CPD Article: Antidepressant-induced sexual dysfunction Antidepressant-induced sexual dysfunction Outhoff K, MBChB, MFPM(UK) Department of Pharmacology, University of Pretoria, South Africa Correspondence to: Dr Kim Outhoff, e-mail: [email protected] Keywords: depression; sexual dysfunction; antidepressants Depression and sexual dysfunction are both common in the general population. When they co-exist they have the potential to impact negatively on each other in a bidirectional manner. Medication used to treat depression may cause additional problems with the sexual response cycle; although no drug is completely innocent, serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) are most frequently implicated in antidepressant-induced sexual dysfunction. Adherence to long-term treatment may be compromised, which may have serious consequences. Various psychological and pharmacological strategies, including the ad hoc use of sildenafil, may offer some respite.
Cases 4-page layout c 04/07Cases & Commentaries New Technology for Periodontal Treatment From the Editor
Few novel therapies for the treatment of oral infections have been developed over the past decade. The current standard of care is to provide scaling and root planing, with or without antibiotics delivered eitherlocally or systemically. The introduction of photodisinfection to Canada and Europe in 2006 represented amilestone in new and innovative approaches to the treatment of oral infections.
Photodisinfection is based on a well-known reaction that happens when a photosensitizer compound is combined with a color-matched, non-thermal light source. This reaction creates a consequent reactionwhereby the light-activated photosensitizer is able to transfer energy to surrounding oxygen, creating a fluxof oxygen-derived free radicals. These radicals, in turn, are able to physically destroy the bacterial cell membraneand, thus, the bacterial cell, significantly reducing the numbers of gram negative bacteria, inactivating thevirulence factors associated with periodontal diseases, and enhancing the healing process.
A clear advantage of the photodisinfection approach is that there is no known path to bacterial resistance, a concern surrounding the use of antibiotics with which we are all too familiar. Photodisinfection wasdeveloped as a safer and more effective alternative to antibiotics when used in conjunction with or withoutscaling and root planing. While there has been extensive laboratory research documenting the safety and efficacy of photodisinfection for more than ten years, we are now seeing the successful completion of many clinical cases by practitionerswho have made it a part of their normal routine in the treatment of periodontal disease. This is the first ina series of case studies utilizing the Periowave™ system. As we see more and more of these documentedcases, the realization that there is indeed an alternative to traditional antibiotic therapy that will provideincreased benefit to the patient and to the dental profession in general will become apparent.
We welcome your comments on this series and your questions about Periowave™. Roger Andersen, MD, MPH VP, Regulatory & Medical Affairs Ondine Biopharma Corporation Presented as a service to the dental profession by Ondine Biopharma Corporation Copyright 2007 Professional Audience Communications, Inc. All rights reserved.
In-Office Application of the Periowave™ PhotodynamicDisinfection Technology – Four Unique Clinical Cases The following Periowave™ clinical cases were submitted by our Guest Clinician Claude G. Ibbott, DMD, FRCD. Dr Ibbott is
a periodontist in Regina, Saskatchewan, Canada. His RDH, Leanne Carlson-Mann, submitted these in conjunction with him.
Generalized Severe Bleeding
Figure 1.4 –
Figure 1.5 – Post-treatment
The patient was a 30-year-old Pre-treatment 5 mm pocket 5 mm pocket reduced to 3 mm Caucasian woman who complainedof bleeding gums over the previous The patient was monitored weekly over a period of six weeks. At 12 months. She described severe the end of six weeks, there was a reduction of approximately 1 mm bleeding with eating or brushing in both deep pocket probing sites. A single clinician did all the (Figure 1.1).
probing with a plastic probe. Little or no improvement in the bleedingwas noted, however. The patient then agreed to treatment with Figure 1.1 – Severe gingival bleeding
Her medical history revealed no the Periowave system.
significant findings. She had recently undergone a complete medicalexamination with extensive laboratory testing with no significant All teeth were again scaled and root planed, and the entire mouth findings. She had tried seeing a naturopathic physician and had was treated with Periowave in two sessions, one day apart. tried a non-yeast diet for the control of her gingival bleeding withno improvement. She was on no medications.
Within 1 week, all bleeding on probing ceased. The patient wasmonitored weekly for another six weeks with no recurrence of The dental examination revealed generalized severe bleeding on bleeding. Probing depths at sites 13, 12, 22 and 23 were reduced probing. Pocket probing depths were in the 4 mm range, except to 3 mm at 6 weeks (Figures 1.2 - 1.5).
for a 7 mm pocket distofacial #13, and a 5 mm pocket mesiofacial#23. Minimal plaque deposits were found and her home care wasgood. This patient had a history of regular 6-month scaling andthere was minimal calculus. Her last scaling was within one month with no improvement. There was little to no clinical inflammation.
Occlusion, tooth position, and mobility patterns were normal. No Gingival Inflammation and Tooth Loss
restorative problems were noted. Treatment and Results
Scaling and root planing were done in two sessions for the entire mouth This is the case of a 55-year-old Hispanic woman who presented utilizing ultrasonics and hand scaling. A local anesthetic was used for with a complaint of sore gums and tooth loss. The patient was in sites 13, 12, 22, and 23. The patient was instructed in the use of a otherwise good health with no serious medical problems noted manual soft-bristle toothbrush and the use of waxed dental floss.
The dental examination showed the upper arch to consist of teeth13, 11, 21, and 23. The patient had a poorly fitting maxillary acrylicappliance. The lower arch was intact with no restorative problems.
The lower arch had moderate calculus formation, but few signsof clinical inflammation; probing pocket depths were generally 3-4 mm. Radiographs showed normal bone levels. The maxillary teeth Figure 1.2 –
Figure 1.3 – Post-treatment
exhibited severe inflammation with engorgement and bleeding Pre-treatment 7 mm pocket 7 mm pocket reduced to 3 mm (Figure 2.1).
Treatment and Results
The patient was out of the country after treatment for severalmonths, but did return for a 12-week follow-up visit, at which time The lower arch responded to routine scaling and root planing.
the pocket probing depth was reduced to 3 mm with no signs of However, because of the severe maxillary inflammation, the inflammation (Figure 3.2). Periowave system was used for one session immediately after scaling.
The acrylic partial appliance was relined with a soft liner as atemporary measure.
Gingival Inflammation and Pain
Due to Oral Lichen Planus
Figure 2.1 – Pre-treatment
Figure 2.2 – Post-treatment
This is the case of a 72-year-old Caucasian woman who presented gingival inflammation resolution of gingival inflammation with a complaint of gingival pain on 11 and 21 during eating andbrushing. She had no significant medical history (Figure 4.1).
Within 14 days, the upper teeth responded to SRP and adjunctivePeriowave treatment, with a complete resolution of inflammation She described discomfort from 11, 21 for the previous six months.
Incisional biopsies were performed, and immunofluorescencesuggested oral lichen planus. Since there is no cure for OLP, attemptswere made to treat the symptoms with Lidex® and later tacrolimus,though these measures provided no relief.
Treatment and Results
Unsuccessful Prior Periodontal Therapy
The patient underwent one treatment session with Periowave.
This is the case of a 52-year-old East Indian female who was onregular four-month maintenance following previous periodontaltherapy. The patient had been treated three years prior for generalizedsevere periodontitis. The treatment at that time consisted of scalingand root planing, home care instructions, occlusal equilibration, andosseous surgery.
Figure 4.1 – Pre-treatment gingival
Figure 4.2 – Post-treatment
inflammation due to OLP resolution of gingival inflammation The patient was in generally good health apart from high blood Within one week following Periowave therapy, the gingival pressure, which was stable on lisinopril (Prinivil®) once a day.
inflammation had resolved (Figure 4.2) and the patient experiencedcomplete relief from the presenting complaint of pain.
The dental examination showed a 6 mm inflamed bleeding pocketthat was evident between 43 and 42 (Figure 3.1); the rest of themouth was healthy.
Summary & Conclusions from the Guest Clinician
Treatment and Results
These cases demonstrate some of the applications of the Periowave Scaling and root planing with local anesthesia was used to treat 43 system in our dental office. Of particular utility was the rapid and 42, with adjunctive treatment with Periowave following the scaling.
treatment times and non-invasiveness of the procedure itself. Patientswere very accepting of this new modality and were appreciative ofhaving the opportunity to use new technology, especially whentraditional therapies had failed to achieve complete resolution oftheir symptoms. While Periowave may not apply to every patient,it certainly provides one more tool for the clinician to offer patientsprior to more invasive, and less appealing therapies. Dr. Claude Ibbott Figure 3.1 – Pre-treatment gingival
Figure 3.2 – Post-treatment
inflammation near the pocket resolution of gingival inflammation
Intrauterine Devices (IUDs) in Developing Countries: Assessing Opportunities for Expanding Access and Use Project Team: Amy E. Pollack MD, MPH John Ross PhD Gordon Perkin MD "A deeper commitment to contraception, including the IUD, can ease the burden of many health problems in every country. Foundations can highlight the leverage that contraception offers for lessening those burdens. They can advance advocacy at the highest levels and partner with other donors in a common strategy, thus leveraging the investment of USAID and the private sectors commitment."