Dental Management Of Patients Research Articles

Dental management of patients with inherited bleeding disorders: a retrospective study

Dental management of patients with inherited bleeding disorders: a retrospective study

Oral Management of Steinert's Disease and Role of Anxiolysis

Myotonic dystrophy type I (DM1) is a genetic autosomal dominant disorder; malignant hyperthermia is a possible complication. It may occur following administration of some halogenated general anesthetics, muscle relaxants, or surgical stress. The purpose of this case report is to evaluate the dental management of patients with Steinert's disease. The patient needed dental extraction. A locore-gional paraperiosteal anesthesia was performed using bupiva-caine without vasoconstrictor and sedation with nitrous oxide. The syndesmotomy of the elements 3.1, 4.1, and 4.2 was executed. The elements were dislocated through a straight lever and avulsed with an appropriate clamp. The socket was courted, washing with saline solution, inserting a fibrin sponge, and applying sutures (silk 3-0). Dental treatment of the patient with Steinert's dystrophy must be carried out under a hospital environment and the use of local anesthetic without vasoconstrictor and with use of nitrous oxide; anxiolysis is recommended. This case report describes the precautions to perform oral surgery in patients with Steinert's disease and emphasizes the role of anxiolysis to avoid episodes of malignant hyperthermia.

Dental Management of the Cardiovascular Compromised Patient: A Clinical Approach

Cardiovascular disease trends, complications, and associated therapeutics, impact the dental health and treatment. Such patients require special consideration with regard to when and which dental treatment is appropriate and what precautions are required. A clinical approach is provided for the dental management of patients with Arterial hypertension, Heart failure, and Ischemic Heart disease, Cardiac Arrhythmias, Infective Endocarditis, Stroke and Cardiac Pacemaker. A Medline-PubMed search was conducted of the literature over the last 20 years using the keywords: “cardiovascular diseases”, “dental management”, “arterial hypertension”, “heart failure”, “ischemic heart disease”, “cardiac arrhythmias”, “infective endocarditis”, “stroke” and “cardiac pacemaker”. A total of 46 articles were reviewed, of which 32 were literature reviews, 3 were expert committee guides and updates and 11 original research papers. The appropriate management of dental patients with cardiovascular disease is contingent on appropriate assessment and evaluation. This article aims to allay many of these uncertainties by describing the commoner cardiac conditions, the risk they pose during dental practice and how they may affect dental treatment. It outlines prophylactic and remediable measures that may be taken to enable safe delivery of dental care. Key words: Cardiovascular disease, Dental management, Arterial hypertension, Heart failure, Ischemic heart disease, Cardiac arrhythmias, Infective endocarditis, Stroke and Cardiac pacemaker.

Increasing popularity of waterpipe tobacco smoking and electronic cigarette use: Implications for oral healthcare.

Cigarette smoking increases the risk of developing several systemic conditions including cancer, cardiovascular and pulmonary diseases. Cigarette smoking is also detrimental to oral health as it increases the incidence and severity of oral cancer, periodontal diseases and peri-implantitis, as well as impacting negatively on the dental patients' response to therapy. Therefore, consideration of smoking behavior and recommendation of smoking cessation are important parts of dental treatment planning. However, cigarettes are no longer the most popular form of tobacco use among adolescents in the United States and globally. In recent years, tobacco smoking using a waterpipe ("hookah," "shisha") and use of electronic cigarettes (ECIGs) has increased significantly. Thus, dental clinicians likely will treat more patients who are waterpipe and/or ECIG users. Yet, the literature on the health effects of waterpipe and ECIGs use is sparse. Both waterpipe and ECIGs deliver the dependence-producing drug nicotine. Waterpipe tobacco smoking has been associated with periodontitis, dry socket, premalignant lesions, and oral and esophageal cancer. The health effects of long-term ECIG use are unknown. The purpose of this review is to inform healthcare professionals about waterpipes and ECIGs, highlight emerging evidence on the biological effects of these increasingly popular tobacco products, and introduce perspectives for dental patient management and future research.

Orthodontic care for patients with bleeding disorders

Oral care providers must be aware of the impact of bleeding disorders on the management of dental patients. Initial recognition of a bleeding disorder, which may indicate the presence of a systemic pathologic process, may occur in dental practice. Furthermore, prophylactic, restorative and surgical dental care of patients with bleeding disorders is best accomplished by practitioners who are knowledgeable about the pathology, complications and treatment options associated with these conditions. The purpose of this paper is to review common bleeding disorders and their effects on the delivery of oral health care. Keywords: Blood coagulation/physiology; Blood coagulation disorders/complications; Dental care

Dental Treatment in a State-Funded Primary Dental Care Facility: Contextual and Individual Predictors of Treatment Need?

ObjectiveThis study examined individual and contextual factors which predict the dental care received by patients in a state-funded primary dental care training facility in England.MethodsRoutine clinical and demographic data were extracted from a live dental patient management system in a state-funded facility using novel methods. The data, spanning a four-year period [2008–2012] were cleaned, validated, linked by means of postcode to deprivation status, and analysed to identify factors which predict dental treatment need. The predictive relationship between patients’ individual characteristics (demography, smoking, payment status) and contextual experience (deprivation based on area of residence), with common dental treatments received was examined using unadjusted analysis and adjusted logistic regression. Additionally, multilevel modelling was used to establish the isolated influence of area of residence on treatments.ResultsData on 6,351 dental patients extracted comprised of 147,417 treatment procedures delivered across 10,371 courses of care. Individual level factors associated with the treatments were age, sex, payment exemption and smoking status and deprivation associated with area of residence was a contextual predictor of treatment. More than 50% of children (<18 years) and older adults (≥65 years) received preventive care in the form of ‘instruction and advice’, compared with 46% of working age adults (18–64 years); p = 0.001. The odds of receiving treatment increased with each increasing year of age amongst adults (p = 0.001): ‘partial dentures’ (7%); ‘scale and polish’ (3.7%); ‘tooth extraction’ (3%; p = 0.001), and ‘instruction and advice’ (3%; p = 0.001). Smokers had a higher likelihood of receiving all treatments; and were notably over four times more likely to receive ‘instruction and advice’ than non-smokers (OR 4.124; 95% CI: 3.088–5.508; p = 0.01). A further new finding from the multilevel models was a significant difference in treatment related to area of residence; adults from the most deprived quintile were more likely to receive ‘tooth extraction’ when compared with least deprived, and less likely to receive preventive ‘instruction and advice’ (p = 0.01).ConclusionThis is the first study to model patient management data from a state-funded dental service and show that individual and contextual factors predict common treatments received. Implications of this research include the importance of making provision for our aging population and ensuring that preventative care is available to all. Further research is required to explain the interaction of organisational and system policies, practitioner and patient perspectives on care and, thus, inform effective commissioning and provision of dental services.

Dentists' Knowledge, Attitude and Practice in Treating Patients Taking Oral Antithrombotic Medications - A Survey.

India lists high on patients suffering from diabetes, hypertension, stroke and myocardial infarction. Hence, a large proportion of the population is on long term Oral Antithrombotic Medications (OAM). Though several guidelines exist on dental management of these patients, previous surveys have shown variation among the dentists. The purpose of this study was to assess the knowledge, attitude and practice of dentists in Chennai, India, towards dental management of patients taking OAM using a questionnaire survey. The survey was conducted among 256 dentists in Chennai, India using a printed questionnaire containing 16 questions, at their university location. Descriptive statistical analysis was used to analyze the data. Of the final population of dentists who were included in the survey (n =212), majority of them were aware about drugs such as warfarin and aspirin compared to other newer drugs (dabigatran, rivaroxaban). Most participants took physician's opinion before proceeding with any invasive dental procedure and thromboembolic events were their major concern while treating patients on OAM. The survey revealed dentists are knowledgeable about management of patients on OAM. However, they tend to overestimate the bleeding risk, thus being cautious in their treatment approach. Based on the results of the study, the authors suggest that continuing dental education programs and further training on management of such medically complex patients will be beneficial in order to provide optimum dental care to people taking OAM.

Perceptions of dental interns in Saudi Arabia toward implant placement in medically compromised patients.

BACKGROUND AND AIM:Increasing incidence of medically compromised patients seeking dental treatment and implant rehabilitation, necessitates greater knowledge toward managing such patients. The objective of the present study was to evaluate the perceptions of dental interns in Riyadh, Saudi Arabia, toward dental implant therapy for medically compromised patients.MATERIALS AND METHODS:Using a convenience random sampling technique, a cross-sectional questionnaire-based study was conducted to evaluate the perceptions of the interns from dental schools in Riyadh, Saudi Arabia. Data pertaining to demographic details of the participants, academic grade point average (GPA), clinical implant training and experience and perceptions about dental implant therapy for medically compromised patients were collected.RESULTS:The survey response rate was 82.9% (n = 174/210; Males-129/Females-45). Less than half of the interns (n = 82/174; 47.1%) had performed dental implants, out of which 41.5% (n = 34/82) had placed implants in medically compromised patients. Most medical illnesses except controlled diabetes mellitus and hypertension were perceived by the interns as contraindications for dental implant placement.CONCLUSION:Based on the results of the present study, it could be concluded that courses with a greater emphasis toward management of dental patients with medical problems and undergraduate implant training for such patients would result in better knowledge and perception among dental interns regarding dental implant placement in medically compromised patients.

Dental management in patients with antiplatelet therapy: A systematic review.

IntroductionCardiovascular diseases are the most frequent cause of death in the Western world. Its treatment frequently needs therapy with antiplatelet agents, which increases the haemorrhage risk after oral surgical procedures. The aim of this study is to present a review on the dental management of the patients under antiplatelet treatment.Material and MethodsA systematic review was carried out following PRISMA recommendations including studies searched in Pubmed-Medline, Embase and Cochrane databases.ResultsThe current trend is to maintain the treatment during the surgical procedure, assuring a good control of the haemorrhage with local haemostatic measures. However, new antiplatelet drugs protocols are not firmly established.ConclusionsIn spite of the existing recommendations, it is always advisable to consult with the internist or cardiologist of every patient before any intervention. Key words:Antiplatelet, Oral Surgery, Exodontia, Dental Management.

Dental management of patients taking novel oral anticoagulants (NOAs): Dabigatran.

BackgroundA new group of oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban) with clear advantages over classic dicoumarin oral anticoagulants (warfarin and acenocoumarol) has been developed in recent years. Patients being treated with oral anticoagulants are at higher risk for bleeding when undergoing dental treatments.Material and MethodsA literature search was conducted through April 2016 for publications in the ISI Web of Knowledge, PubMed and Cochrane Library using the keywords “dabigatran”, “rivaroxaban”, “apixaban”, “edoxaban”, “new oral anticoagulants”, “novel oral anticoagulants”, “bleeding” and “dental treatment”.ResultsThere is no need for regular coagulation monitoring of patients on dabigatran therapy. Whether or not to temporarily discontinue dabigatran must be assessed according to the bleeding risk involved in the dental procedure to be performed.ConclusionsThe number of patients under treatment with new oral anticoagulants will increase in the coming years. It is essential to know about the pharmacokinetics and pharmacodynamics of new oral anticoagulants and about their interactions with other drugs. It is necessary to develop clinical guidelines for the perioperative and postoperative management of these new oral anticoagulants in oral surgical procedures, and to carefully evaluate the bleeding risk of dental treatment, as well as the thrombotic risk of suppressing the new oral anticoagulant. Key words:Dabigatran, rivaroxaban, apixaban, edoxaban, novel oral anticoagulants, bleeding.

Orofacial Findings and Dental Management of a Child with Williams Syndrome

Williams syndrome (WS) is a multisystem, congenital and panethnic disorder characterized by developmental and physical abnormalities. Developmental abnormalities in dentition are frequently observed in various patients with craniofacial syndromes, however there are a few reports regarding dental management in patients with WS. The aim of the present report is to describe the case of a 6-year-old child with characteristic facial features of WS with remarkable orofacial findings and the ensuing dental management. An intraoral examination revealed a mixed dentition period, with tooth agenesis and caries requiring treatment such as extraction, restoration and fluoride application. The dental treatment was carried out under local anesthesia and was completed successfully. Since then clinical and radiographic evaluations have been conducted periodically.

Oral rehabilitation of patients with Chediak-Higashi syndrome using zygoma and root form implant-supported fixed prostheses: A report of two patients

Chediak-Higashi syndrome (CH-S) is a rare genetic immunodeficiency disorder. Fewer than 500 individuals with CH-S have been reported worldwide in the past 20 years. The dental management of patients in whom CH-S has been diagnosed has been rarely reported and only in the form of a case report. All reports addressed the severe periodontal disease found in those patients, and most studies concluded that periodontal treatment had an unfavorable prognosis. As a result, complete edentulism at an early age because of severe periodontal disease is expected. The purpose of this report was to present 2 patients with CH-S seeking oral rehabilitation after early tooth loss and severe bone resorption as a manifestation of severe periodontal disease. The treatment used bilateral zygoma implants and an all-on-4 concept. The complications encountered and management with a 5-year post-surgery follow-up are also presented.

The dental management of patients with severe depression disorder (Literature review)

The dental management of patients with severe depression disorder (Literature review)

MANAGEMENT OF DENTAL PATIENTS RECEIVING ANTICOAGULATION THERAPY

Analysis of native and foreign special literature regarding the management of dental patients, who receive anticoagulation therapy, is presented in the review. Knowledge of specialists on this problem was estimated; recommendations on raising the level of skill were made. Peculiarities of managing dental patients with anticoagulation therapy, based on recently developed methodical recommendations for therapeutic and surgical reception of patients, are described. The problem of orthopedic management of dental patients is accentuated.

Dental Management of Special Needs Patients: A Literature Review

The dental management of special needs patients creates doubt and anxiety among dentists. The theme is underexplored throughout the undergraduate course and the dentists have not enough theoretical foundation to work on this field. Special needs patients are those individuals who have permanent or transitory mental, physical, organic social and / or behavioral impairments. Thus, the aim of this study was to assist dentists in the best dental management choice for special needs patients. It was revised and more specifically detailed the management on dental base office, the management under sedation and under general anesthesia, and home care treatments for patients with special needs, with the aim of developing guidelines on management of dental patients with special health care needs to facilitate the execution of dental treatment of these patients. From this literature review, we proposed a guideline to assist the dentist in choosing the best therapeutic approach for the dental treatment of patients with special needs.

Dental management in patients with cirrhosis

The present article makes a brief review about dental management of the patients with cirrhosis. It focus on problems related with infections, haemorrhagic events and treatment with drugs of common use in odontology.

Mouthguard biosensor with telemetry system for monitoring of saliva glucose: A novel cavitas sensor

We develop detachable “Cavitas sensors” to apply to the human oral cavity for non-invasive monitoring of saliva glucose. A salivary biosensor incorporating Pt and Ag/AgCl electrodes on a mouthguard support with an enzyme membrane is developed and tested. Electrodes are formed on the polyethylene terephthalate glycol (PETG) surface of the mouthguard. The Pt working electrode is coated with a glucose oxidase (GOD) membrane. The biosensor seamlessly is integrated with a glucose sensor and a wireless measurement system. When investigating in-vitro performance, the biosensor exhibits a robust relationship between output current and glucose concentration. In artificial saliva composed of salts and proteins, the glucose sensor is capable of highly sensitive detection over a range of 5–1000µmol/L of glucose, which encompasses the range of glucose concentrations found in human saliva. We demonstrate the ability of the sensor and wireless communication module to monitor saliva glucose in a phantom jaw imitating the structure of the human oral cavity. Stable and long-term real-time monitoring (exceeding 5h) with the telemetry system is achieved. The mouthguard biosensor will be useful as a novel method for real-time non-invasive saliva glucose monitoring for better management of dental patients.

ASUHAN KEPERAWATAN GIGI DAN MULUT PADA PASIEN DIABETES MELITUS (LAPORAN KASUS)

TITLEDental nursing care in diabetes mellitus patients (case report)ABSTRACTTo determine dental and oral health care, operators must be able to recognize the symptoms and signs possibility patients suffer systemic disease should be detected as these influence oral hygiene condition. Patients who often visit dental clinic are patients with diabetes mellitus. It is important for operator to know dental management of patients with diabetes melitus therefore diagnosis and treatment can be drawn as needed. Operator also can contribute dental health care and improve quality life of patients diabetes melitus by improving oral hygiene management and complication prevention. Purpose of this report to identify and understand dental and oral health care based on human need with behavior management for dental disease prevention.A diabetes melitus patient with caries occlusal 16 with diagnosis caries reach pulp visit dental clinic. Dental and oral health care to restore tooth shape and function, prevent further caries and reduce pain. Treatment for the patient was dental prophylaxis, dental health education and referral for root canal treatment. Evaluation need to be done regularly.Dental and oral health care are expected to be systematically so that the management of patients with diabetes mellitus can be continue. Dental management patient with diabetes melitus need good communication, laboratorium test and knowledge of operator about diabetes melitus including the effect of dental care, therefore diabetic patient can undergo dental care safety. Key words : Dental and Oral Health Care, Diabetic Patient

Behavior management for dental patients with special needs

Individuals with special needs include those with behavioral issues, developmental disorders, cognitive disorders, congenital or genetic disorders, or systemic disease. These conditions may place them at increased risk for oral diseases. Dental management of patients with special needs require in-depth understanding of the background of disability and available behavioral guidance theories. Therefore dental team members need more training in the theory and practice of behavior management principles, which might lead to a clinical experience that is more respectful of the dignity and independence of patients with special needs. The dental professional should be flexible to modify the behavior management approach according to the individual patients needs. Also a family/care-giver centered approach based on their preferences and concerns, the patient's challenging behaviors, and related medical problem can serve to improve the treatment planning and oral health management of dental patients with special needs. This article focuses on uncooperative behavior and behavior management, which help practicing dentists to understand their role in the care of patients with special needs.

Novel anticoagulants: general overview and practical considerations for dental practitioners.

Currently, 4 novel Direct Oral Anticoagulants (DOACs) were approved by the FDA. This review focuses on these agents and proposes a matrix for the general dentists to assess bleeding risk in dental management of patient on DOACs. The outline covers the pharmacology of DOACs (rivaroxaban, apixaban, edoxaban and dabigatran), bleeding complications, risk associated with discontinuation, monitoring/reversal, and implications for the dental practitioners. A total of 18 randomized controlled trials were identified with mixed results in regards to the risk for bleeding. Considering the pharmacology of DOACs and challenges in monitoring and reversing their effect, the dentist should consider carefully the management of patients on DOACs as it may differ from patients on conventional anticoagulants. Based on the type of dental procedure and the medical risk assessment, several general treatment approaches can be considered: continue DOACs, time dental treatment as late as possible after the last DOACs dose, discontinue DOACs for 24hrs, or discontinue DOACs for 48hrs. Based on the current reported dental literature, limited dental surgery may benefit from the first 2 conservative options. However, this needs to be proven in comparative clinical trials.