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Ear, Nose and Throat (ENT)

Welcome to the ear, nose and throat (ENT) category for physicians and pharmacists. This clinical category has links to otolaryngology resources such as clinical guidelines, medical journal articles and prescribing guidance.

American Academy of Otolaryngology - Head and Neck Surgery Clinical Practice Guidelines

Source: entnet.org
Clinical Resource: Guidelines
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Last Checked: 21/08/15 Link Error: Report It

 

American Academy of Otolaryngology - Head and Neck Surgery Clinical Consensus Statements

Source: entnet.org
Clinical Resource: Consensus Statements
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Last Checked: 21/08/15 Link Error: Report It

 

American Academy of Otolaryngology - Head and Neck Surgery Postion Statements

Source: entnet.org
Clinical Resource: Position Statements
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Last Checked: 21/08/15 Link Error: Report It

 

Ear, nose and throat - CLEAR: clinical enquiry and response service

The CLEAR service is delivered by a team of information professionals based at Healthcare Improvement Scotland and NHS Greater Glasgow and Clyde.

CLEAR aims to provide clinicians with summarised evidence relating to aetiology, diagnosis, prognosis and treatment queries about patient care.

Source: knowledge.scot.nhs.uk
Clinical Resource: Evidence Based Answers to Clinical Questions
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Last Checked: 25/03/13 Link Error: Report It

 

BestBETs
Ent problems

BETs were developed in the Emergency Department of Manchester Royal Infirmary, UK, to provide rapid evidence-based answers to real-life clinical questions, using a systematic approach to reviewing the literature. BETs take into account the shortcomings of much current evidence, allowing physicians to make the best of what there is.

Source: bestbets.org
Clinical Resource: Evidence Based Answers to Clinical Questions
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Last Checked: 25/03/13 Link Error: Report It

 

The Cochrane Collaboration
Cochrane Reviews

The Cochrane Collaboration is an international, non-profit, independent organisation, established to ensure that up-to-date, accurate information about the effects of healthcare interventions is readily available worldwide. It produces and disseminates systematic reviews of healthcare interventions, and promotes the search for evidence in the form of clinical trials and other studies of the effects of interventions.

Topics:

Ear, Nose, & Throat
Dentistry & Oral Health

Source: cochrane.org
Clinical Resource: Systematic Reviews
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Last Checked: 13/07/15 Link Error: Report It

 

Bandolier Knowledge
Ear nose and throat

In these pages are collected the stories from Bandolier relating to ear, nose and throat problems.

Source: bandolier.org.uk
Clinical Resource: Evidence Based Abstracts
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Last Checked: 13/06/17 Link Error: Report It

 

Pocket Guide to Antimicrobial Therapy in Otolaryngology - Head and Neck Surgery, 13th Edition
Written by David N.F. Fairbanks, M.D.

Find out the latest about antimicrobial therapy in otolaryngology with this comprehensive guide

Offers practical overview of antimicrobials for the practicing physician

Updated details on drug selection and dosages, antimicrobial prophylaxis, monitoring and preventing ototoxicity

Use the reference tables on drugs of choice and dosages

Source: entnet.org
Clinical Resource: eBook
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Last Checked: 21/08/15 Link Error: Report It

 

Dr. Quinn's Online Textbook of Otolaryngology: Grand Rounds Archive.

Source: utmb.edu
Clinical Resource: Textbook
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Last Checked: 25/03/13 Link Error: Report It

 

Primary Care Otolaryngology
American Academy of Otolaryngology—Head and Neck Surgery Foundation

The third edition of this popular handbook continues its goal of improving clinical judgment by teaching the basics of otolaryngology. Targeted to medical students and allied health professionals with an interest in otolaryngology–head and neck surgery, this e-book helps readers manage uncomplicated clinical problems and recognize when to refer more serious conditions to an otolaryngologist.

Highlights include:

  • New advice on presenting on rounds and evaluating patients
  • Updated chapters reflecting current clinical practice guidelines
  • Question and answer section at end of each chapter
Source: entnet.org
Clinical Resource: eBook
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Last Checked: 21/08/15 Link Error: Report It

 

Otitis Externa: Review and Clinical Update

Otitis externa can take an acute or a chronic form, with the acute form affecting four in 1,000 persons annually and the chronic form affecting 3 to 5 percent of the population. Acute disease commonly results from bacterial (90 percent of cases) or fungal (10 percent of cases) overgrowth in an ear canal subjected to excess moisture or to local trauma. Chronic disease often is part of a more generalized dermatologic or allergic problem. Symptoms of early acute and most chronic disease include pruritus and local discomfort.

Source: aafp.org
Clinical Resource: Journal Article
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Last Checked: 25/03/13 Link Error: Report It

 

National Institute for Health and Care Excellence (NICE) Guidance >Surgical management of otitis media with effusion in children

Source: nice.org.uk
Clinical Resource: Guidance
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Last Checked: 18/05/15 Link Error: Report It

 

An Update on Treatment Strategies for Acute Otitis Media

Following a successful review of this article, the reader should be able to:

  1. Describe the epidemiology of AOM.
  2. Describe the pathophysiology and microbiology of AOM.
  3. Discuss several currently recommended strategies for treatment of AOM.
  4. Categorize the advantages and disadvantages of antibacterials currently approved for treatment of AOM.
Source: inetce.com
Clinical Resource: CE / CPD / Learning
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Last Checked: 25/03/13 Link Error: Report It

 

American Academy of Audiology Position Statement and Clinical Practice Guidelines
Ototoxicity Monitoring

Source: audiology.org
Clinical Resource: Position Statement and Guideline
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Last Checked: 21/08/15 Link Error: Report It

 

Ototoxicity

Any drug with the potential to cause toxic reactions to structures of the inner ear, including the cochlea, vestibule, semicircular canals, and otoliths, is considered ototoxic. Drug-induced damage to these structures of the auditory and balance system can result in hearing loss, tinnitus, and dysequilibrium or dizziness.

Source: medscape.com
Clinical Resource: Article
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Last Checked: 25/03/13 Link Error: Report It

 

Ear drops and ototoxicity

Ototoxicity is a rare but potentially serious complication of the use of aminoglycoside and other cochleo-toxic ear drops. This risk is increased when there is a perforation of the tympanic membrane or a patent grommet.

Source: nps.org.au
Clinical Resource: Journal Article
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Last Checked: 08/08/16 Link Error: Report It

 

Ten Top Tinnitus Tips

This useful list of Ten Top Tinnitus Tips is aimed at informing GPs of helpful ways to advise tinnitus patients.

Source: tinnitus.org.uk
Clinical Resource: List
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Last Checked: 25/03/13 Link Error: Report It

 

8 Minute Primary Care Tinnitus Consultation

The characteristics of the tinnitus should be noted. Is the noise pulsatile, in one ear, both ears or in the head? Is the noise constant or intermittent and how often does it occur if intermittent?

Source: aintreehospitals.nhs.uk
Clinical Resource: Consultation
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Last Checked: 07/05/13 Link Error: Report It

 

British Society for Allergy and Clinical Immunology guidelines for the management of rhinosinusitis and nasal polyposis

Source: bsaci.org
Clinical Resource: Guideline
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Last Checked: 08/05/15 Link Error: Report It

 

European Position Paper on Rhinosinusitis and Nasal Polyps 2007

Source: eaaci.org
Clinical Resource: Position Paper
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Last Checked: 25/03/13 Link Error: Report It

 

Infectious Diseases Society of America Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults

Source: idsociety.org
Clinical Resource: Guideline
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Last Checked: 15/05/15 Link Error: Report It

 

The diagnosis and management of sinusitis: A practice parameter update

These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology.

Source: aaaai.org
Clinical Resource: Practice Parameter
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Last Checked: 08/05/15 Link Error: Report It

 

Alberta Clinical Practice Guideline for The Diagnosis and Management of Acute Bacterial Sinusitis

Source: topalbertadoctors.org
Clinical Resource: Guideline
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Last Checked: 19/10/15 Link Error: Report It

 

Acute sinusitis

Acute sinusitis is a common infection of the paranasal sinuses, with inflammation of the nasal and sinus mucosa. In the first few days, symptoms are likely to be due to a viral upper respiratory tract infection, but this may later become complicated by a bacterial infection.

Source: webarchive.org.uk
Clinical Resource: National Prescribing Centre Bulletin
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Last Checked: 24/04/15 Link Error: Report It

 

Diagnosis and Management of Infectious Sinusitis

This article will provide useful information regarding the clinical diagnosis of infectious sinusitis as well as describe symptoms, common causative organisms, and predisposing factors. Finally, using primary literature, this article will underscore the management of infectious acute sinusitis including a clinical summary table.

Source: ufl.edu
Clinical Resource: Publication
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Last Checked: 25/03/13 Link Error: Report It

 

Chronic rhinosinusitis
‘It’s my sinus doc!’

This article outlines the diagnosis of adult CRS, the differential diagnoses, and appropriate investigations and management.

Source: racgp.org.au
Clinical Resource: Journal Article
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Last Checked: 25/03/13 Link Error: Report It

 

British Society for Allergy and Clinical Immunology guidelines for the management of allergic and non-allergic rhinitis

Source: bsaci.org
Clinical Resource: Guideline
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Last Checked: 08/05/15 Link Error: Report It

 

The diagnosis and management of rhinitis: An updated practice parameter

These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology.

Source: aaaai.org
Clinical Resource: Practice Parameter
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Last Checked: 08/05/15 Link Error: Report It

 

British Society for Allergy and Clinical Immunology guidelines on immunotherapy for allergic rhinitis

Source: bsaci.org
Clinical Resource: Guideline
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Last Checked: 08/05/15 Link Error: Report It

 

European Academy of Allergy and Clinical Immunology Position Paper on Occupational Rhinitis

Source: eaaci.org
Clinical Resource: Position Paper
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Last Checked: 25/03/13 Link Error: Report It

 

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008

The 2008 revision of the ARIA Report, published as a Supplement in the European Journal of Allergy and Clinical Immunology, reviews the latest scientific evidence on the definition and classification of rhinitis, risk factors, mechanisms, and diagnosis and treatment, with extensive citations from the scientific literature.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2010 Revision

In 2010, the ARIA expert panel completed an analysis of the key clinical questions in the ARIA Report according to the WHO GRADE methodology. This document gives additional perspective on the use of various treatments for allergic rhinitis using a careful, conflict-of-interest-free analysis.

Source: whiar.org
Clinical Resource: Report and Update
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Last Checked: 25/03/13 Link Error: Report It

 

Allergic Rhinitis and its Impact on Asthma Pharmacist's Guide
Management of Allergic Rhinitis Symptoms in the Pharmacy

This guide provides a practical, step-by-step approach to aid pharmacists in advising patients:

  • in recognising allergic rhinitis and assessing its severity,
  • in understanding the effect of treatment on rhinitis and co-morbidities,
  • in determining whether management in the pharmacy is appropriate,
  • in initiating an appropriate treatment and monitoring plan,
  • and in proposing appropriate preventive measures.
Source: whiar.org
Clinical Resource: Report
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Last Checked: 25/03/13 Link Error: Report It

 

Common questions about hay fever

This Bulletin explores common questions about hay fever around management of symptoms, over-the-counter (OTC) products, advice for pregnant women, evidence for newer antihistamines, alternative therapies and the place of immunotherapy

Source: webarchive.org.uk
Clinical Resource: National Prescribing Centre Bulletin
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Last Checked: 24/04/15 Link Error: Report It

 

Persistent rhinitis – allergic or nonallergic?

Although rhinitis has been classified as being either allergic, noninfectious, or “other forms” (nonallergic noninfectious), these categories lack strict classification criteria and often overlap. The term “nonallergic noninfectious rhinitis” is commonly applied to a diagnosis of any nasal condition, in which the symptoms are similar to those seen in allergic rhinitis but an allergic aetiology has been excluded. This group comprises several subgroups with ill-defined pathomechanisms, and includes idiopathic rhinitis, irritative-toxic (occupational) rhinitis, hormonal rhinitis, drug-induced rhinitis, and other forms (non-allergic rhinitis with eosinophilia syndrome [NARES], rhinitis due to physical and chemical factors, food-induced rhinitis, emotion-induced rhinitis, atrophic rhinitis).

Source: eu.wiley.com
Clinical Resource: Journal Article
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Last Checked: 25/03/13 Link Error: Report It

 

Risk of first-generation H1-antihistamines: a Global Allergy and Asthma European Network position paper

Source: eaaci.org
Clinical Resource: Position Paper
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Last Checked: 25/03/13 Link Error: Report It

 

Comparative pharmacology of the H1 antihistamines

Although the efficacy of the different H1 antihistamines in the treatment of allergic patients is similar, even when comparing first- and second-generation drugs, they are very different in terms of chemical structure, pharmacology and toxic potential. Consequently, knowledge of their pharmacokinetic and pharmacodynamic characteristics is important for the correct usage of such drugs, particularly in patients belonging to extreme age groups, pregnant women, or subjects with concomitant diseases.

Source: jiaci.org
Clinical Resource: Journal Article
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Last Checked: 25/03/13 Link Error: Report It

 

H1 Antihistamines in Allergic Disease

H1 antihistamines remain first-line medications for the treatment of allergic rhinoconjunctivitis and urticaria. Second-generation antihistamines are preferred to their predecessors because of better benefit- to-risk ratios. The newer antihistamines are not only more potent, but also have anti-allergic and anti-inflammatory properties. Although they are more expensive than the traditional antihistamines, the cost is substantially offset by their superior efficacy and safety profile when used in recommended dosages.

Source: allergysa.org
Clinical Resource: Journal Article
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Last Checked: 21/08/15 Link Error: Report It

 

Effect of H1 antihistamines upon the cardiovascular system

Histamine exerts a series of actions upon the cardiovascular system. Thus, through mediation of the H1 and H2 receptors, histamine increases vascular permeability and induces hypotension, with reflex tachycardia. In turn, at heart muscle level, histamine action upon the H1 receptors induces an increase in atrioventricular node conduction, while the H2 receptors mediate positive chronotropic and inotropic effects. The H1 antihistamines, as inverse agonists, exert the opposite effect, with partial countering of the aforementioned actions. However, the main concern in relation to the cardiovascular safety of the antihistamines refers to their cardiac arrhythmogenic potential. A review is provided below of the principles and clinical particulars of these worrisome adverse effects.

Source: jiaci.org
Clinical Resource: Journal Article
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Last Checked: 25/03/13 Link Error: Report It

 

Second generation antihistamines and pregnancy

The first generation antihistamines (i.e. chlorpheniramine which can be found in Chlor-Trimeton Allergy) are preferred for pregnancy because they have been around longer and better studied during pregnancy. However, second generation antihistamines may be preferred by women due to their lower rates of CNS side effects, such as sedation and performance impairment (Blaiss, 2003). Therefore, this Risk Newsletter will discuss pregnancy outcomes following use of the second generation antihistamines, cetirizine (Zyrtec), fexofenadine (Allegra), and loratadine (Claritin).

Source: fetal-exposure.org
Clinical Resource: Teratogen Information Service Newsletter
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Last Checked: 19/08/13 Link Error: Report It

 

Antihistamines and Breastfeeding

Source: breastfeedingnetwork.org.uk
Clinical Resource: Drug Information Factsheet
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Last Checked: 08/08/16 Link Error: Report It

 

Which oral antihistamines are available in lactose-free formulations?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

The table below gives details of lactose free formulations of oral antihistamine

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

The Use of Leukotriene Receptor Antagonists to Treat Allergic Rhinitis

This article will address the pharmacology, AR clinical trials, adverse effects, dosing, and costs of the two LTRAs available in this country, montelukast and zafirlukast.

Source: ufl.edu
Clinical Resource: Publication
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Last Checked: 25/03/13 Link Error: Report It

 

Treatment of Allergic Rhinitis in Pregnancy and Breastfeeding

Allergic rhinitis affects approximately one-third of women of childbearing age. Drug treatment may be needed for symptoms during pregnancy and/or breastfeeding. Pre-existing rhinitis may worsen, improve, or remain unchanged during pregnancy.

Source: druginformation.co.nz
Clinical Resource: Drug Information Service Bulletin
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Last Checked: 07/05/14 Link Error: Report It

 

Decongestant Use in Hypertension

This article will focus on standards of care and medications used for nasal congestion, including oral and topical nasal decongestants and alternatives to decongestants.

Source: uspharmacist.com
Clinical Resource: Journal Article
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Last Checked: 25/03/13 Link Error: Report It

 

Scottish Intercollegiate Guidelines Network (SIGN) Guideline > Management of Sore Throat and Indications for Tonsillectomy

Source: sign.ac.uk
Clinical Resource: Guideline
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Last Checked: 18/05/15 Link Error: Report It

 

How effective are treatments other than antibiotics for acute sore throat?

Patients frequently attend general practices in the industrial western world with the complaint of sore throat. Although the illness is usually self-limiting, it is such a common reason for attending the doctor that its treatment is of considerable interest. Treatment has always been controversial, with most debate concerning whether antibiotics should be used.

Source: nih.gov
Clinical Resource: Journal Article
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Last Checked: 25/03/13 Link Error: Report It

 

Mouth Cancer Information Sheet for Pharmacists

Source: cancerresearchuk.org
Clinical Resource: Information Sheet
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Last Checked: 25/03/13 Link Error: Report It

 

Common Oral Lesions: Part I. Superficial Mucosal Lesions

This article, part I of a two-part series, reviews superficial mucosal lesions: candidiasis, herpes labialis, aphthous stomatitis, erythema migrans, hairy tongue, and lichen planus.

Common Oral Lesions: Part II. Masses and Neoplasia

This article reviews common oral lesions that may appear as masses or represent neoplastic change.

Source: aafp.org
Clinical Resource: Journal Articles
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Last Checked: 25/03/13 Link Error: Report It

 

Oral candidiasis

Oral candidiasis is an opportunistic infection of the oral cavity. It is common and underdiagnosed among the elderly, particularly in those who wear dentures and in many cases is avoidable with a good mouth care regimen. It can also be a mark of systemic disease, such as diabetes mellitus and is a common problem among the immunocompromised. Oral candidiasis is caused by an overgrowth or infection of the oral cavity by a yeast-like fungus, candida.

Source: europepmc.org
Clinical Resource: Journal Article
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Last Checked: 07/04/14 Link Error: Report It

 

Oral ulceration: GP guide to diagnosis and treatment

Simple mouth ulcers are usually self-limiting and rarely present in general practice. However, severe, recurrent or persistent oral ulceration can be extremely painful and may result from an underlying systemic pathology. Dr Flint describes the different causes of oral ulcers and discusses treatment options.

Source: eu.wiley.com
Clinical Resource: Journal Article
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Last Checked: 25/03/13 Link Error: Report It

 

Drymouth.info
Welcome to the practitioner portal

This portal of drymouth.info is primarily about Drugs and Dry Mouth. Information is also provided about select drugs which may induce ocular dryness. In addition, data are given regarding the symptoms, signs, causes and potential remedies for dry mouth.

Source: drymouth.info
Clinical Resource: Various
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Last Checked: 25/03/13 Link Error: Report It

 

Helping patients with dry mouth

Xerostomia is defined as dry mouth resulting from reduced or absent saliva flow. Xerostomia is not a disease, but it may be a symptom of various medical conditions, a side effect of a radiation to the head and neck, or a side effect of a wide variety of medications.

Source: oralcancerfoundation.org
Clinical Resource:
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Last Checked: 25/03/13 Link Error: Report It

 

Oral Manifestations of Systemic Disease

This article provides a guide for recognizing the oral manifestations of select systemic diseases.

Source: aafp.org
Clinical Resource: Journal Article
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Last Checked: 25/03/13 Link Error: Report It

 

Oral Manifestations of Drug Reactions

An estimated 2-4% of hospital admissions are related to adverse drug reactions. Mucocutaneous eruptions are often central to these untoward reactions, and an ever-expanding list of medications is linked to pathologic reactions in the oral and perioral region. These adverse drug reactions have a broad spectrum of clinical manifestations that can mimic those of other disease states, including both local and systemic conditions.

Source: medscape.com
Clinical Resource: Article
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Last Checked: 25/03/13 Link Error: Report It

 

Oral Adverse Drug Reactions to Cardiovascular Drugs

This review focuses on those cardiovascular drugs reported to induce oral drug reactions. In addition, it will provide data on specific drugs or drug classes, and outline and discuss recent research on possible mechanisms linking ADRs to drug metabolism patterns.

Source: sagepub.com
Clinical Resource: Journal Article
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Last Checked: 25/03/13 Link Error: Report It

 

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