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Introduction The purpose of this study was to review evidence-based recommendations for the safe perioperative management of patients undergoing endodontic microsurgery who are currently taking antiplatelet or anticoagulant medications. Using the PICO (Population, Intervention, Comparison, Outcome) format, the following scientific question was asked: In patients taking anticoagulant or antiplatelet agents, what is the available evidence in the management of endodontic microsurgery? Methods MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov databases were searched to identify current recommendations regarding the management of antiplatelet and anticoagulant medications in the context of outpatient dental surgical procedures. Additionally, the authors hand searched the bibliographies of all relevant articles, the gray literature, and textbooks. Because of the lack of clinical studies and evidence on this subject, articles and guidelines from other organizations and association position statements were included. Results Because any minor surgery can become a major surgery, the treating doctor needs to best assess the risk of bleeding, especially if the surgery is anticipated to take longer than 45 minutes. Every patient should be stratified on a case-by-case basis. Consultation with the patient’s physician is highly recommended. Conclusions In order to maximize the effects of these medications (to prevent thrombosis) while minimizing the potential risks (procedural hemorrhage), clinicians should be aware of the best available evidence when considering continuation or discontinuation of antiplatelet and anticoagulant agents perioperatively for endodontic microsurgery. Ideally, a joint effort from an expert panel for microsurgery would be warranted.

Acetaminophen is a popular, universally used, over-the-counter pain medication contained in more than 600 different products and available in a plethora of dosage forms. Acetaminophen is an important adjunct to manage postoperative dental pain in combination with a nonsteroidal anti-inflammatory drug such as ibuprofen. For the treatment of more severe pain, acetaminophen is often formulated with non-opioid and opioid agents. Because of the accessibility of acetaminophen and its widespread use, dental practitioners need to be cognizant of any significant safety concerns that may be associated with this drug, including acetaminophen toxicity. This article discusses the history of acetaminophen, its pharmacology, metabolism, and toxicity, as well as strategies to help address some of the potential safety issues with this medication, including unintentional overdosing.

Blood biochemistry values are routinely employed during clinical examinations to assess the health of the patient and to identify potential underlying conditions. No blood biochemistry data are currently available for Temminck’s pangolin (Smutsia temminckii), a species that is being confiscated from both the domestic and international trade with increasing frequency, and this lack of data is hampering rehabilitation efforts. We determined haematological and serum biochemical values for ten Temminck’s pangolins rescued from the illegal wildlife trade in Zimbabwe and placed in the care of the Tikki Hywood Foundation as part of their rehabilitation. Our results suggest a large overlap in serum biochemistry and haematology values with previously reported values for other pangolin species, but also suggest some apparent differences. Haemoglobin, mean corpuscular haemoglobin and albumin:globulin ratio were positively correlated with mass, while alkaline phosphatase and amylase were negatively correlated with mass. Lymphocytes and monocytes were positively correlated with body condition, while mean corpuscular volume, alanine aminotransferase and total bilirubin were negatively correlated with condition. These results suggest that at least some parameters are independent of mass and are directly correlated with body condition and may therefore be informative in rapid health assessments of confiscated individuals.

The importance of effective local anesthesia delivery in dentistry cannot be overstated, as many dental procedures could not be performed without it. Despite the availability to oral healthcare professionals of various successful local anesthetics, the administration of local anesthesia continues to provoke anxiety among dental patients and remains an often unpleasant experience. A number of techniques may be utilized to help mitigate injection pain and improve the patient experience. This article reviews four strategies clinicians may consider to increase the effectiveness of their delivery of local anesthesia: warming or cooling of local anesthetic solutions, vibration and distraction techniques, liposomal encapsulation, an buffering or alkalinization of dental local anesthetics.

The aim of this review was to discuss the current and newly emerging antiresorptive medications and their potential implications for dental surgeries.The authors searched PubMed (MEDLINE), Cochrane, Embase, and other electronic databases for articles related to osteonecrosis of the jaw and medication-related osteonecrosis of the jaw (MRONJ). In addition, the authors hand searched the bibliographies of all relevant articles, the gray literature, textbooks, and guidelines in association position statements.The following information for MRONJ risk should be evaluated before any invasive dental procedure: metastatic carcinoma has a higher risk than osteoporosis; parenterally administered bisphosphonates and denosumab have a higher risk than orally administered bisphosphonates or antiangiogenic agents; dose and duration of medication received; adjunctive medications or combination of antiresorptive agents also may increase the risk of MRONJ; additive factors and comorbidities such as diabetes, autoimmune disease, immunosuppression, or any condition that might affect healing negatively would result in potentially higher risk of developing MRONJ; angiogenic inhibitors as part of a cancer treatment regimen, with or without antiresorptive medication, are considered high risk.Patients who received antiresorptive therapy for malignancy were at higher risk of developing MRONJ than those who received the therapy for osteoporosis, regardless of the route of administration and type of drug. Antiangiogenic agents, bevacizumab, aflibercept, and tyrosine kinase inhibitors such as sunitinib were implicated most commonly in the development of MRONJ. Patients who are taking multiple doses of angiogenic inhibitors should be monitored closely for early diagnosis of possible MRONJ.

Purpose To present the visual and safety outcomes of surgery for primary idiopathic macular holes including predictors of visual acuity and the impact of combined phacovitrectomy surgery. Design Registry-style, prospective, nonrandomized, observational cohort study. Participants Patients with idiopathic macular holes undergoing primary surgery. Methods Surgeons were invited to submit clinical details of all macular hole cases receiving surgery. Baseline demographic and clinical information, and details of surgical intervention were collected. Primary follow-up data were collected at 3 months postoperatively or before revision surgery, and surgeons were also asked to submit data at 12 and 24 months postoperatively. Main Outcome Measures Visual acuity improvement ≥15 letters and ≥0 letters, change in mean visual acuity, visual acuity ≥70 letters (20/40), retinal detachment, and endophthalmitis. Results A total of 2455 eyes of 2366 patients were included in the study, and hole closure was achieved in 95.6% of eyes with a single procedure. Mean baseline vision was 48.3 letters. The proportion of successful eyes improving ≥15 letters at 3, 12, and 24 months was 59.1%, 69.4%, and 68.2%, respectively. The mean improvement in acuity at 3, 12, and 24 months was 16.0, 19.2, and 23.6 letters, and 92.4%, 93.4%, and 95.8% improved ≥0 letters at 3, 12, and 24 months, respectively. Eyes receiving SF6 gas had better visual acuities at all time points postoperatively (adjusted effect 3.4, 3.1, and 4.6 letters better at 3, 12, and 24 months vs. longer-acting gas, respectively). Combined phacovitrectomy in phakic eyes was associated with better corrected visual acuity postoperatively (vs. vitrectomy surgery alone), a difference that vanished when eyes went on to have subsequent cataract surgery. The rate of retinal detachment postoperatively was 1.3%, and the odds of detachment were greater in eyes receiving longer-acting gases versus SF6 gas (adjusted odds ratio, 2.2; 95% confidence interval, 1.04–4.77; P = 0.039). There were no reported cases of endophthalmitis. Conclusions Macular hole surgery substantially improved acuity in approximately two thirds of patients and was seldom associated with loss of vision. SF6 gas was associated with better visual outcomes, an effect that warrants further study.

Alkalinization or buffering of dental local anesthetics to raise the pH of these acidic solutions is a well-documented technique that results in clinical benefits such as decreased injection pain, reduced onset time, and the need for less overall volume of local anesthesia.In a previous study, two options available for buffering local anesthetics in dentistry were compared, one using the Onpharma® mixing system (Onpharma), and the other by hand mixing with 8.4% sodium bicarbonate using a "remove and replace" technique. The results of that study showed no statistically significant difference in buffering outcomes between the two methods. This follow-up in vitro study introduces and examines a less complex, direct injection, chairside hand-mixing approach using four commercially available dental local anesthetic preparations.The authors prepared multiple buffered samples of four different commercially available local anesthetic solutions. The buffered samples were mixed to 9:1, 19:1, and 18:1 ratios (local anesthetic to 8.4% sodium bicarbonate). Sample pH was recorded using a pH meter. Two samples of each local anesthetic at each ratio were prepared and sequentially pH tested. The pH was recorded via the same pH meter, which was cleaned between each test.The pH change between unbuffered solutions and all buffered samples was statistically different (P.01, CI 99%). There was no final pH difference between the 9:1 and 19:1, and 19:1 and 18:1 buffering ratios (P.01); however, a statistical difference was seen between the final pHs of the solutions resulting from the 9:1 and 18:1 buffering ratios (P = .006, CI 99%). After correction for multiple comparisons, the difference between the 9:1 and 18:1 ratio was marginally significant (P = .048).Each of the buffering ratios tested can be used to alkalinize dental local anesthetic solutions. For practical purposes, a direct injection chairside of 0.1 mL of 8.4% sodium bicarbonate into any of the four local anesthetics tested is easy, simple, and safe compared to the more complex remove and replace method. Further studies are needed to evaluate if a clinically significant difference exists between the 9:1, 19:1, and 18:1 ratio solutions.The potential benefits of buffering local anesthetic solutions prior to injection, such as decreased injection pain, faster onset, and greater depth of anesthesia, may be particularly advantageous in patients who have difficulty achieving profound anesthesia for clinical dentistry, and for anesthetizing infected areas. Dentists can effectively buffer local anesthetic preparations using commercially available mixing systems or by utilizing a hand-mixing technique. Rather than using a remove and replace technique, practitioners may consider a direct injection technique, adding 0.1 mL of 8.4% sodium bicarbonate directly into any local anesthetic cartridge regardless of local anesthetic concentration.

Dry mouth is a pervasive oral health problem, with 5% to 46% of the population experiencing this condition. Patient factors such as age, gender, systemic diseases, and medication use play significant roles in correctly diagnosing this presentation. The subjective feeling of dry mouth is often referred to as xerostomia but may be more correctly diagnosed as salivary gland dysfunction: a reduced volume of saliva secretion or a change in salivary composition. Symptoms of dry mouth may range from mild oral discomfort to significant oral disease that can negatively impact patients' health, dietary intake, and quality of life. Despite the significant prevalence of xerostomia in the general population, however, no standard treatment guidelines exist. Successful treatments are typically individualized for the specific patient and should be targeted at the underlying pathophysiology of the disease. For these reasons, an accurate diagnosis of xerostomia is paramount so that patients may be offered the best treatment possible, and this treatment often involves a multimodal approach.

Purpose: To evaluate the safety and efficacy of dexamethasone intravitreal implant (Ozurdex, DEX implant) 0.7 and 0.35 mg in the treatment of patients with diabetic macular edema (DME).Design: Two randomized, multicenter, masked, sham-controlled, phase III clinical trials with identical protocols were conducted. Data were pooled for analysis.Participants: Patients (n = 1048) with DME, best-corrected visual acuity (BCVA) of 20/50 to 20/200 Snellen equivalent, and central retinal thickness (CRT) of ≥300 μm by optical coherence tomography.Methods: Patients were randomized in a 1:1:1 ratio to study treatment with DEX implant 0.7 mg, DEX implant 0.35 mg, or sham procedure and followed for 3 years (or 39 months for patients treated at month 36) at ≤40 scheduled visits. Patients who met retreatment eligibility criteria could be retreated no more often than every 6 months.Main Outcome Measures: The predefined primary efficacy endpoint for the United States Food and Drug Administration was achievement of ≥15-letter improvement in BCVA from baseline at study end. Safety measures included adverse events and intraocular pressure (IOP).Results: Mean number of treatments received over 3 years was 4.1, 4.4, and 3.3 with DEX implant 0.7 mg, DEX implant 0.35 mg, and sham, respectively. The percentage of patients with ≥15-letter improvement in BCVA from baseline at study end was greater with DEX implant 0.7 mg (22.2%) and DEX implant 0.35 mg (18.4%) than sham (12.0%; P ≤ 0.018). Mean average reduction in CRT from baseline was greater with DEX implant 0.7 mg (−111.6 μm) and DEX implant 0.35 mg (−107.9 μm) than sham (−41.9 μm; P < 0.001). Rates of cataract-related adverse events in phakic eyes were 67.9%, 64.1%, and 20.4% in the DEX implant 0.7 mg, DEX implant 0.35 mg, and sham groups, respectively. Increases in IOP were usually controlled with medication or no therapy; only 2 patients (0.6%) in the DEX implant 0.7 mg group and 1 (0.3%) in the DEX implant 0.35 mg group required trabeculectomy.Conclusions: The DEX implant 0.7 mg and 0.35 mg met the primary efficacy endpoint for improvement in BCVA. The safety profile was acceptable and consistent with previous reports.

Background The purpose of this investigation was to identify evidence-based clinical trials to aid dental clinicians in establishing the efficacy for recommending or prescribing analgesics for pain of endodontic origin. Types of Studies Reviewed The authors prepared and registered a protocol on PROSPERO and conducted electronic searches in MEDLINE, Scopus, the Cochrane Library, and ClinicalTrials.gov. In addition, the authors manually searched the bibliographies of all relevant articles, the gray literature, and textbooks for randomized controlled trials. Two authors selected the relevant articles independently. There were no disagreements between the authors. Results The authors analyzed 27 randomized, placebo-controlled trials. The authors divided the studies into 2 groups: preoperative and postoperative analgesic treatments. There was moderate evidence to support the use of steroids for patients with symptomatic irreversible pulpitis. Also, there was moderate evidence to support nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively or postoperatively to control pain of endodontic origin. When NSAIDs were not effective, a combination of NSAIDs with acetaminophen, tramadol, or an opioid appeared beneficial. Conclusions and Practical Implications NSAIDs should be considered as the drugs of choice to alleviate or minimize pain of endodontic origin if there are no contraindications for the patient to ingest an NSAID. In situations in which NSAIDs alone are not effective, the combination of an NSAID with acetaminophen or a centrally acting drug is recommended. Steroids appear effective in irreversible pulpitis.

Background In this article, the authors examine the available scientific evidence regarding adverse effects of short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Short-term use was defined as 10 days or fewer. Methods The authors reviewed randomized controlled clinical trials and cohort and case-controlled clinical studies published between 2001 and June 2015 in which the investigators reported on the safety of nonselective cyclooxygenase inhibitors and of cyclooxygenase-2 selective inhibitor NSAIDs. Results The systematic review process according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines allowed the authors to identify 40 studies that met the inclusion criteria. Conclusions On the basis of the available scientific evidence, NSAIDs may be considered relatively safe drugs when prescribed at the most effective dose and for the shortest duration of time, which was defined to be 10 days or fewer. Practical Implications Although the US Food and Drug Administration recommends the use of NSAIDs beyond 10 days to be accompanied by a consultation with a health care provider, the use of NSAIDs may be considered relatively safe when prescribed at the most effective dose and for the shortest duration of time, which was defined as 10 days or fewer. Exceptions would be for patients at risk of developing NSAID-exacerbated respiratory disease, patients with prior myocardial infarction who are receiving antithrombotic therapy, patients with asthma, and patients with a history of renal disease.

Background As North Americans live longer, have more chronic conditions and take more medications, adverse oral events are likely to increase and aggravate the symptoms of Sjogren syndrome (SS). Methods A total of 151 adults who self-reported having SS and who had a mean (standard deviation [SD]) age of 65.8 (11.5) years completed a survey that included questions about basic demographic information, current medical conditions, medications used (prescription and over the counter [OTC]) and the use of oral products to manage SS symptoms. Owing to the self-reporting process in our survey, the term "SS" in our study population represented a mixture of people with SS and people with dry mouth symptoms. Results The mean (SD) number of daily medications recorded as prescription, OTC and oral care products were 4.9 (3.5), 4.5 (2.8) and 4.6 (1.4), respectively. Participants with four or more comorbid medical conditions (n = 74; 49.0 percent) had significant differences ( P P Conclusions The survey results indicated that medication use and comorbid medical conditions demonstrated significant differences and may have had a substantial impact on the oral symptoms in adults who self-reported having SS. Clinical Implications Given the prevalence of SS, obtaining an accurate and complete medical and pharmacological history has implications for dental practitioners because medication use and comorbid medical conditions have a significant impact on oral symptoms in patients with SS.

Background. Given the prevalence of vitamin and mineral supplement use among consumers and the potential for vitamin- and mineral-drug interactions, as well as oral and systemic adverse effects of excess consumption, oral health care providers (OHCPs) should ask all patients about their use. The challenges for OHCPs are how to recognize oral and systemic manifestations of these interactions and how to safely manage the care of these patients while avoiding potential interactions. Methods. The authors reviewed the literature regarding interactions between popular vitamin and mineral supplements and medications used commonly in dentistry. They used clinical databases and decision support tools to classify interactions according to their level of patient risk. They address interactions of greatest clinical concern with a high-quality evidence-based foundation in either randomized controlled clinical trials or meta-analyses. Conclusion. Most medications used commonly in dentistry can be prescribed safely without regard to vitamin- and mineral-drug interactions. However, patients taking anticoagulants or cytochrome P450 3A4 substrates (such as clarithromycin, erythromycin, ketoconazole, itraconazole, midazolam and triazolam) in addition to specific vitamin or mineral supplements (vitamins D, E, K, calcium, fluoride, iron, magnesium, selenium or zinc) may face additional challenges. OHCPs need to recognize these potential interactions and know how to manage the care of patients who may be receiving treatment with these combination therapies. Practical Implications. Recognition and avoidance of potential vitamin- and mineral-drug interactions will help clinicians optimize patient treatment while emphasizing patient safety.

Estimation of the risk of revisit to the emergency department (ED) soon after discharge in the older population may assist discharge planning and targeting of post discharge intervention in high risk patients. In this study we sought to derive a risk prediction calculator for this purpose. In a prospective observational study in two tertiary ED, we conducted a comprehensive assessment of people aged 65 and over, and followed them for a minimum of 28 days post discharge. Cox proportional hazard models relating any unplanned ED revisit in the follow up period to observed risk factors were used to compute a probability nomogram. From 1,439 patients, 189 (13.1 %) had at least one unplanned revisit within 28 days. Revisit probability was weighted towards chronic and difficult to modify risk factors such as depression, malignancy and cognitive impairment. We conclude that the risk of revisit post discharge is calculable using a probability nomogram. However, revisit is largely related to immutable factors reflecting chronic illness burden, and does not necessarily reflect poor ED care during the initial index presentation.

Though uncommon, medical emergencies in the dental office are harrowing occurrences that can be the result of adverse drug reactions. Pharmacological antagonists have been developed for administration as reversal agents in emergency situations in which patients may have an untoward effect, typically caused by too much medication. Dental practitioners should be familiar with these agents to keep patients safe and help mitigate drug-induced medical emergencies. This article reviews the pharmacokinetic and pharmacodynamic principles of pharmacological antagonists; it emphasizes six specific reversal agents as they relate to the clinical practice of dentistry: naloxone, flumazenil, epinephrine, diphenhydramine, phentolamine, and atropine. Outside of emergency situations, the pharmacological antagonist phentolamine has been developed to reverse the effects of the vasoconstrictor in dental local anesthesia preparations when the effects of the agonist medication are no longer required. Such newer reversal agents are being considered for more routine use once the dental procedure is complete. This article is intended to assist dental practitioners who are familiar with pharmacological antagonists to be better able to help mitigate drug-induced medical emergencies should they occur.

To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety.Multicenter retrospective case series.All patients receiving intravitreal injections from 7 retinal specialists.An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine.Incidence of endophthalmitis after intravitreal injections.A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used.Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients.

Researchers compared two methods-hand mixing and a commercial system-for buffering local anesthesia in seven commercially available dental preparations.

The purpose of this investigation was to identify evidence-based clinical trials to aid dental clinicians in establishing the efficacy for recommending or prescribing analgesics for pain of endodontic origin.The authors prepared and registered a protocol on PROSPERO and conducted electronic searches in MEDLINE, Scopus, the Cochrane Library, and ClinicalTrials.gov. In addition, the authors manually searched the bibliographies of all relevant articles, the gray literature, and textbooks for randomized controlled trials. Two authors selected the relevant articles independently. There were no disagreements between the authors.The authors analyzed 27 randomized, placebo-controlled trials. The authors divided the studies into 2 groups: preoperative and postoperative analgesic treatments. There was moderate evidence to support the use of steroids for patients with symptomatic irreversible pulpitis. Also, there was moderate evidence to support nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively or postoperatively to control pain of endodontic origin. When NSAIDs were not effective, a combination of NSAIDs with acetaminophen, tramadol, or an opioid appeared beneficial.NSAIDs should be considered as the drugs of choice to alleviate or minimize pain of endodontic origin if there are no contraindications for the patient to ingest an NSAID. In situations in which NSAIDs alone are not effective, the combination of an NSAID with acetaminophen or a centrally acting drug is recommended. Steroids appear effective in irreversible pulpitis.

Background Nitrous oxide–oxygen sedation is used widely in dentistry because of its relative safety and efficacy. The most important safety consideration is the prevention of hypoxia. Safety features have been designed to prevent hypoxia by ensuring a minimal oxygen flow, thus limiting the amount of nitrous oxide that can be administered. Methods The authors review the 12 safety features used to ensure the safety and efficacy of nitrous oxide–oxygen sedation. They provide examples of safety feature failures, as well as steps to follow to help prevent negative outcomes. Conclusions Nitrous oxide–oxygen delivery systems typically are limited to a maximum of 70 percent nitrous oxide and 30 percent oxygen delivery, which ensures that the patient is receiving at least 9 percent more oxygen than found in ambient air. Other safety features stop the delivery of nitrous oxide if oxygen flow stops. The pin-index safety system prevents the accidental attachment of a nonoxygen tank to the oxygen attachment portal, and diameter-index systems help ensure that the appropriate gas flows through the appropriate tubing. Although these safety features are in place, dentists have reported incidents of hypoxia involving incorrect equipment installation or equipment damage. Practice Implications If a safety feature failure is suspected during administration of nitrous oxide–oxygen sedation, the clinician should remove the face mask from the patient immediately.

Purpose The International Normalized Ratios (INRs) measured by two point-of-care (POC) devices were compared with those obtained via laboratory-based venipuncture. Methods In an outpatient, pharmacist-managed anticoagulation clinic, 52 patients receiving oral warfarin therapy had their INR values measured using two POC devices, i-STAT PT/INR (Abbott Laboratories, Abbott Park, IL) and CoaguChek XS Plus (Roche Diagnostics, Indianapolis, IN). At the same visit, one venous blood sample was collected from each patient for INR measurement by the reference laboratory’s instrumentation (STAGO, Diagnostica-Stago, Parsippany, NJ). Accuracy was evaluated by calculating the absolute difference for each set of INR values. Clinical correlation was defined as an INR measurement obtained by the POC devices that would have resulted in the same therapeutic decision as the INR value measured by the reference laboratory’s instrumentation. Results Accuracy was superior with the CoaguChek XS Plus device. The absolute difference (mean ± S.D.) in the INR measurements obtained using STAGO versus CoaguChek XS Plus was 0.28 ± 0.31 ( p < 0.0001). The absolute difference in INR values measured using STAGO and the i-STAT PT/INR device was 0.51 ± 0.44 ( p < 0.0001). For clinical correlation, 17 (33%) of 52 INR measurements with the CoaguChek XS Plus were sufficiently different from the STAGO-measured INR values to have resulted in a different therapeutic decision ( p < 0.001), compared with 28 (54%) of 52 with the i-STAT PT/INR ( p < 0.001). Conclusion INR measurements generated by POC devices exhibited positive bias, compared with laboratory-based venipuncture, for INR values at the high end of the INR range.

Purpose To evaluate the efficacy of a large-spot subthreshold infrared laser protocol to treat diabetic maculopathy. Methods In a prospective, fellow eye, controlled case series, all patients had clinically significant diabetic macular edema (DME) treated with a single application of subthreshold infrared (810 nm) laser. If bilateral disease was present, the fellow eye was treated with conventional macular laser. The study was to include 20 patients. Visual acuity and central macular thickness (CMT) measured by optical coherence tomography (OCT) were assessed in the study and fellow eyes at baseline and 6 months, and any changes were compared. Results The 11th patient developed a choroidal infarct with subsequent profound loss of vision immediately after treatment. The study was terminated prematurely at this point. For the remaining 10 patients, there was a trend toward improvement in visual acuity in the study eye compared with the fellow eye at the 6-month follow-up (median change: +1.5 letters for study eye vs -6.5 letters for fellow eye; P = 0.08). There was also significant improvement in OCT-measured CMT in the study eye (mean decrease, 117 microm) compared with deterioration in OCT-measured CMT in the fellow eye (mean increase, 24 microm; P = 0.02). Conclusion This subthreshold infrared laser protocol led to improvement in OCT-measured CMT and stabilization of vision in most subjects. The current protocol is however unpredictable and should not be used in the treatment of DME without further modification.

The use of sedatives has established efficacy and safety for managing anxiety regarding dental treatment. This article will provide essential information regarding the pharmacology and therapeutic principles that govern the appropriate use of orally administered sedatives to provide mild sedation (anxiolysis). Dosages and protocols are intended for this purpose, not for providing moderate or deeper sedation levels.