we’ve scaled our impact within the dental community. When I founded Doctor of Dentistry back in 2004, it felt like launching a passion project into the unknown. But watching it evolve, and then witnessing the game-changing expansion with Implant Practice US and Endodontic Practice US in 2007, followed by Orthodontic Practice US in 2009, and Dental Sleep Practice in 2014 — each launch was like watching my children take their first steps. Through this incredible journey, we’ve successfully published 297 publications to date since MedMark’s inception — that’s countless late nights, early mornings, weekend marathons, and probably tens of thousands of road-warrior travel hours poured into every single issue. Each publication represents not just content, but sleepless nights, endless revisions to ensure excellence, and the unwavering commitment to advancing our profession. The authentic connections I’ve built with some of the most visionary minds in dentistry have been nothing short of life-changing.
When MedMark became part of the Nexus Dental Systems family in 2020, it marked a pivotal moment in our growth story. Now, as I step into my next-level adventure as Chief Marketing Officer for Nexus Dental Systems, I’m overwhelmed with gratitude. I’ll still be championing the dental community, driving purpose-driven innovation at the intersection of dental and medical breakthroughs. And MedMark? Our publications will continue disrupting the status quo, empowering excellence across all specialties while scaling our content reach and finding new ways to innovate.
These 2 decades have been the most beautiful discovery — our dental community isn’t just an industry, it’s a family of mission-driven change-makers, visionary innovators, and most importantly, treasured friends who have enriched my life beyond measure. The relationships I’ve built with these healthcare heroes, these brilliant minds determined to revolutionize patient care, have become some of the most meaningful friendships of my lifetime. Every revolutionary thought leader, inventor, and disruptor I’ve had the privilege to know personally hasn’t just shared their next-generation technologies with me — they’ve shared their hopes, their dreams, their breakthrough moments, and even their setbacks over countless conversations that turned strangers into lifelong friends.
Our publications became so much more than a showcase for disruptive innovations in imaging, instrumentation, equipment, patient communication, and practice management — they became the bridge that connected hearts and minds. We’ve amplified the voices of clinicians who became dear friends, brave souls willing to challenge outdated paradigms and pioneer bold new methodologies. Every single author who graced our pages didn’t just bring their expertise — they brought their authentic selves, their infectious passion, and often, their friendship. What started as professional relationships blossomed into an ecosystem where readers don’t just
Published by
Editor in Chief, Publisher, and Senior Strategic Advisor
Scott S. De Rossi, DMD, MBA scott.derossi@nexusdentalsystems.com
Managing Editor Mali Schantz-Feld, MA, CDE mali@medmarkmedia.com Tel: (727) 515-5118
Director of Business Development Adrienne Good agood@medmarkmedia.com Tel: (623) 340-4373
Director of Publishing Amanda Culver amanda@medmarkmedia.com
Director of Operations Melissa Minnick melissa@medmarkmedia.com
Director of Marketing Amzi Koury amzi@medmarkmedia.com
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become industry leaders — they become mentors, collaborators, and genuinely cherished friends.
I’m tearing up just thinking about the incredible people I’ve encountered on this journey. Some of my closest confidants, the people I turn to for advice, the friends who celebrate my victories and support me through challenges — many of them came from this extraordinary profession. I have always said that I didn’t find my dental profession; it found me. It has been a career built on divine alchemy and serendipitous moments. Twenty years of shared experiences, industry events that felt more like family reunions, deep conversations about life, work passions that turned into lifelong friendships, and a network of support that extends far beyond business cards and LinkedIn connections. This community has given me a chosen family I never expected to find. And for that, I am eternally grateful.
Our content strategy has always been laser-focused on real-time relevance and community impact. We survived even during the darkest chapter of the pandemic shutdown; our team’s resilience was extraordinary. We pivoted to address the moment’s most pressing challenges — how to continue serving patients with unwavering safety protocols for patients, staff, and doctors. Watching the rise of tele-dentistry and other innovative platforms during that time, seeing our community’s incredible
adaptability of hope — it was a masterclass in transformation that redefined the entire profession, and one that I was proud to be a part of.
But never fear, MedMark publications will continue their exponential growth trajectory, serving our loyal community with cutting-edge topics, breakthrough innovations, and an unwavering commitment to helping you scale the successful businesses of your dreams. I’m thrilled to welcome our new Publisher/Editor in Chief Scott S. De Rossi, DMD, MBA, and I’m genuinely excited about the fresh perspective and seasoned expertise he’ll bring to our brand. Scott is a true professional and one of the best author/writers that I’ve had the pleasure to be associated with lately. Look for his contributions to be informative, smart, and engaging!
As I embark on this new adventure, my heart is filled with excitement while simultaneously overflowing with pride for what we’ve built together from the ground up. I’ll always be part of this incredible MedMark family, and my commitment remains rock-solid — I still remain in our industry to empower your journey to unprecedented success!
With endless gratitude, anticipation for the new journey, and always…to your best success!
Lisa Moler
Implant dentistry demands more than skill — it requires equipment you can trust. The Boyd E530 Exam & Treatment Chair combines steel-frame stability with ergonomic comfort to support long procedures with ease.
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A journey in progress: my path to oral and maxillofacial surgery
Dr. Lindsay Scoggins finds the intersection of science, art, and people
My life journey to become an oral surgeon is constantly evolving and has been shaped by unique life experiences, motivation, and determination. At an early age, my parents recognized my independent nature and promoted diverse activities for education and travel that have grown my capabilities for empathy and understanding — qualities that now influence how I care for patients.
Pursuing dentistry was a natural progression. I excelled at the sciences at school and took elective and summer courses in woodshop, photography, and art. I studied abroad while at University of Maryland and traveled to various areas of the world, including Australia, Vietnam, Laos, and Europe. I discovered that dentistry allowed me to treat people from unique backgrounds that shape their expectations of care. Understanding this has helped me to develop a sense of trust with my patients and allowed me to offer the ideal blend of technical skill and human connection.
Discovering oral and maxillofacial surgery
Initially intending to become a general dentist, I found my true calling in Oral and Maxillofacial Surgery during my first 2 years at the University of Medicine and Dentistry of New Jersey. Courses in anatomy and pathology captured my interest, and clinical exposure confirmed the path forward.
Dr. Lindsay Scoggins
Matching into the Jacobi/Beth Israel residency program was a turning point — it provided extensive training in trauma and orthognathic surgery and allowed me to stay close to my husband, whom I met in dental school. I am the daughter of a former school teacher and Department of Defense employee, with no relatives in medicine or dentistry.
Balancing career and family
I was born in Maryland and have spent nearly 25 years in northern New Jersey, embracing its diversity and richness. I began my career splitting time between private practice and a hospital setting. Soon, life at home also got a bit busier. I had two boys within 2 years, the second being born 1 month after I took my oral board exam. After several years in practice, I longed to be fully engaged with like-minded people, in a thriving and progressive oral surgery practice where I could be fully immersed and aligned with a unified culture.
Finding a home at Clifton Oral and Maxillofacial Surgery
Over 11 years ago, I stepped into Clifton Oral and Maxillofacial Surgery and immediately knew it was the right fit. Dr. Glenn Gorab, the founder, impressed me with his thoughtful approach and the practice philosophy: “Your Care, Our Commitment.” The environment was intentional, professional, and compassionate — exactly what I was seeking.
During that transition, I also was navigating early motherhood. To retain a sense of identity, I began marathon training. Running has become both a physical outlet and a mental space to reflect, plan surgeries, and build lasting friendships. To date,
I’ve run 15 marathons and continue to meet with running partners several mornings a week.
Compassion at the core of care
Regardless of a procedure’s complexity, my approach to care remains consistent — empathy, clear communication, and setting expectations. I recognize that even a routine surgery may carry deep emotional weight for a patient. I treat patients as I would family members or friends, taking my time to explain procedures and answer questions, and realizing that much of a patient’s fear of dentistry stems from the unknown.
The impact of dental implants and building a team-centered practice
Implants have become one of the most fulfilling aspects of my practice. In under an hour, I can restore oral function and confidence. Whether it is replacement of a congenitally missing lateral incisor, a 30-minute single implant procedure that a patient has been anticipating for 10 years, or a full-arch transformation, it is truly amazing what implants can do for a patient’s life. What makes our practice unique isn’t just the cutting-edge technology — scanners, guided surgery, PRF, lasers — but the warmth and attentiveness patients receive from our entire team. We aim to ensure each patient feels genuinely cared for from start to finish.
Partnering with Specialty1 Partners
Specialty1 entered the picture at the perfect time in my professional and private life. In our geographic area, at a time when several specialty practices were joining larger management
Dr. Lindsay Scoggins with a patient
Dr. Scoggins (left) discusses a case with Dr. Gorab (right)
groups, Specialty1 has served as a branch of support to our already spectacular team. To both patients and staff, the transition was seamless. We have continued to practice in the same manner as before the transition with regards to patient care, but Specialty1 has improved the business management component and has alleviated the stressors associated with practice management, all while allowing us to maintain the same clinical standards.
Continuous growth and collaboration
Work-life balance allows me to be present with my children while remaining fully engaged in my professional journey. Growth, however, requires ongoing learning. As co-chair of the Metro NJ ITI Study Club, I work alongside colleagues to explore every dimension of implantology. These meetings deepen our collective knowledge and raise the bar for patient outcomes. Within the office, collaboration between me and the other doctors helps to devise sound treatment plans for patients and obtain other perspectives for care. Dr. Gorab has 45 years of experience in treating patients, working with referrals, and managing the practice. Dr. El Hassan is a recent graduate and has a fresh perspective.
A practice built on passion and purpose
Clifton Oral and Maxillofacial Surgery is more than a workplace — it’s a community built on shared values. This is truly a team effort from a unique group of individuals that values patients and the practice as a whole. Our reputation is rooted in trust, skill, and heartfelt care. The compassion that patients experience at our office is what sets us apart from other practices. I feel fortunate to have found an office that is well supported, in a profession that I love. I look forward to what the future holds — for my practice, my patients, and my family. IP
Dr. Scoggins (left) with Dr. Gorab and Dr. El Hassan (far right)
The Clifton Oral and Maxillofacial Surgery team
Precision and predictability: a case study using the Panthera Fusion Bar™ and Shining 3D Photogrammetry for digital full-arch excellence
Mark Chan, DD, Andreas Klie, RDT, and Andriy Khomyn, DD, RDT, combine digital technology with a multidisciplinary approach for accuracy and efficiency
Introduction
The dental industry’s rapid technological advancements present a significant challenge for clinicians. Fortunately, solutions now exist to help them navigate this complex landscape. This article outlines the clinical journey from patient assessment to final prosthesis delivery, focusing on how digital technology and a multidisciplinary approach can lead to optimal outcomes.
Mark Samuel Chan, DD, SwissNF, received his diploma for Denturism in Toronto at George Brown College with honors. Currently Mark is practicing in Ontario, Canada, with a main focus on high-end removable and implant prosthetics. With a passion for both technical and clinical techniques, he is certified in Bio-logic, BPS, and SDC denture concepts and is an “Art of Denture” award winning Denturist. He is a sought-after international lecturer and opinion leader for many companies and the youngest recipient of the “George Connolly Memorial Award,“ one of Denturism’s highest and top honors.
Andreas Klie, RDT, Panthera Dental, is a Registered Dental Technologist with over 38 years of experience in the dental field. Andreas graduated as an RDT in South Africa in 1986. He founded La Lucia Dental Laboratory in 1991 and operated it until he came to Canada in 2001. In 2005, he became an RDT in Ontario. Andreas is a Senior Technical Expert and plays a major role in Panthera Dental’s strategy to incorporate more technical guides and articles into its portfolio. His experience as a dental technologist, combined with his field experience, allows him to offer customers precise and detailed solutions on a more technical level.
Andriy Khomyn, RDT, DD, Smile Care Denture Centre, is the founding Denturist behind Smile Care Denture Centre and a recognized leader in modern denture implant solutions. With a background in Dental Technology, he became a Registered Dental Technician (RDT) in Ontario in 2007 before advancing his expertise by completing the Denturism program with honors, earning his Denturist (DD) license. Andriy is a licensed BPS Denture provider and a skilled Suction Effective Mandibular Complete Denture (SEMCD) clinician. His pursuit of excellence has taken him across Canada and internationally, where he continuously integrates cuttingedge denture technologies into his practice. Beyond patient care, Andriy is deeply involved in denturist education. As a member of AIC Education Canada, he teaches lectures on locator dentures, immediate locators, and implant conversions, sharing his expertise with fellow professionals.
Patient presentation and referral
The patient, a 73-year-old female, was referred for consultation regarding a full upper denture and a partial lower denture.
Key findings
• Upper arch: Periodontally compromised with a poor prognosis for all remaining teeth.
• Lower arch: Retention of teeth Nos. 44, 43, 33, 34, and 37 (Universal Tooth Numbering System teeth Nos. 28, 27, 21, 22, and 18) was possible despite some pocketing.
• Primary concern: The patient experienced significant discomfort and mobility in the upper anterior teeth, making chewing difficult.
Referring clinician’s suggestions
• Address both arches simultaneously for better occlusion.
• Consider interim and final prostheses.
• Coordinate surgical timing with denture readiness.
Denturist exam and treatment plan discussion
During initial examination, the patient voiced strong opposition to a full upper denture with palatal coverage due to concerns regarding taste alteration and discomfort. To address patients’ concerns, we opted for an implant-supported fixed solution (teeth-in-a-day).
The patient was then referred to Aspen Oral Surgery, where Maxillofacial Surgeon Dr. Martin Cloutier performed a thorough evaluation and planned the subsequent procedures:
Surgical intervention
1. Extractions: All maxillary teeth were extracted.
2. Implant placement: Seven implants were immediately placed in the maxilla.
a. Six implants achieved high primary stability, enabling immediate function.
b. A seventh implant was placed for potential inclusion in the final prosthesis.
Immediate same-day conversion
After surgery, I (Andriy Khomyn) performed the chairside conversion of the All-on-X provisional prosthesis.
TECHNOLOGY
Steps
1. Provisional prosthesis: Adapted to the implant positions and secured with Multi-Unit Abutments (MUAs) for immediate function.
2. Fit and function: Adjustments were made to ensure proper fit, function, and esthetics.
3. Occlusal verification: Undue stresses were minimized to protect the implants during healing.
4. Night guard: A transitional night guard was provided to reduce stress on the implants and promote optimal healing. The immediate solution restored function and esthetics, greatly improving the patient’s confidence and comfort during the healing phase.
Six-month follow-up
Oral surgeon review and final torque test: Six months later, the patient returned to Dr. Cloutier for evaluation. He performed a final implant torque test to ensure implant integration and stability. The Multi-Unit Abutments (MUAs) were retorqued to their recommended specifications to confirm the implant stability before the fabrication of the final prosthesis.
Digital workflow: scanning for the definitive prosthesis
On the same day, the patient returned to my office for the final prosthesis workflow.
Pre-scan preparation
Temporary prosthesis assessment: The temporary fixed provisional was evaluated for fit and function.
Scanning process using the Shining Aoralscan Elite
A comprehensive scan was performed to record all anatomical landmarks, including the palate, residual ridge, implant positions, and opposing arch.
1. A detailed pre-op scan was performed before removing the temporary prosthesis. This is a vital step as the temporary serves as a blueprint for the final esthetics and occlusion.
First, the prosthesis is scanned in the patient’s mouth, followed by moving systematically from the anterior teeth to the posterior region on one side, and then repeating the process on the other side. I ensure I capture all surfaces — the occlusal, buccal, and palatal. It is important to scan the soft tissue contours around the prosthesis.
2. Soft tissue and opposing arch scans: After removing the temporary prosthesis, I scanned the upper arch soft tis-
sues, including the residual ridges and palate, to capture all anatomical details.
I used smooth, steady motions to ensure a complete scan without gaps or stitching errors, focusing on areas that would directly interact with the prosthesis for a clear, detailed scan of the soft tissue.
Next the opposing arch is scanned for occlusal alignment (Figure 1).
3. Implant Scan. Proper seating of scan bodies is crucial; even one scan body that isn’t fully seated can disrupt the entire digital workflow (Figure 2).
First, I scan fiducial (reference) markers. These markers allow the scanning software to accurately identify and align each implant’s position and orientation, ensuring precise digital mapping, which is essential for implant-supported prosthesis design and fabrication.
After the fiducial markers, I scan the scan bodies and surrounding soft tissue on one side of the arch, then proceed to scan all remaining scan bodies on the other side.
4. Next, I perform the bite registration. We reinsert the temporary prosthesis, ensuring proper seating prior to proceeding.
I ask the patient to bite into their natural centric occlusion and keep their bite steady. Then, I use the scanner to capture the buccal surfaces of both arches, starting at the midline and moving towards the posterior regions on both sides. The bite scan must show clear contact points and alignment; any discrepancies are corrected with adjustments and rescanning (Figure 3).
Stitching and verification
The scans of the implant positions and soft tissue were digitally stitched to create a seamless model.
Pre-op scan integration
The pre-op scan of the temporary prosthesis was overlaid with the implant scan data to guide the final prosthesis design.
I can manually inspect the alignment to confirm everything is accurate. If corrections are needed, I can easily address them at this point.
Finally, all scan data is exported as STL files and uploaded to Panthera Dental, with specific notes on tissue compression preferences, esthetic requirements, and the reference points from the pre-op scan.
Tips
• Take your time with the implant scan bodies. This is the foundation of the entire case, so precision is key
Figure 1
Figure 2
Figure 3
• Utilize your scanner’s AI to identify gaps or missed areas.
• Always verify the alignment of your scans before sending them to the lab. Small errors now can cause major issues later.
By following this workflow, I can ensure the prosthesis will fit precisely, function optimally, and meet the patient’s esthetic expectations. The Shining Aoralscan Elite has become an indispensable tool in my practice, streamlining the process and improving outcomes for complex implant cases like this one.
Laboratory phase
The digital scans were processed in exocad using the temporary prosthesis as a guide to design the patient’s final smile. This approach ensured the design mirrored the provisional’s esthetics and function while enhancing tissue adaptation and compression. Two designs were produced to evaluate tissue compression, as the intaglio surface of the final will be finished in highly polished titanium.
Importance of intaglio surface design
The intaglio surface of the prosthesis (tissue-facing) was carefully designed to be flat or slightly convex, which is essential because:
• It minimizes soft tissue irritation and ensures even pressure distribution.
• It reduces the risk of food entrapment and tissue overgrowth by avoiding concave designs.
• This design promotes healthier tissue and provides a better seal (Figure 4).
Prototyping with 3D printing
Two full-arch prototypes were printed using Rodin® Titan resin and were then used for clinical evaluations. This allowed us to:
• Evaluate fit: Confirm accurate seating on the implants and tissue adaptation.
• Verify tissue compression: Check the effectiveness of tissue support without causing discomfort.
• Assess esthetics: Confirm the final smile’s appearance and alignment in relation to the patient’s facial features.
• Ensure implant fit: Leveraging accurate implant scan data ensured that the bar would align perfectly with the implants, reducing stress and enhancing longevity.
• Guide esthetics: The provisional prosthesis’ pre-op scan provided a roadmap for replicating the desired smile, ensuring the patient’s expectations for appearance were met.
Full digital workflow for the manufacturing of the PFB
We were able to fully integrate the photogrammetry scans from Andriy into our workflow, designing and manufacturing the PFB for his patient.
The following scans (Figures 5, 6, 7, 8) were sent to Panthera as per the required scans to proceed with the design and manufacture of the PFB:
• Tissue scan;
• DESS scanbody;
• Post-op temp on the model; and
• Post-op temp off the model.
Using the received files and a specialized splitting protocol, Panthera designed the implant bar and overlay with a straight milling line, ensuring no undercuts for streamlined production and precise fit. The Panthera Fusion Bar (PFB) workflow offers various options in terms of overlay manufacturing: most choose to receive the overlay’s STL file for in-house milling in their preferred material. Alternatively, the overlay can be milled at Panthera for them — the option Andriy chose for this case (Figures 9 and 10).
After design completion, Andriy reviewed the case in the online 3D Viewer. The bar is shown in relation to the overlay a cross-sectional view allows to see the bar’s size and shape inside the overlay, as well as its position on the soft tissues. In this case, the bar measured 6 mm at its highest point and 3 mm at its low-
Figures 9 and 10
Figure 4
Figures 5-8: 5 (top left). Tissue scan. 6 (top right). Post op temp on the model. 7 (bottom left). DESS scanbody. 8 (bottom right). Post op temp off the model
est. Upon Andriy’s approval, the case proceeded to production (Figures 11 and 12).
Milling and finishing
Panthera offers various options for manufacturing cases. Andriy opted to have Panthera mill the zirconia. Panthera has also sent the STL overlay to Andriy to mill or print any additional overlays if needed.
The Zirconia overlay was milled with Vita YZ® ST. Andriy chose preparation A2 for the tooth base shade and Gingiva Light Pink (Figure 13 and 14).
The bar was trimmed, polished, and fitted on the model which was printed by Mark Chan for this case.
Panthera offers multiple choices for the bar finish. Andriy chose the sandblast and anodizing options. This provides the surface texture recommended for cementation, and the anodizing minimizes the dark grey titanium showing through the zirconia overlay (Figures 15 and 16).
The bar and the milled zirconia overlay were shipped to Andriy for his technician to complete the case (Figures 17 and 18).
Final prosthesis insertion
• Upon receiving the Panthera Fusion Bar, the bar and prosthesis were evaluated and confirmed for optimal fit and function.
• The final insertion went very smoothly, without any adjustments required.
• The lower cast partial denture was modified to achieve ideal bite management, ensuring proper occlusion with the new upper prosthesis.
• To protect the implants and maintain the occlusion, the patient was provided with a hard night guard.
This workflow maximizes accuracy and efficiency, ensuring seamless digital capture, design, and final prosthesis delivery for full-arch implant cases. The smooth insertion of the Panthera Fusion Bar demonstrates the importance of precise scanning and careful planning in achieving predictable outcomes (Figures 19-22).
Patient review
Following the procedure, the patient shared this review: “I am not one for writing reviews. There isn’t anything more I can say that hasn’t already been written in all the others before this one.
So I am just going to say thank you.
Andriy, you and your wonderful staff made a very distressing situation so incredibly easy.
I know it might sound a bit strange under the circumstances, but it has been fun.
To the people reading reviews to possibly make a decision as to which denture clinic to visit — there is no better than Smile Care Denture Centre.
You will be so pleased you did.
Thank you again.”
This heartfelt review reflects the positive experience and quality care provided throughout the process, highlighting the impact of a supportive and professional team.
This section highlights the clinical journey from patient assessment to the final prosthesis delivery (Figure 23).
Figures 11 and 12
Figures 15 and 16
Figures 17 and 18
Figures 13 and 14
Understanding NSAIDs: essential knowledge for dentists
Dr. Lisa Chan and Barbara Madej, RPh, review the benefits and drawbacks of NSAID use in the dental practice
Introduction
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are a widely used class of medications that effectively manage pain, inflammation, and fever by inhibiting cyclooxygenase (COX) enzymes responsible for prostaglandin production. In dental practice, NSAIDs play a crucial role in controlling pain and inflammation associated with common procedures such as extractions, root canals, and periodontal treatments. Their proven efficacy, accessibility, and non-opioid mechanism make them a preferred choice for both acute and chronic dental pain management.
The purpose of this article is to provide dental practitioners with comprehensive knowledge about NSAID use, including their mechanisms, benefits, risks, prescribing guidelines, and considerations for special populations, to ensure safe and effective pain management for patients.
How do NSAIDs work?
NSAIDs work by targeting enzymes in the body called cyclooxygenases (COX-1 and COX-2), which are essential for producing prostaglandins — hormone-like chemicals that promote inflammation, pain, and fever.
There are two main types of COX enzymes in the body: COX-1 and COX-2.1 Both enzymes are responsible for making prostaglandins, but the effects of these prostaglandins differ based on their origin:
Lisa Chan, DDS, co-founder and Chief Executive Officer, MedAssent DDS, has over 35 years of dentistry experience, including roles as a hospital dentist at Kaiser Permanente, a private practitioner, and a California State Dental Board consultant. With a DDS from USC, she focuses on promoting equity and integrated care, addressing challenges in patient safety. Dr. Chan also serves on educational and community boards, including Santa Monica College, UC San Diego, Los Angeles FBI, and the Salvation Army.
Barbara Madej, RPh, Chief Science Officer, MedAssent DDS, is a licensed pharmacist with a passion for improving lives through education on proper medication use. After earning her pharmacy degree from the University of Saskatchewan, she has served both Canada and Los Angeles, California. Through MedAssent DDS, Barbara aims to reduce medication errors at the intersection of dentistry and pharmacy, enhancing workplace efficiency and patient safety. Her lifelong goal is to make a meaningful impact in healthcare for all involved.
Disclosures: The authors of this article are affiliated with MedAssent DDS (www.medassentdds.com), a platform designed to support dental professionals in medication management and patient care.
Educational aims and objectives
This self-instructional course for dentists aims to provide dental practitioners with a comprehensive understanding of the mechanisms, benefits, and risks of nonsteroidal anti-inflammatory drug (NSAID) use in dental practice.
Expected outcomes
Implant Practice US subscribers can answer the CE questions by taking the quiz online at implantpracticeus.com to earn 2 hours of CE from reading this article. Correctly answering the questions will demonstrate the reader can:
• Identify the mechanisms of action of NSAIDs, including their impact on COX enzymes and prostaglandin production and their relevance to dental pain management.
• Recognize the benefits of NSAIDs as a non-opioid alternative for managing pain and inflammation in dental practice.
• View the risks and potential adverse effects of NSAIDs in patient populations with comorbid conditions, including gastrointestinal, cardiovascular, and renal complications.
• Realize the importance of tailoring NSAID prescribing practices based on individual patient factors, including age, medical history, and concurrent medications.
• Pinpoint strategies to educate patients on the safe use of NSAIDs, emphasizing proper dosing, duration, and awareness of drug interactions and side effects.
• COX-1 enzymes: These produce prostaglandins that help protect the stomach lining and intestinal tract from digestive acids, as well as thromboxane which regulates blood clotting. While COX-1 inhibitors block inflammation, they also interfere with these protective functions, potentially leading to side effects like stomach ulcers and bleeding.2 A common COX-1 enzyme used in dental practices is indomethacin.
• COX-2 enzymes: These primarily produce prostaglandins involved in inflammation and pain. By selectively blocking COX-2, these NSAIDs can reduce inflammation effectively without significantly affecting the protective prostaglandins made by COX-1.2,3 Celecoxib, etodolac, and meloxicam are common examples of COX-2 NSAIDs.
• Traditional NSAIDs (COX-1 & COX-2): These block both COX-1 and COX-2 enzymes. This dual action reduces
inflammation and alleviates pain by decreasing the production of prostaglandins involved in these processes, while also affecting prostaglandins that regulate other bodily functions like stomach lining protection and blood clotting. Many NSAIDs block both COX-1 and COX-2, although one can be better than the other depending on the medication. Some traditional NSAIDs include aspirin, ibuprofen, naproxen, diclofenac, ketorolac, ketoprofen, and nabumetone.
NSAID use in dentistry
NSAIDs are essential in dental pain management due to their effective dual action in alleviating pain and reducing inflammation.4,5 Acetaminophen is often used in combination with NSAIDs because of its complementary action. While most NSAIDs exert their effects peripherally by reducing inflammation and pain at the site of tissue injury, acetaminophen works centrally, inhibiting prostaglandin synthesis in the central nervous system.6 This complementary action blocks pain signal transmission centrally while NSAIDs address inflammation locally, making their combined use highly effective in managing mild to moderate pain.6
Key applications
1. Postoperative pain and inflammation management: NSAIDs are widely used after dental procedures, such as extractions, root canals, and periodontal surgeries, to reduce pain and swelling, promoting faster recovery and enhancing patient outcomes.
2. Adjunctive use in inflammatory conditions: NSAIDs have shown potential as adjuncts to controlling inflammation in dental conditions like periodontitis.7 By targeting localized swelling and pain, they may complement conventional periodontal treatments and aid in managing discomfort. However, their use should be carefully weighed against potential risks, highlighting the need for a tailored approach in incorporating NSAIDs into dental care plans.8
3. Non-opioid pain management alternative: In light of the opioid crisis, NSAIDs offer a safer, non-addictive alternative for pain management. This makes them particularly beneficial for patients at risk of dependency or those with a history of substance abuse.
4. Patient accessibility and compliance: NSAIDs are widely available both over-the-counter and by prescription, with various formulations (e.g., tablets, capsules, topical gels) that accommodate individual patient preferences. Their familiarity and convenience encourage adherence to pain management regimens, improving treatment outcomes.
Pharmacokinetics and pharmacodynamics
NSAIDs are well-absorbed after oral administration, typically reaching peak plasma concentrations within hours.9 Once in the bloodstream, they bind extensively to plasma proteins, primarily albumin, and are metabolized in the liver by enzymes like cytochrome P450 (e.g. CYP2C9, CYP3A4).9 These processes yield inactive metabolites that undergo further processing, often through glucuronidation, to enhance water solubility, facilitating excretion primarily via urine and, to a lesser extent, bile in the feces.10
The plasma half-life of NSAIDs closely determines their onset and duration of action.11 Short-acting NSAIDs, including aspirin, diclofenac, and ibuprofen, are effective for rapid relief of acute pain or inflammation due to their half-lives of less than 6 hours. Long-acting options like naproxen and celecoxib, with half-lives exceeding 10 hours, are better suited for managing chronic conditions such as arthritis, maintaining therapeutic levels over extended periods. Choosing between short- and long-acting NSAIDs depends on the clinical need for immediate relief versus sustained control of chronic symptoms.
Patient response to NSAIDs is influenced by pharmacokinetic profiles, genetic variations (e.g., CYP2C9 activity), and individual factors like age, organ function, and comorbidities.11 Personalized treatment strategies and clear communication are essential for optimizing outcomes, ensuring proper adherence to dosing schedules, and tailoring therapy to meet patient-specific needs.
Risks and side effects of NSAIDs
NSAIDs are effective medications but can cause a range of side effects, from mild to severe.12,13 Common mild side effects include:4
• Nausea, vomiting, bloating, and heartburn
• Dizziness, headache, and drowsiness
• Tinnitus (ringing in the ears)
• Diarrhea, constipation, and stomach discomfort
More serious complications may include:4
• Gastrointestinal (GI) toxicity: Ulcers, bleeding, or perforation
• Cardiovascular issues: Hypertension, heart attack, and stroke
• Kidney damage (nephrotoxicity) and liver damage (hepatotoxicity)
• Thrombocytopenia, hyperkalemia, and anemia
• Rare hypersensitivity reactions like Stevens-Johnson Syndrome
These risks underscore the importance of careful patient selection and ongoing monitoring during NSAID use.
Contraindications and special considerations
NSAIDs are contraindicated in specific situations, including:
• Patients undergoing coronary artery bypass graft (CABG) surgery for perioperative pain
• Individuals with known hypersensitivity to NSAIDs or aspirin
• Patients with a history of asthma, urticaria, or allergic reactions triggered by NSAIDs
Special caution is required for:
• Older adults
• Patients with a history of peptic ulcer disease (PUD) or GI bleeding
Prescription NSAIDs carry black box warnings for cardiovascular thrombotic events and GI risks. Similarly, prescription acetaminophen warns against hepatotoxicity, particularly at doses exceeding 4,000 mg/day, which can cause acute liver failure. In cases where NSAIDs are contraindicated, consider alternatives like acetaminophen or acetaminophen-based opiate combinations (e.g., Tylenol #3).
Risks with prolonged use
Chronic NSAID use increases the risk of severe complications, especially in older populations. These include:
• Peptic ulcer disease14 and acute kidney injury (AKI)15
• Worsening pre-existing conditions such as hypertension and heart failure
The inhibition of prostaglandin production — vital for protecting the GI mucosa and maintaining kidney function — can lead to gastrointestinal damage, reduced renal perfusion, and impaired drug clearance. Patients with moderate to severe renal issues or those on dialysis should be closely monitored, as NSAIDs can exacerbate renal dysfunction and increase the risk of AKI.15
Patient education
Educating patients on the safe use of NSAIDs is crucial. Key points to emphasize include:
• Use the lowest effective dose for the shortest duration.
• Avoid combining prescription and OTC NSAIDs to reduce adverse effects.
• Carefully review OTC medication labels to prevent duplicate or excessive dosing.
Patients should be informed about potential side effects and encouraged to report symptoms promptly. Clear communication helps minimize risks and maximize treatment effectiveness.
NSAID interactions with other medications
NSAIDs commonly interact with other medications, leading to adverse effects.3,17
Common drug interactions
• Other NSAIDs or aspirin: Co-administration increases the risk of gastrointestinal ulcers, bleeding, hypertension, and hyperkalemia.
• Corticosteroids (e.g. prednisone, methylprednisolone): Combination heightens the likelihood of GI bleeding, fluid retention, and hypertension.
• Anticoagulants (e.g. warfarin, rivaroxaban, dabigatran, apixaban, edoxaban): Combination significantly elevates the risk of serious bleeding.
• Methotrexate, lithium, phenytoin, and calcium channel blockers: Some NSAIDs, such as celecoxib, can increase blood levels of these drugs, raising the risk of nephrotoxicity.18
• Oral antidiabetic drugs: NSAIDs may increase the risk of hypoglycemia.
• Antifungals (e.g. fluconazole): Can elevate celecoxib levels, amplifying side effects.
• Quinolone antibiotics (e.g. ciprofloxacin, levofloxacin): May enhance the risk of central nervous system stimulation and seizures when combined with NSAIDs.
Patient risk factors
Special caution is necessary for patients with the following conditions, as NSAID use must be carefully monitored to prevent exacerbation:19
• Cardiovascular conditions (e.g., heart failure, uncontrolled high blood pressure, history of stroke or heart attack).
• Diabetes, bleeding disorders, or poorly managed chronic illnesses.
Best practices for safe NSAID use
1. Patient evaluation: Thoroughly review the patient’s medical history to identify potential risks or contraindications.
2. Appropriate NSAID selection: Choose the safest option based on the patient’s health status, and prescribe the lowest effective dose for the shortest duration.
3. Monitoring: Regularly assess kidney and liver function, particularly in long-term NSAID users.
4. Patient education: Inform patients about:
a. Risks of overuse or combining NSAIDs with other medications.
b. The importance of adhering to dosing instructions.
c. Recognizing early signs of adverse effects (e.g., gastrointestinal bleeding, swelling, unusual fatigue).
5. Reevaluation: Periodically reassess the need for NSAIDs and consider alternative therapies where appropriate. By understanding and mitigating potential interactions, healthcare providers can enhance patient safety and reduce the risks associated with NSAID therapy in dental practice.
Special considerations for pediatric, geriatric, and perinatal patients
Pediatrics
Prescribing NSAIDs for children requires careful attention to their unique needs.20
• Dosing and formulation: Always calculate doses based on weight to avoid toxicity, and choose age-appropriate formulations for ease of use.
• Precautions: Use NSAIDs cautiously in children with asthma or kidney problems, as these conditions can worsen with their use.
• Aspirin contraindication: Avoid aspirin in children under 18 due to the risk of Reye’s Syndrome, a rare but serious condition.
• Safer options: Ibuprofen is a well-studied and reliable choice for children when used at the right dose.
Geriatrics
For older adults, NSAIDs can be effective, but they come with increased risks due to age-related changes in the body.21,22
• Risks: For geriatric patients, increased sensitivity to NSAIDs, slower metabolism, and a higher likelihood of adverse effects, such as gastrointestinal bleeding, renal impairment, and cardiovascular complications, necessitate a more cautious approach.
• Strategies: Start with the lowest effective dose, limit how long the medication is used, and monitor regularly for any side effects.
Pregnant and breastfeeding patients
NSAIDs require extra caution during pregnancy and breastfeeding to protect both mother and child.23
• Pregnancy:
o In 2020, the FDA updated the prescribing information for prescription NSAIDs to highlight the risk of kidney problems in unborn babies, which can lead to low amniotic fluid levels (oligohydramnios). The updated guidance advises avoiding NSAIDs in pregnant women starting at 20 weeks of pregnancy, a change from the previous recommendation of 30 weeks.
o Avoid NSAIDs in the third trimester, as they can lead to serious complications for the baby, including renal injury, oligohydramnios, ductus arteriosus constriction, persistent pulmonary hypertension, necrotizing enterocolitis, and intracranial hemorrhage.
• Breastfeeding:
o NSAIDs generally result in low infant exposure through breastmilk and are considered safe, with ibuprofen and naproxen preferred over aspirin due to their more favorable risk profiles.
Best practices for NSAID prescribing
Effective dental pain management involves tailoring analgesics to the expected level of pain. These evidence-based guidelines offer a structured approach to prescribing based on pain severity:4
NSAIDS are a cornerstone of care that, when used thoughtfully, can profoundly impact a patient’s comfort and recovery.
Anticipated pain level: mild
For patients experiencing mild pain, a non-prescription NSAID is often sufficient:
• Oral analgesic option: Ibuprofen 200–400 mg as needed for pain, every 4 to 6 hours.
Anticipated pain level: mild to moderate
For mild-to-moderate pain, a fixed dosing schedule initially ensures better pain control, followed by as-needed administration:
• Oral analgesic option: Ibuprofen 400–600 mg on a fixed interval, every 6 hours for the first 24 hours. Then, ibuprofen 400 mg as needed for pain, every 4 to 6 hours.
For patients requiring longer-term pain management, meloxicam can be considered as an option due to its once-daily dosing and favorable safety profile when used appropriately.
• Meloxicam dosage:24 Start with 7.5 mg orally once daily, and adjust based on individual response. The maximum recommended daily dose is 15 mg. In patients undergoing hemodialysis, the dose should not exceed 7.5 mg/ day. To minimize gastrointestinal upset, it can be administered with food. Use the lowest effective dose for the shortest duration to align with treatment goals.
Anticipated pain level: moderate to severe
For moderate-to-severe pain, combining an NSAID with acetaminophen offers enhanced analgesic efficacy:
• Oral analgesic option: Ibuprofen 400–600 mg plus acetaminophen 500 mg on a fixed interval, every 6 hours for the first 24 hours. Then, ibuprofen 400 mg plus acetaminophen 500 mg as needed for pain, every 6 hours.
Anticipated pain level: severe
For severe pain, a combination of an NSAID, acetaminophen, and an opioid is recommended initially, with a step-down approach as pain diminishes:
• Oral analgesic option: Ibuprofen 400–600 mg plus acetaminophen 650 mg with hydrocodone 10 mg on a fixed interval, every 6 hours for 24 to 48 hours. Then, ibuprofen 400–600 mg plus acetaminophen 500 mg as needed for pain, every 6 hours.
After prescribing NSAIDs, careful monitoring is essential to ensure patient safety and prevent adverse effects.25 Key considerations include assessing kidney function through renal studies and liver health with liver function tests. Coagulation studies, such as prothrombin time and international normalized ratio (INR), are particularly important in patients on anticoagulants. A complete blood count (CBC) can help detect signs of anemia
or other blood-related issues, as well as symptoms of gastrointestinal bleeding. Patients should also be advised to monitor for warning signs of bleeding, such as nosebleeds, unusual bruising, blood in the stool or urine, or feelings of dizziness.26
Additionally, regular monitoring of blood pressure is necessary, as NSAIDs can contribute to hypertension, especially in patients with pre-existing cardiovascular conditions. These measures help identify potential complications early and ensure the safe, effective use of NSAIDs.
Case studies and clinical scenarios
The importance of thorough medication review and patient history cannot be overstated, as highlighted by the experiences of this paper’s co-authors.
Dr. Lisa Chan shared a harrowing case from her husband who is a hospitalist. A patient was prescribed ibuprofen by their dentist to manage dental pain. Soon after, they were rushed to the emergency room with severe gastrointestinal bleeding, requiring two pints of blood. The cause? The patient had already been taking celecoxib, another NSAID, prescribed by their physician. Similarly, over many years in pharmacy practice, Barbara Madej, RPh, encountered situations where combining NSAIDs with selective serotonin reuptake inhibitors (SSRIs) — such as citalopram, sertraline, fluoxetine, or paroxetine — significantly increased the risk of upper gastrointestinal bleeding. In these scenarios, careful consideration of the risks and benefits is crucial. When such combinations are unavoidable, co-prescribing a proton pump inhibitor (PPI) can help mitigate the risk of serious complications.
These examples highlight the critical importance of reviewing patient histories and checking for drug interactions before prescribing NSAIDs. A simple review of current medications using new, dentistry-specific technology such as the MedAssent DDS Digital Drug Handbook could have prevented the severe, avoidable outcomes in these cases.
Conclusion
NSAIDs are more than just a tool for managing dental pain — they are a cornerstone of care that, when used thoughtfully, can profoundly impact a patient’s comfort and recovery. Yet, their power comes with responsibility. As dental professionals, the choices we make in prescribing NSAIDs can mean the difference between relief and harm, between trust and fear.
Each patient brings a unique story, a medical history that demands our attention and respect. By taking the time to review drug interactions, anticipate risks, and educate our patients, we reinforce the trust they place in us that forms the foundation of excellent care.
REFERENCES
1. Cryer B, Feldman M. Cyclooxygenase-1 and cyclooxygenase-2 selectivity of widely used nonsteroidal anti-inflammatory drugs. Am J Med. 1998;104(5):413-421. doi:10.1016/s0002-9343(98)00091-6.
2. Qureshi O, Dua A. COX Inhibitors. [Updated 2024 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www. ncbi.nlm.nih.gov/books/NBK549795/
3. Cleveland Clinic. COX-2 inhibitors: Uses, side effects, and more. Cleveland Clinic website. Last reviewed: May 24, 2022. https://my.clevelandclinic.org/health/
drugs/23119-cox-2-. https://my.clevelandclinic.org/health/drugs/23119-cox-2-inhibitors. Accessed January 14, 2025.
4. American Dental Association. Oral analgesics for acute dental pain. American Dental Association. https://www.ada.org/resources/ada-library/oral-health-topics/oral-analgesics-for-acute-dental-pain. Updated February 2, 2024. Accessed December 18, 2024.
5. Pergolizzi JV, Magnusson P, LeQuang JA, Gharibo C, Varrassi G. The pharmacological management of dental pain. Expert Opin Pharmacother. 2020;21(5):591-601. doi:10. 1080/14656566.2020.1718651
6. Altman RD. A rationale for combining acetaminophen and NSAIDs for mild-to-moderate pain. Clin Exp Rheumatol. 2004;22(1):110-117.
7. Salvi GE, Lang NP. The effects of non-steroidal anti-inflammatory drugs (selective and non-selective) on the treatment of periodontal diseases. Curr Pharm Des. 2005;11(14):1757-1769. doi:10.2174/1381612053764878.
8. Ren J, Fok MR, Zhang Y, Han B, Lin Y. The role of non-steroidal anti-inflammatory drugs as adjuncts to periodontal treatment and in periodontal regeneration. J Transl Med. 2023;21(1):149. Published 2023 Feb 25. doi:10.1186/s12967-023-03990-2.
9. Verbeeck RK, Blackburn JL, Loewen GR. Clinical pharmacokinetics of non-steroidal anti-inflammatory drugs. Clin Pharmacokinet. 1983;8(4):297-331. doi:10.2165/00003088-198308040-00003.
10. Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochem Pharmacol. 2020;180:114147. doi:10.1016/j.bcp.2020.114147.
11. Davies NM, Skjodt NM. Choosing the right nonsteroidal anti-inflammatory drug for the right patient: a pharmacokinetic approach. Clin Pharmacokinet. 2000;38(5):377-392. doi:10.2165/00003088-200038050-00001.
12. NAPROSYN (naproxen). DailyMed website. National Library of Medicine. https:// dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8bff5df5-d856-4237-b6a8ae445b454844. Updated January 2 2025. Accessed January 14, 2025.
13. Harirforoosh S, Asghar W, Jamali F. Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications. J Pharm Pharm Sci. 2013;16(5):821-847. doi:10.18433/j3vw2f.
14. Drini M. Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Aust Prescr. 2017;40(3):91-93. doi:10.18773/austprescr.2017.037.
15. Lucas GNC, Leitão ACC, Alencar RL, Xavier RMF, Daher EF, Silva Junior GBD. Pathophysiological aspects of nephropathy caused by non-steroidal anti-inflammatory drugs. J Bras Nefrol. 2019;41(1):124-130. doi:10.1590/2175-8239-JBN-2018-0107.
16. Varga Z, Sabzwari SRA, Vargova V. Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drugs: An Under-Recognized Public Health Issue. Cureus. 2017;9(4):e1144. doi:10.7759/cureus.1144.
17. Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug-drug interactions with over-the-counter NSAIDs. Ther Clin Risk Manag. 2015;11:1061-1075. doi:10.2147/TCRM.S79135.
18. Kim SJ, Seo JT. Selection of analgesics for the management of acute and postoperative dental pain: a mini-review. J Periodontal Implant Sci. 2020;50(2):68-73. doi:10.5051/ jpis.2020.50.2.68.
19. Cleveland Clinic. Non-steroidal anti-inflammatory medicines (NSAIDs). Cleveland Clinic website. https://my.clevelandclinic.org/health/treatments/11086-non-steroidal-anti-inflammatory-medicines-nsaids. Updated July 24, 2023. Accessed January 14, 2025.
20. American Academy of Pediatric Dentistry. Useful Medications for Oral Conditions. The Reference Manual of Pediatric Dentistry. 2024-2025/ P. 644-651. https://www.aapd. org/research/oral-health-policies--recommendations/useful-medications-for-oral-conditions/. Accessed December 19, 2024.
21. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. Aging Dis. 2018;9(1):143-150. doi:10.14336/AD.2017.0306.
22. Buckinghamshire Healthcare NHS Trust/Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board. 299FM.5 Guideline For Prescribing Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) In Adults. https://www.bucksformulary.nhs.uk/docs/ Guideline_299FM.pdf. Published July 26, 2023. Accessed January 14, 2025.
23. Bloor M, Paech M. Nonsteroidal anti-inflammatory drugs during pregnancy and the initiation of lactation. Anesth Analg. 2013;116(5):1063-1075. doi:10.1213/ ANE.0b013e31828a4b54.
24. Boehringer Ingelheim Pharmaceuticals, Inc. Mobic (Celebrex) [package insert]. U.S. Food and Drug Administration. Revised March 2012. Accessed December 19, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020938s022lbl.pdf
25. Specialist Pharmacy Service. NSAIDs: Monitoring Requirements. Published June 22, 2021. Accessed December 19, 2024. https://www.sps.nhs.uk/monitorings/ nsaids-monitoring/.
26. de Jong JC, van den Berg PB, Tobi H, de Jong-van den Berg LT. Combined use of SSRIs and NSAIDs increases the risk of gastrointestinal adverse effects. Br J Clin Pharmacol. 2003;55(6):591-595. doi:10.1046/j.0306-5251.2002.01770.x.
Continuing Education Quiz
Understanding NSAIDs: essential knowledge for dentists CHAN/MADEJ
1. NSAIDs work by targeting enzymes in the body called cyclooxygenases (COX-1 and COX-2), which are essential for producing prostaglandins — hormone-like chemicals that promote ______.
a. inflammation
b. pain
c. fever
d. all of the above
2. ________ produce prostaglandins that help protect the stomach lining and intestinal tract from digestive acids, as well as thromboxane which regulates blood clotting.
a. COX-1 enzymes
b. COX-2 enzymes
c. CYP2C7 activity
d. Genetic deficiencies
3. _______ primarily produce prostaglandins involved in inflammation and pain.
a. COX-1 enzymes
b. COX-2 enzymes
c. Anticoagulants
d. Antidiabetic drugs
4. While most NSAIDs exert their effects peripherally by reducing inflammation and pain at the site of tissue injury, work(s) centrally, inhibiting prostaglandin synthesis in the central nervous system.
a. plasma proteins
b. cytochrome P450
c. acetaminophen
d. anticoagulants
5. NSAIDs have shown potential as adjuncts to controlling inflammation in dental conditions like periodontitis.
a. True
b. False
6. Patient response to NSAIDs is influenced by _______.
a. pharmacokinetic profiles
b. genetic variations
c. individual factors like age, organ function, and comorbidities
d. all of the above
Each article is equivalent to two CE credits. Available only to paid subscribers. Free subscriptions do not qualify for the CE credits. Subscribe and receive up to 16 CE credits for only $149; call 866-579-9496, or visit https://implantpracticeus.com/ subscribe/ to subscribe today.
n To receive credit: Go online to https://implantpracticeus.com/continuingeducation/, click on the article, then click on the take quiz button, and enter your test answers.
AGD Code: 010
Date Published: October 5, 2025
Expiration Date: October 5, 2028 2 CE CREDITS
7. Educating patients on the safe use of NSAIDs is crucial. One key point to emphasize is to use _________.
a. the lowest effective dose for the shortest duration
b. the highest effective dose for the longest duration
c. the highest effective dose for the shortest duration
d. the lowest effective dose for the longest duration
8. Quinolone antibiotics (e.g. ciprofloxacin, levofloxacin) may enhance the risk of central nervous system stimulation and seizures when combined with NSAIDs.
a. True
b. False
9. When prescribing NSAIDs for children, always calculate doses based on ________, and choose age-appropriate formulations for ease of use.
a. the parents’ own experience
b. weight to avoid toxicity
c. the likelihood of compliance
d. height
10. For geriatric patients, __________ necessitate(s) a more cautious approach.
a. increased sensitivity to NSAIDs
b. slower metabolism
c. a higher likelihood of adverse effects, such as gastrointestinal bleeding, renal impairment, and cardiovascular complications
d. all of the above
To provide feedback on CE, please email us at education@medmarkmedia.com Legal disclaimer: Course expires 3 years from date of publication. The CE provider uses reasonable care in selecting and providing accurate content. The CE provider, however, does not independently verify the content or materials. Any opinions expressed in the materials are those of the author and not the CE provider. The instructional materials are intended to supplement, but are not a substitute for, the knowledge, skills, expertise and judgement of a trained healthcare professional.
Dentistry for individuals with special needs
Dr. William J. Maloney provides guidance on modifications that may be needed in the treatment of special needs patients
While providing dental care, dentists must take into consideration that each patient is a unique individual who may require modifications to treatment in order to allay their fears and provide safe, comfortable, and effective dental treatment. Special needs patients often require individualized treatment due to a disability or medical condition that affects their ability to function on a daily basis. These individuals may have chronic illnesses or emotional, physical, mental, or learning disabilities that require special care while receiving dental treatment. It is imperative that special needs patients receive quality dental care on a regular basis. Failure to receive proper dental treatment can cause pain, poor oral health, and exacerbate already existing conditions which the individual is challenged by on a daily basis. The dentist is a vital and integral part of the special needs patient’s healthcare team and, as such,
William J. Maloney, DDS, PgCertMed, FACD, is presently an attending dentist at the BronxCare GPR program. He is a retired clinical associate professor at New York University College of Dentistry. Dr. Maloney holds a postgraduate certificate in healthcare writing from Harvard Medical School and practices in Rye and Scarsdale, New York. He is the author of hundreds of articles published worldwide.
Educational aims and objectives
This self-instructional course for dentists aims to discuss the role of dentists and their teams in tailoring treatment to patients who may have specific medical or physical conditions that affect the delivery of treatment in the dental practice.
Expected outcomes
Implant Practice US subscribers can answer the CE questions by taking the quiz online at implantpracticeus.com to earn 2 hours of CE from reading this article. Correctly answering the questions will demonstrate the reader can:
• Identify some ways to alter the practice’s environment to remove physical barriers to treatment areas.
• Realize some methods of providing a comforting emotional environment to reduce fear and anxiety for patients with special needs.
• Identify dental conditions that often are present in patients with specific special needs.
• Identify some useful strategies and tips for making the dental visit successful for a special needs child.
• Recognize some ways to handle obstacles such as volatile behavior.
must work collaboratively with the patient, caregivers, and family members as well as other healthcare providers.
We, as dentists, must look at our facilities through the eyes of our special needs patients. Often, these individuals face various barriers while seeking dental treatment, including difficulty accessing dental treatment and higher associated costs.1 When designing new dental facilities or renovating existing ones, it is highly advised to keep in mind the physical challenges these patients may encounter while seeking dental care in our facilities. Some of these considerations can include ramps for those who cannot use stairs and more spacious treatment areas which would help facilitate a more comfortable environment for the patients who need a wheelchair and their caregivers.
In many instances, especially for youthful patients, it is helpful to have a family member or trusted friend in the treatment area in order to calm the special needs dental patient. Having someone the patient trusts in the treatment area can help allay the patient’s fears and anxiety and, in turn, allow the dentist to provide dental care in a safer and more effective manner. Also, the trusted friend or caregiver often has knowledge of the individual’s triggers and coping mechanisms which can be shared with the dental team.
If the patient is an adult, different strategies may be helpful. Firstly, it is very important that the atmosphere of the dental setting is warm, calm, and relaxing.
Gentle music can always set the proper tone. Communication between the clinician and the special needs adult patient and the caregiver is absolutely essential. Effective communication techniques build rapport and trust between the dental professional and the patient. This connection leads to more effective and efficient dental treatment. As such, active listening is very important. The dental staff should listen carefully to the patient’s fears and concerns. This allows the dental team to understand and address their concerns and anxieties. As is true with any patient, the essential element of building a strong and successful relationship is trust. If patients trust the dental team, they will be much less likely to be uncooperative as effective communication aids the dental team in addressing issues that may be potential triggers.
Morning appointments can often be more suitable for both the adult and the pediatric special needs patient. This is true because the patient may be tired and more anxious in the afternoon.
Also, allow the patient to take breaks during the procedure. This gives the patients a sense of control over their surroundings. Tell the patient to give the dentist a predetermined sign whenever a break is needed. Sometimes just stopping for half a minute or so can allow the patient to catch their breath or rinse out and avoid any sudden attempt by the patient to stop the dental treatment.
Sedation options can be extremely helpful while treating both youthful and adult special needs patients. Nitrous oxide can calm the patient in a very efficient manner. Another benefit of sedation is it can help patients who may have a severe gag reflex. The appropriate form of sedation should be tailored to the individual’s specific conditions and in consultation with the special needs patient’s medical providers.
We, as dentists, must look at our facilities through the eyes of our special needs patients.”
Many times patients with special needs, especially children, have dietary issues such as restricted diets or sensory sensitivities.2 This can exacerbate existing oral challenges. In such cases, it is very important for the dentist to work with the caregiver and, if possible, a dietician in order for the caregiver to fully understand the effects of various food and beverages on the individual’s oral health.
Obtaining informed consent is essential before providing treatment to any dental patient, but additional challenges may present when treating a special needs patient. Such patients may have dfficulty with various forms of communication.
Visual aids and involving caregivers might be helpful in such circumstances. Also, some special needs patients, which obviously includes all minors, may not have the capacity to consent, which necessitates obtaining the consent from the patient’s legal guardian.3
Excessive tooth grinding or bruxism is often present in children with cerebral palsy4 as well as others with neurological or developmental conditions. This can lead to exposed dentin and thermal sensitivity, sleep disturbances, temporomandibular joint disorders, and fractures of the teeth. Many times, an occlusal guard is recommended. It is essential for the dentist to work collaboratively with the caregiver and other healthcare professionals to determine the underlying cause of the excessive tooth grinding if not already known.
Delayed eruption of both deciduous and permanent teeth in certain special needs children, such as those with Down syndrome, are often seen. In these children, delays in the normal eruption pattern may be up to 2 years.5 Some children with Down syndrome retain their deciduous teeth until up to 15 years of age.5 This commonly leads to both malocclusion and overcrowding.6 These orthodontic issues very frequently lead to serious dental concerns which the dentist must be both aware of and take actions to mitigate their effects. Such actions can include the use of fluoride therapies and an increased amount of time spent educating both the patient and caregiver on oral hygiene techniques.
Special needs patients most likely will be taking multiple medications. Some of these medications may cause various dental side effects. Some of these medications include anticoagulants (gingival hyperplasia, xerostomia, stomatitis), anticholinergics (xerostomia, bruxism), and muscle relaxants (xerostomia).7
There are many useful strategies and tips for making the dental visit successful for a special needs child. These tips include the following:8,9
1. Have a desensitization visit where the patient can become familiar with the environment.
2. Ask the caregiver what time of day the patient is most calm and cooperative.
3. Start the exam with fingers only.
4. Keep light out of eyes.
5. Praise good behavior.
6. If possible, ignore inappropriate behavior
7. Utilize the same staff and dental chair at each visit.
8. Minimize stimuli such as odors, sounds, and bright lights.
9. Ask permission before starting any dental treatment.
10. The patient might not give a verbal “OK” for you to start treatment. If they don’t try to stop you, consider that they have given you permission.
11. Including your entire staff including front desk personnel and dental assistants in the dental visit will make the patient feel more comfortable. This will also allow the patient to develop trust for the staff which will help lessen the patient’s fears and anxieties.
12. Make sure to ask if the patient has an allergy to latex before starting treatment as latex allergies are more common among individuals with developmental disabilities.
13. Have the special needs patient bring certain comfort items, such as a pillow, a stuffed animal, or a blanket, to the dental appointment to provide reassurance during the dental visit.
Special needs dental patients experience many obstacles to achieving ideal oral health. Some of these challenges include overcrowding, delayed eruption of teeth, and an increased incidence of dental caries. Homecare and oral hygiene are extremely important for everyone, but it is imperative for special needs patients that their oral hygiene and homecare are at a very high level. The importance of oral hygiene must be reinforced at every dental visit. Oral hygiene instructions must be regularly reviewed not only with the patient but, also with the patient’s caregiver. An electric toothbrush might be recommended for patients with manual dexterity difficulties. Home fluoride therapies also are recommended to combat their high incidence of dental decay. Also, working with an orthodontist may prove useful in order to correct overcrowding issues which can cause difficulty in keeping the teeth clean which can lead to dental decay.
A follow-up telephone call the day after the procedure to check on the well-being of the patient is a great way to both
address any questions or concerns which the patient or caregiver may have and also build and strengthen the all-important relationship between the patient and the dental team.
At times, special needs patients may exhibit volatile behavior. In such instances it is essential to ensure the safety of both the patient and staff. De-escalation techniques should be initially employed by using non-threatening and calming verbage and body language. Calmly reinforce positive and cooperative behavior while clearly telling the individual which behaviors are unacceptable along with the possible consequences of continued unacceptable behavior. At this time, it would be wise to discreetly call for assistance and/or consider ending the appointment. If the behavior does not cease, or there is potential risk of bodily harm to the patient or others, law enforcement should be notified. After the incident has been resolved, the details of the incident should be discussed with the entire dental team. An analysis of what happened and what caused it to occur should be discussed. Future dental treatment should be discussed as to how to avoid another negative event in the future. A referral to a specialized center for patients with special needs might be the best option for some individuals with complex special needs and for those individuals who do not respond to in-office techniques.
Special needs dental patients often present with unique challenges. Some of these challenges might be more significant than others and require significant modifications to the usual course of dental care delivery. However, the key to treating all special needs individuals is patience — taking the time to let the patient become familiar with the dental environment and allowing the patient to become comfortable in their surroundings. As a profession, it is our duty, responsibility, and most profound privilege to champion the oral health of patients with special needs.
REFERENCES
1. Machado KP. Overcoming obstacles to dental care for patients with special needs. Decisions in Dentistry. Available at: https://decisionsindentistry.com/ 2024/16/overcoming-obstacles-to-dental-care-for-patients-with-special-needs/. Published; October 20, 2024. Accessed: July 6, 2025.
2. Al-Mashhadani S, Nasser M, Alsalami A, Burns L, Paisi M. Barriers and Facilitators to Dental Care Services Utilization Among Children With Disabilities: A Systematic Re-view and Thematic Synthesis. Health Expect. 2024 Oct;27(5):e70049. doi: 10.1111/hex.70049
3. Romer M. Consent, restraint, and people with special needs: a review Spec Care Dentist. 2009 Jan-Feb;29(1):58-66. doi: 10.1111/j.1754-4505.2008.00063.x
4. Oliveira CA, de Paula VA, Portela MB, Primo LS, Castro GF. Bruxism control in a child with cerebral palsy. ISRN Dent. 2011;2011:146915. doi: 10.5402/2011/146915. Epub 2010 Dec 1.
5. U. S. Department of Health and Human Services. Oral conditions in children with special needs. Accessed on July 4, 2025. Available at: https://www.in.gov/health/oralhealth/files/OralConditions_Special_Needs_Patients.pdf. Accessed July 17, 2025.
6. Penn Dental Medicine. Dental Management for Patients with Down Syndrome. Accessed on July 4, 2025. Available at: https://penndentalmedicine.org/patient-information/dentist-for-special-needs/down-syndrome-dental-management/. Accessed July 17, 2025.
7. University of Washington, Washington State Oral Health Program. Oral Health Fact Sheet for Dental Professionals: Children with Cerebral Palsy. https://Dental.washington. Edu/media/CP-dental.pdf. Accessed July 17, 2025.
8. Oklahoma Disabilities Council. Oral health care for children with special health care needs. https://oklahoma.gov/content/dam/ok/en/ddco/documents/publications/ Oral%20Healthcare%20for%20Children%20with%20Special%20Needs.pdf. Accessed August 10, 2025.
9. National Institute of Dental and Craniofacial Research. Developmental Disabilities & Oral Health. Available at: https://www.nidcr.nih.gov/health-info/developmental-disabilities. Accessed on July 15, 2015.
Continuing Education Quiz
Dentistry for individuals with special needs MALONEY
1. Special needs patients may have chronic illnesses, ______, or learning disabilities that require special care while receiving dental treatment.
a. emotional disabilities
b. physical disabilities
c. mental disabilities
d. all of the above
2. Failure to receive proper dental treatment can cause pain, poor oral health, and exacerbate already existing conditions which the individual is challenged by on a daily basis.
a. True
b. False
3. In many instances, especially for youthful patients, _______ in order to calm the special needs dental patient.
a. it is helpful to have a family member or trusted friend in the treatment area
b. it is necessary to separate the patient from his caregiver
c. it is necessary to play loud, fast music
d. do not allow the patient to speak with anyone other than the dentist
4. _______ can often be more suitable for both the adult and the pediatric special needs patient.
a. Evening appointments
b. Afternoon appointments
c. Morning appointments
d. Weekend appointments
5. Allow the patient to take breaks during the procedure.
a. True
b. False
6. Sedation options _______ while treating both youthful and adult special needs patients.
a. should not be an option
b. can be extremely helpful
c. can interfere with successful treatment
d. are extremely dangerous and not recommended
7. When obtaining informed consent, _______ might be helpful in such circumstances.
Each article is equivalent to two CE credits. Available only to paid subscribers. Free subscriptions do not qualify for the CE credits. Subscribe and receive up to 16 CE credits for only $149; call 866-579-9496, or visit https://implantpracticeus.com/ subscribe/ to subscribe today.
n To receive credit: Go online to https://implantpracticeus.com/continuingeducation/, click on the article, then click on the take quiz button, and enter your test answers.
AGD Code: 750
Date Published: October 5, 2025
Expiration Date: October 5, 2028
a. visual aids
b. involving caregivers
c. just asking them repeatedly to sign
d. both a and b
CREDITS
8. Also, some special needs patients, which obviously includes all minors, may not have the capacity to consent, which necessitates ________.
a. letting the assistant sign the paper for them
b. obtaining the consent from the patient’s legal guardian
c. having the dentist’s lawyer present
d. speaking more loudly
9. Excessive tooth grinding or bruxism, often present in children with cerebral palsy as well as others with neurological or developmental conditions, can lead to exposed dentin and thermal sensitivity, ________.
a. sleep disturbances
b. temporomandibular joint disorders
c. fractures of the teeth
d. all of the above
10. Some children with Down syndrome retain their deciduous teeth until up to ______ years of age.
a. 6
b. 7
c. 10
d. 15
To provide feedback on CE, please email us at education@medmarkmedia.com
Legal disclaimer: Course expires 3 years from date of publication. The CE provider uses reasonable care in selecting and providing accurate content. The CE provider, however, does not independently verify the content or materials. Any opinions expressed in the materials are those of the author and not the CE provider. The instructional materials are intended to supplement, but are not a substitute for, the knowledge, skills, expertise and judgement of a trained healthcare professional.
Anaphylaxis preparedness in dental practices: what to know to be prepared
J. Wesley Sublett, MD, MPH, Board-Certified Allergist in Louisville, Kentucky, and Donald Cohen, DMD, from New York State, inform dentists on how to approach this dangerous allergic reaction
One of the most dangerous emergencies you may encounter in a dental office is anaphylaxis, a severe allergic reaction that can happen within minutes and can be fatal if not treated immediately with epinephrine. The American Dental Association (ADA) recommends that dental practices have plans in place for responding to allergic emergencies, including using epinephrine auto-injectors to treat anaphylaxis. We asked J. Wesley Sublett, MD, and Donald Cohen, DMD, about the key facts every dental practice should know about anaphylaxis and how to prepare for it.
Q: What are common triggers for anaphylaxis in a dental office?
Dr. Cohen: The most common triggers of anaphylaxis in dental practice are antibiotics, antiseptics, and latex-containing products, such as gloves, bite-wing tabs, adhesive tape, and rubber dams. But these are not the only possible triggers.1 Medications, such as NSAIDs, local anesthetics, sedatives, and the materials used in endodontics and impressions can also cause anaphylaxis.1
Q: What are the symptoms of anaphylaxis?
Dr. Sublett: Because anaphylaxis is life-threatening and can occur quickly, it’s critical for dentists and their staff to recognize symptoms and respond immediately. Symptoms can occur in a number of different systems in the body.2 For example, there may be skin changes, including rash, hives, redness, itching, or swelling below the skin surface. The patient’s mouth, throat, or tongue can become swollen, causing swallowing or breathing difficulties such as wheezing or rapid breathing. The patient may experience nausea, vomiting, or other gastrointestinal symptoms. Cardiac symptoms, such as rapid heartbeat and a drop in blood pressure, can also occur.
Q: How can dentists and their staff treat anaphylaxis when it happens in the office?
Dr. Sublett: Epinephrine is the first-line treatment for anaphylaxis,4 and administering epinephrine early has been shown to reduce the risk of hospitalization and life-threatening consequences.5,6 A dose of epinephrine appropriate to the patient’s weight class should be given immediately.7 I recommend Intramuscular Injection (IM), as it is a proven route of administration that reliably delivers the full dose of epinephrine and whose effects have a rapid onset.8 The ADA recommends that practices
have a plan in place, which includes using epinephrine to deliver a premeasured dose to treat anaphylaxis.7
In addition, the World Allergy Organization Anaphylaxis Guidance recommends implementing the following protocol immediately if anaphylaxis is suspected:5
1. If the trigger can be identified, remove it immediately (if feasible).
2. Activate emergency medical services.
3. Assess the patient’s vitals and weight.
4. And, simultaneously, give the weight-appropriate dose of epinephrine.
5. If necessary, give the patient high-flow supplemental oxygen via a face mask.
Q: What are considerations during surgery for administering epinephrine to respond to anaphylaxis?
Dr. Cohen: Since use of a nasal cannula is common during dental surgery,10 I recommend IM epinephrine since it can easily be given during use of a nasal cannula and IV.
Q: When choosing an epinephrine device, what features should dental practices consider?
Dr. Sublett: Epinephrine auto-injectors, like AUVI-Q, simplify administration during an emergency because they can be administered through clothing and are pre-measured with a weight-appropriate dose to keep anaphylaxis symptoms from
J. Wesley Sublett, MD, (left) and Donald Cohen, DMD (right)
Is Your Dental
Practice Prepared?
It’s critical to recognize the symptoms of anaphylaxis and to respond quickly.
Choose a Dental Kit that includes AUVI-Q
• Can administer epinephrine through clothing
• Features voice instructions to help users confidently administer epinephrine
• Is the only epinephrine device available in three weight-appropriate doses
• Common adverse reactions to epinephrine include anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties.
Indication
Scan code to equip your practice
AUVI-Q (epinephrine injection, USP) is indicated in the emergency treatment of allergic reactions (Type I) including anaphylaxis to allergens, idiopathic and exercise-induced anaphylaxis. AUVI-Q is intended for patients with a history of anaphylactic reactions or who are at increased risk for anaphylaxis.
Important Safety Information
AUVI-Q is intended for immediate self-administration as emergency supportive therapy only and is not a substitute for immediate medical care. In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care. Each AUVI-Q contains a single dose of epinephrine for single-use injection. More than two sequential doses of epinephrine should only be administered under direct medical supervision. Since the doses of epinephrine delivered from AUVI-Q are fixed, consider using other forms of injectable epinephrine if doses lower than 0.1 mg are deemed necessary.
Please see additional Important Safety Information on next page, and full Prescribing Information and Patient Information available at www.auvi-q.com.
The only epinephrine device with voice instructions.
Designed to provide confidence from start to finish—no experience required.1-3
A calm voice in a moment of anxiety
Voice instructions guide users through administration during anaphylaxis.
Simply press and hold
For 2-second administration that patients may not even feel.
Important Safety Information (continued)
Hear the voice instructions for yourself
Reassuring dose delivery confirmation LED lights flash red and voice instructions confirm administration.
Scan code to equip your practice
AUVI-Q should ONLY be injected into the anterolateral aspect of the thigh. Do not inject intravenously, or into buttock, digits, hands, or feet. Instruct caregivers to hold the leg of young children and infants firmly in place and limit movement prior to and during injection to minimize the risk of injection-related injury.
Rare cases of serious skin and soft tissue infections have been reported following epinephrine injection. Advise patients to seek medical care if they develop any of the following symptoms at an injection site: redness that does not go away, swelling, tenderness, or the area feels warm to the touch.
Epinephrine should be administered with caution to patients with certain heart diseases, and in patients who are on medications that may sensitize the heart to arrhythmias, because it may precipitate or aggravate angina pectoris and produce ventricular arrhythmias. Arrhythmias, including fatal ventricular fibrillation, have been reported in patients with underlying cardiac disease or taking cardiac glycosides or diuretics. Patients with certain medical conditions or who take certain medications for allergies, depression, thyroid disorders, diabetes, and hypertension, may be at greater risk for adverse reactions. Common adverse reactions to epinephrine include anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties.
Please see the full Prescribing Information and the Patient Information available at www.auvi-q.com.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088
References: 1. Kessler C, et al. Usability and preference of epinephrine auto-injectors: Auvi-Q and EpiPen Jr. Ann Allergy Asthma Immunol. 2019;123(3):256-262. 2. Turner P, et al. Pharmacokinetics of adrenaline autoinjectors. Clin Exp Allergy. 2022;52(1):18-28. 3. Camargo CA Jr, et al. Auvi-Q versus EpiPen: preferences of adults, caregivers, and children. J Allergy Clin Immunol Pract. 2013;1(3):266-272. e1-e3.
and
progressing. AUVI-Q is the only epinephrine device available in three weight-appropriate doses: 0.1 mg for young children weighing 16.5-33 pounds, 0.15 mg for children weighing 33 to 66 pounds, and 0.3 mg for adults and children weighing 66 pounds and above.
In addition, AUVI-Q has voice instructions that guide untrained users through administration during a moment of anxiety. In a recent usability study, users of AUVI-Q were significantly more likely to correctly demonstrate its use compared to other epinephrine auto-injectors.14
Q: What other steps can dental practices take to ensure their anaphylaxis preparedness?
Dr. Cohen: It’s critical to ensure the dental team is always prepared and confident in their ability to respond to allergic emergencies. To this end, regular team training in recognizing anaphylaxis and how to properly use emergency devices, like AUVI-Q, is essential.15
Dental practices should also keep emergency medical kits on hand.15 The ADA Member Advantage program has endorsed HealthFirst as its exclusive provider of dental emergency medical kits for ADA members. Dental professionals can learn more about emergency kits from HealthFirst that include AUVI-Q by visiting healthfirst.com/EMK.
Disclosure: Dr. Sublett is a paid advisor of Kaléo This information was provided by Kaléo.
Indication
AUVI-Q® (epinephrine injection, USP) is indicated in the emergency treatment of allergic reactions (Type I) including anaphylaxis to allergens, idiopathic and exercise-induced anaphylaxis. AUVI-Q is intended for patients with a history of anaphylactic reactions or who are at increased risk for anaphylaxis.
Important Safety Information
AUVI-Q is intended for immediate self-administration as emergency supportive therapy only and is not a substitute for immediate medical care. In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care. Each AUVI-Q contains a single dose of epinephrine for single-use injection. More than two sequential doses of epinephrine should only be administered under direct medical supervision. Since the doses of epinephrine delivered from AUVI-Q are fixed, consider using other forms of injectable epinephrine if doses lower than 0.1 mg are deemed necessary.
AUVI-Q should ONLY be injected into the anterolateral aspect of the thigh. Do not inject intravenously, or into buttock, digits, hands, or feet. Instruct caregivers to hold the leg of young children and infants firmly in place and limit movement prior to and during injection to minimize the risk of injection-related injury.
Rare cases of serious skin and soft tissue infections have been reported following epinephrine injection. Advise patients to seek medical care if they develop any of the following symptoms at an injection site: redness that does not go away, swelling, tenderness, or the area feels warm to the touch.
Epinephrine should be administered with caution to patients with certain heart diseases, and in patients who are on medications that may sensitize the heart to arrhythmias, because it may precipitate or aggravate angina pectoris and produce ventricular arrhythmias. Arrhythmias, including fatal ventricular fibrillation, have been reported in patients with underlying cardiac disease or taking cardiac glycosides or diuretics. Patients with certain medical conditions or who take certain medications for allergies, depression, thyroid disorders, diabetes, and hypertension, may be at greater risk for adverse reactions. Common adverse reactions to epinephrine include anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties.
Please see the full Prescribing Information (https://bit.ly/4j9fPAQ) and the Patient Information (https://bit.ly/4iZ2o6o).
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Emergency dental kits from HealthFirst
REFERENCES
1. Goto T. Management of Anaphylaxis in Dental Practice. Anesth Prog. 2023;70(2):93-105. doi: 10.2344/anpr-70-02-16. Epub 2023 Jun 28.
2. Jevon P, Shamsi S. Management of anaphylaxis in the dental practice: an update. Br Dent J. 2020 Dec;229(11):721-728. doi: 10.1038/s41415-020-2454-1. Epub 2020 Dec 11.
3. Asthma and Allergy Foundation of America (AAFA). Food Allergy Anaphylaxis in Infants and Toddlers. https://aafa.org/asthma-allergy-research/our-research/food-allergy-anaphylaxis-in-infants/. Accessed March 24, 2025.
4. Brown JC, Simons E, Rudders SA. Epinephrine in the Management of Anaphylaxis. J Allergy Clin Immunol Pract. 2020 Apr;8(4):1186-1195. doi: 10.1016/j.jaip.2019.12.015. Erratum in: J Allergy Clin Immunol Pract. 2021 Jan;9(1):604. doi: 10.1016/j.jaip.2020.11.035.
5. Bock SA, Muñoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol. 2007 Apr;119(4):1016-1018. doi: 10.1016/j.jaci.2006.12.622. Epub 2007 Feb 15.
6. Fleming JT, Clark S, Camargo CA Jr, Rudders SA. Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization. J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):57-62. doi: 10.1016/j.jaip.2014.07.004. Epub 2014 Sep 8.
7. Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S, Geller M, Gonzalez-Estrada A, Greenberger PA, Sanchez Borges M, Senna G, Sheikh A, Tanno LK, Thong BY, Turner PJ, Worm M. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020 Oct 30;13(10):100472. doi: 10.1016/j.waojou.2020.100472.
8. HealthFirst. Dr. Malamed: The Importance of Epinephrine Auto-Injectors. https://www. healthfirst.com/videos/dr-stanley-malamed-the-importance-of-epinephrine-auto-injectors/. Accessed March 24, 2025.
9. American Academy of Pediatric Dentistry. Managing Professional Risks, ADA Guidelines for Practice Success™ (GPS™), ADA Tip Sheet on Managing Patients’ Medical Emergencies. https://www.aapd.org/globalassets/media/safety-toolkit-2.0/tip-sheet-on-managingpatients-medical-emergencies.pdf. Accessed March 24, 2025.
10. Becker DE, Rosenberg MB, Phero JC. Essentials of airway management, oxygenation, and ventilation: part 1: basic equipment and devices. Anesth Prog. 2014 Summer;61(2):78-83. doi: 10.2344/0003-3006-61.2.78.
11. Krishnamurthy M, Venugopal NK, Leburu A, Kasiswamy Elangovan S, Nehrudhas P. Knowledge and attitude toward anaphylaxis during local anesthesia among dental practitioners in Chennai - a cross-sectional study. Clin Cosmet Investig Dent. 2018 Jun 28;10:117-121. doi: 10.2147/CCIDE.S159341.
12. Çetinkaya F, Sezgin G, Aslan OM. Dentists’ knowledge about anaphylaxis caused by local anaesthetics. Allergol Immunopathol (Madr). 2011 Jul-Aug;39(4):228-231. doi: 10.1016/j. aller.2010.07.009. Epub 2011 Jan 13.
13. Smereka J, Aluchna M, Aluchna A, Szarpak Ł. Preparedness and attitudes towards medical emergencies in the dental office among Polish dentists. Int Dent J. 2019 Aug;69(4):321328. doi: 10.1111/idj.12473. Epub 2019 Mar 7.
14. Zhang E, Sicherer S, Agyemang A. Proper use of epinephrine autoinjectors is related to device type, prior physical demonstration, and sociodemographic factors. J Allergy Clin Immunol Pract. 2025 Feb;13(2):418-420.e1. doi: 10.1016/j.jaip.2024.11.006. Epub 2024 Nov 19.
15. Rosenberg M. Preparing for medical emergencies: the essential drugs and equipment for the dental office. J Am Dent Assoc. 2010 May;141 Suppl 1:14S-19S. doi: 10.14219/jada. archive.2010.0351.
Dr. Yitzchak Mashiach discusses his experience with this user-friendly and efficient implant system
Ihave been working with TAG Dental for more than 8 years and have observed a very satisfying success rate of their implants, both in the short term and long term. To date, I am placing about 3,000 implants per year, and so far 50,000 in total.
The service provided by TAG Dental is highly professional and has always met my complete satisfaction. The company offers a full range of rehabilitation options, both digital and manual. They also provide various types of implants in unique and appealing sizes.
TAG Dental offers an implant system that is user-friendly and efficient. All rehabilitation platforms are compatible with all implant diameters, providing flexibility and ease of use. The surgical kit is easy to use as well and includes stoppers. Additionally, the hexagonal implant diameters are compatible with those of many other leading implant systems.
One of TAG Dental’s advantages is that all implant diameters — from 3.3 mm to 6 mm — use the same rehabilitation platform. The system includes implants up to 16 mm in length, as well as short implants as small as 6 mm. The implant itself has a very strong grip in the bone and is ready for immediate load.
Titanium Grade 23 (Ti-6Al-4V ELI) is a popular titanium alloy in dental implants due to its excellent biocompatibility, high strength, and corrosion resistance.
Key benefits
• High mechanical strength and resistance
• Well-tolerated by the body, ideal for long-term use
• Bonds effectively with bone for stable implant placement
• Commonly used in dental implants, abutments, attachments, overall prosthetics, crowns, bridges, and other restorations.
With over 30 years of manufacturing experience by Noga-Medical, TAG Dental is committed to continuously improving the quality of its implants. The company consistently updates its technology and design to meet evolving clinical needs. Efforts are also made to offer competitive pricing without compromising on quality. The result is a truly state-of-the-art implant system that reflects TAG Dental’s dedication to excellence.
For more information, call the TAG Dental office at 585-824-3368, email: info@tagdent.com, or view catalog: https://tagdent.com/wp-content/uploads/2025/02/DL52545-Full-Catalog-1.8.24.pdf.
This information was provided by TAG Dental.
Dr. Yitzchak Mashiach is the Clinical Director at TAG Dental.
Dr. Yitzchak Mashiach
TAG Dental Premium Surgical Kit (top), Axis internal hex implant (left), and healing screw (right)
One connection fits ALL.
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