Dental Surgeries Research Articles

The impact of the COVID-19 pandemic on 397 631 elective dental admissions among the under-25s in England: a retrospective study.

COVID-19 caused widespread disruptions to health services worldwide, including reductions in elective surgery. Tooth extractions are among the most common reasons for elective surgery among children and young people (CYP). It is unclear how COVID-19 affected elective dental surgeries in hospitals over multiple pandemic waves at a national level. Elective dental tooth extraction admissions were selected using Hospital Episode Statistics. Admission trends for the first 14 pandemic months were compared with the previous five years and results were stratified by age (under-11s, 11-16s, 17-24s). The most socioeconomically deprived CYP comprised the largest proportion of elective dental tooth extraction admissions. In April 2020, admissions dropped by >95%. In absolute terms, the biggest reduction was in April (11-16s: -1339 admissions, 95% CI -1411 to -1267; 17-24s: -1600, -1678 to -1521) and May 2020 (under-11s: -2857, -2962 to -2752). Admissions differed by socioeconomic deprivation for the under-11s (P<0.0001), driven by fewer admissions than expected by the most deprived and more by the most affluent during the pandemic. Elective tooth extractions dropped most in April 2020, remaining below pre-pandemic levels throughout the study. Despite being the most likely to be admitted, the most deprived under-11s had the largest reductions in admissions relative to other groups.

The Impact of Vitamin Deficiencies on Oral Manifestations in Children.

Vitamins play a vital role in human health, particularly in the development and maintenance of oral health in children. These nutrients are broadly categorized into fat-soluble and water-soluble types, crucial for children's well-being. The objective of this study is to investigate the impact of vitamin deficiencies on the oral health of children, focusing on how these deficiencies contribute to various oral health issues and determining the relationship between specific vitamin shortages and oral diseases. Findings indicate that shortages in vitamins A and D lead to enamel issues and a higher susceptibility to dental diseases, vitamin E assists in treating oral mucositis, and vitamin K is essential for blood clotting in dental surgeries. Deficits in B-complex and vitamin C result in enamel hypomineralization and soft tissue ailments, including aphthous stomatitis and gingival petechiae. Additionally, a lack of vitamin B7 compromises the immune response, increasing oral candidiasis risk. Therefore, vitamin deficiencies markedly affect children's oral health, highlighting the need for joint efforts between dental professionals and caregivers for effective pediatric care. Addressing vitamin deficiencies through supplementation and tailored dental care emphasizes the significance of nutritional health in children's overall and dental well-being, advocating for a collaborative approach to achieve optimal health outcomes.

Franz Alfred (1880-1962) and Georg Frederich (1921-2010) Kantorowicz.

George Kantorowicz was a senior lecturer/consultant in conservative dentistry at the Royal Dental Hospital who provided ground-breaking treatment for cleft palate children at Great Ormond Street Hospital. His father, Alfred, was a Jewish professor, dean at Bonn Dental School and a world-famous advocate of mobile dental surgeries and prevention for children's dental health, until the Nazis put him in a concentration camp. After important interventions, he became director of Istanbul Dental Institute.

Professional Attitudes and Practice of Pediatric Dentists About the Use of Local Anesthesia for the Treatment of Children Under General Anesthesia.

The application of local anesthesia in dental surgeries conducted under general anesthesia poses a challenge in pediatric dentistry. There is a lack of consensus regarding the benefits and drawbacks of using general anesthesia in this field. The purpose of this study was to assess the attitudes and practices of pediatric dentists regarding the use of local anesthesia for dental treatments in children under general anesthesia in Iran. This cross-sectional study involved 110 pediatric dentists from across Iran. The dentists' professional attitudes and practices were assessed using a specially designed questionnaire for this study. The questionnaire was distributed through the Line press system, and the data were analyzed following collection. Regarding professional practices, 34.5% of specialists refrained from using local anesthesia. The most frequent application of local anesthesia was observed in tooth extractions. The preferred local anesthetic agent was 2% lidocaine with 1:100 000 epinephrine. A lower dose than that used in outpatient settings was administered, and most specialists allowed sufficient time for the anesthesia to take effect. This study revealed that opinions and attitudes towards the use of local anesthesia in the dental treatment of children under general anesthesia vary across different specialties and are significantly influenced by the patient's condition, type of treatment, and practice techniques.

Anti-resorptive therapy and MRONJ. A survey of the Italian Society of Periodontology and Implantology.

Anti-resorptive agents have been linked to the development of MRONJ in patients undergoing dental surgical procedures. This survey aims to explore the level of knowledge and experience of Italian Society of Periodontology and Implantology members in the management of patients treated with anti-resorptive agents and with the risk of developing MRONJ. An 18-item questionnaire was submitted by e-mail to the SIdP members. Statistical analyses were carried out. Continuous variables were described as mean ± standard deviation (SD) or median, and first and third quartile according to distribution's normality. Normality of data was checked with Shapiro-Wilk test. Four hundred and fifty-one questionnaires were returned by e-mail (32%). Most of the respondents were private practitioners (81.8%). Only 47.7% declared to be highly confident in managing patients on anti-resorptive therapy while 92.5% reported to have performed tooth extractions and 52.3% implant surgery in patients under anti-resorptive therapy for osteometabolic disorders. One or more MRONJ-affected patients were encountered by 63.2% of the respondents. This survey highlights the need to develop a "dedicated" program both for dentists and prescribers to improve the level of cooperation and to increase the level of awareness of patients treated with anti-resorptive agents.

Prediction of Sjögren’s disease diagnosis using matched electronic dental-health record data

BackgroundSjögren’s disease (SD) is an autoimmune disease that is difficult to diagnose early due to its wide spectrum of clinical symptoms and overlap with other autoimmune diseases. SD potentially presents through early oral manifestations prior to showing symptoms of clinically significant dry eyes or dry mouth. We examined the feasibility of utilizing a linked electronic dental record (EDR) and electronic health record (EHR) dataset to identify factors that could be used to improve early diagnosis prediction of SD in a matched case-control study population.MethodsEHR data, including demographics, medical diagnoses, medication history, serological test history, and clinical notes, were retrieved from the Indiana Network for Patient Care database and dental procedure data were retrieved from the Indiana University School of Dentistry EDR. We examined EHR and EDR history in the three years prior to SD diagnosis for SD cases and the corresponding period in matched non-SD controls. Two conditional logistic regression (CLR) models were built using Least Absolute Shrinkage and Selection Operator regression. One used only EHR data and the other used both EHR and EDR data. The ability of these models to predict SD diagnosis was assessed using a concordance index designed for CLR.ResultsWe identified a sample population of 129 cases and 371 controls with linked EDR-EHR data. EHR factors associated with an increased risk of SD diagnosis were the usage of lubricating throat drugs with an odds ratio (OR) of 14.97 (2.70-83.06), dry mouth (OR = 6.19, 2.14–17.89), pain in joints (OR = 2.54, 1.34–4.76), tear film insufficiency (OR = 27.04, 5.37–136.), and rheumatoid factor testing (OR = 6.97, 1.94–25.12). The addition of EDR data slightly improved model concordance compared to the EHR only model (0.834 versus 0.811). Surgical dental procedures (OR = 2.33, 1.14–4.78) were found to be associated with an increased risk of SD diagnosis while dental diagnostic procedures (OR = 0.45, 0.20–1.01) were associated with decreased risk.ConclusionUtilizing EDR data alongside EHR data has the potential to improve prediction models for SD. This could improve the early diagnosis of SD, which is beneficial to slowing or preventing complications of SD.

Deep learning-based tooth segmentation methods in medical imaging: A review.

Deep learning approaches for tooth segmentation employ convolutional neural networks (CNNs) or Transformers to derive tooth feature maps from extensive training datasets. Tooth segmentation serves as a critical prerequisite for clinical dental analysis and surgical procedures, enabling dentists to comprehensively assess oral conditions and subsequently diagnose pathologies. Over the past decade, deep learning has experienced significant advancements, with researchers introducing efficient models such as U-Net, Mask R-CNN, and Segmentation Transformer (SETR). Building upon these frameworks, scholars have proposed numerous enhancement and optimization modules to attain superior tooth segmentation performance. This paper discusses the deep learning methods of tooth segmentation on dental panoramic radiographs (DPRs), cone-beam computed tomography (CBCT) images, intro oral scan (IOS) models, and others. Finally, we outline performance-enhancing techniques and suggest potential avenues for ongoing research. Numerous challenges remain, including data annotation and model generalization limitations. This paper offers insights for future tooth segmentation studies, potentially facilitating broader clinical adoption.

The Pharyngeal Packs for Dental and Otolaryngological Surgery: A Meta-Analysis of High-Quality Randomized Controlled Trials.

Background: Pharyngeal packs are employed to mitigate postoperative nausea and vomiting (PONV) and have become prevalent in dental and otolaryngological surgeries. However, their clinical efficacy continues to be a topic of debate. The objective of the present study was to conduct a quantitative assessment of the impact of pharyngeal packing in dental and otolaryngological surgeries through meta-analysis. Methods: We identified relevant randomized controlled trials (RCTs) through systematic searches of online databases, including PubMed, Embase, and Cochrane Central. Potential eligible studies were evaluated using the Jadad scoring system (range 0-5 points), with only high-quality RCTs (3 points or more) being included. The incidence of PONV, morbidity, and the level of throat pain were aggregated and estimated. Publication bias was evaluated using funnel plot symmetry and the Egger test. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was utilized to rate the evidence. Results: Ten high-quality RCTs comprising 1026 participants were ultimately included. Subsequent quantitative pooled estimation unveiled that the utilization of pharyngeal packing did not lead to a significant reduction in the incidence of nausea (P = .272), vomiting (P = .775), overall PONV (P = .118), or throat pain (P = .149). By contrast, the application of pharyngeal packs was found to significantly increase the level of throat pain (P = .003). No obvious publication bias was detected, and the majority of evidence was rated high or moderate. Conclusion: Based on the existing evidence, we conclude that pharyngeal packing lacks clinical benefit and is not advised for dental and otolaryngological surgeries.

Exploring the aspirations, expectations and impediments of 'dental anaesthesiology' as a medical and dental speciality: A scoping review.

Local anaesthesia is the anaesthetic technique most frequently used in dentistry. Advanced anaesthetic treatments like conscious sedation and/or general anaesthesia are required for major dental surgical procedures. Although general dentists are capable of administering local anaesthesia, additional training is needed for advanced anaesthetic procedures. It is generally disputed whether advanced anaesthetic techniques should be related to one or two dental specialties or whether they should receive a separate degree. This paper aims at introducing the field of 'dental anaesthesiology' in routine dental practice as applicable within laws laid down for dental and medical specialities. Publications, articles and mouthpieces relevant to the topic of dental anaesthesiology were identified using various search engines like MEDLINE (via PubMed), EMBASE, and Web of Science. The terms used for the search were 'Dental anaesthesiology', 'General anaesthesia', and 'Dental care'. Articles about dental treatment done under anaesthesia were only considered describing various anaesthesia techniques. Additionally, the authors being regular caregivers of dentistry including oral and maxillofacial surgeon have shared their personal experiences and information on the said theme. In total, 127 articles were found of which 33 were available as full texts. Unrelated articles from the available full text were excluded. Finally, 17 studies were incorporated into the review. Majority of dental anaesthesiologist has a positive and favourable attitude towards the profession. Pediatric dentistry, oral and maxillofacial surgery, and special needs dentistry are the fields with the highest service demand. Also, the field is lucrative if the practitioner is refined and provides sophisticated services. It is easier and time saving to train the dentists, especially the ones with oral and maxillofacial surgery background. A degree of dental anaesthesiologist will open new doors to the budding dentist seeking for jobs or wanting to provide the best outcome.

EFFECT OF ELECTRONIC CIGARETTE SMOKING AFTER TOOTH EXTRACTION ON THE INCIDENCE OF ALVEOLAR OSTEITIS

Highlights Smoking is a notable and extensively debated risk factor for problems following tooth extraction, but research on electronic cigarettes remains scarce. Electronic cigarettes contain various components comparable with those in conventional cigarettes, potentially resulting in similar chemical composition and effects on alveolar osteitis. Abstract Background: Tooth extraction is one of the minor dental surgical procedures involving the hard and soft tissues of the oral cavity and has several possible complications. One potential risk is alveolar osteitis, also known as dry socket, which is an inflammation marked by intense pain and the dislodging of the blood clot. Smoking behavior is a significant risk factor for alveolar osteitis. Objective: This article aimed to analyze the effect of smoking and electronic cigarette ingredients on the incidence of alveolar osteitis after tooth extraction. Material and Methods: This research was conducted as a scoping review by performing thorough search of the PubMed, Scopus, ScienceDirect, and Google Scholar databases. Research published between 2013 and August 2023 in English language were assessed in this review. Result: A total of ten papers have been included in the analysis. Comparative studies consistently demonstrated that individuals who engage in smoking are at a significantly elevated risk of developing alveolar osteitis following tooth extraction. Discussion: Both conventional and electronic cigarettes can dislodge the blood clot that forms at the tooth socket after tooth extraction as a result of the sucking movement involved in smoking. Electronic cigarette components reduce oxygen delivery to healing tissues, hence accelerating fibrinolysis. Conclusion: Electronic cigarettes affect the occurrence of alveolar osteitis by the act of smoke inhaling and the presence of substances like carbon monoxide and nicotine.

Conscious sedation in pediatric dental procedures: Experience from Usmanu Danfodiyo University Teaching Hospital, Sokoto, Northwestern Nigeria

Abstract Background: The management of fear and anxiety in children scheduled for dental procedures has been a great challenge to the operating dental surgeon. Despite several controversies regarding the effectiveness, and safety of conscious sedation in dental and minor oral surgical procedures, it is widely used nowadays in dental practice. This study aimed to present a retrospective analysis of pediatric dental patients managed under conscious sedation. Materials and Methods: This was a retrospective study conducted over 5 years. After obtaining ethical approval from the research and ethics committee of the institution, the case records of all patients from 15 years and below who had a dental procedure under conscious sedation were retrieved. The demographics, procedures performed, the drug and dosage used, and length of the procedure were also recorded. Data obtained were analyzed using a statistical package for social sciences (IBM SPSS) version 25. Results: A total of 196 patients were included, 92 (46.9%) males and 104 (53.1%) females in the age range of 1–14 years and mean ± SD of 6.79 ± 2.98 years. The age categories were analyzed against the gender which revealed more female children between 6 and 10 years with no statistically significant difference (χ 2 = 4.566; df = 2; P = 0.102). The conscious sedation was done with ketamine 1–2 mg/kg intravenously in 72 patients (36.7%) and 3–4 mg/kg intramuscularly in 124 patients (63.3%), and additional doses were given in 93 patients (47.4%). Pulpectomy only constitutes the highest procedure performed in 42 patients (21.4%). The range length of the procedures was 5–67 min. Multiple procedures were performed in 52 (26.5%) of the patients. All patients were monitored until complete recovery, and no complications were recorded. Conclusion: Conscious sedation with ketamine was found effective and safe during dental and minor oral surgical procedures. With good functional suction, conscious sedation can provide excellent patient cooperation in carrying out multiple procedures in pediatric dental patients.

МОДЕЛЬ РАЗВИТИЯ БИСФОСФОНАТ-АССОЦИИРОВАННОГО ОСТЕОМИЕЛИТА НИЖНЕЙ ЧЕЛЮСТИ В ЭКСПЕРИМЕНТЕ С ЛАБОРАТОРНЫМИ КРЫСАМИ

Purulent-inflammatory diseases of the maxillary system remain one of the urgent problems in the work of dentists and maxillofacial surgeons due to the high frequency, increased severity and prevalence of the process, a tendency to relapse, and increased antibiotic resistance due to a long period of uncontrolled use of the latter by the population. The choice of the bisphosphonate-associated osteomyelitis model is due, on the one hand, to the widespread use of this group in a number of malignant neoplasms, osteoporosis, and, on the other, to the frequent development of osteonecrosis of the jaw as a complication of bisphosphonate therapy, which can occur after any surgical dental procedure. The undoubted advantage of this model is the relative simplicity of its execution technique, which does not require an expensive material and technical base, the use of highly pathogenic and highly contagious microorganisms, keeping animals in a bacteriological laboratory, and the safety of conducting experiments. Experimental modeling of bisphosphonate-associated osteomyelitis may reveal new aspects in the etiopathogenesis of diseases of the maxillofacial region and justify the correction of nondrug and pharmacotherapeutic approaches to the prevention and treatment of complications.

Surface Morphology and Performance of New and Reused Microblade for Dental Surgery

Objectives: Several dental surgical procedures use disposable and reusable instruments. This study aimed to compare the clinical performance of new and reused microblades to perform dental surgery. Methods: The clinical performance of the microblade was evaluated by the cutting capacity during root coverage modified tunnel surgery. The surgery involved cutting the initial portion of the sulcus in the mandible of ex-vivo pigs. After each surgery, the microblades were cleaned, sterilized, and the surface was analysed by scanning electron microscopy and surface roughness measurement. The surface roughness parameters (Ra, Rq, PV, the number of peaks, the number of valleys, and the density of the peaks and valleys, respectively) were determined by a 3D optical profilerugosimeter. Results: Clinical results showed that in the first, second, and third uses, the forces applied to the microblade to perform the soft tissue flaps were similar. During the fourth surgery, there was a need to increase the force on to microblade to perform the dissection. In a visual inspection of the microblade, no differences were observed in the surface morphologies after any uses. Scanning electron microscopy (SEM) analysis showed that the number of grooves increased as the number of reuses increased. The surface roughness parameters increased after each use. Conclusions: Based on the clinical results, it is possible to conclude that it is feasible to sterilize and reuse microblades a maximum of three times. Visual inspection proved to be an inadequate procedure to identify surface damage and impairment of instrument performance. Clinical Significance: Visual inspection and scanning electron microscopy analysis are inadequate procedures to identify surface damage and impairment of surgical cutting instrument performance. It is advisable to efficiently use the same instrument a maximum of 3 times.

Cone Beam Computed Tomography Evaluation of Median Mandibular Lingual Canal in a Western Indian Subpopulation: A Cross-sectional Study

Introduction: The Mandibular Lingual Canals (MLC), which carry the sublingual artery, are present in the mandible near the genial tubercle. Identification of these canals is important before any dental surgical procedures. Aim: To identify and evaluate the mandibular lingual canal in Cone Beam Computed Tomography (CBCT) of the Western Indian Population. Materials and Methods: The current cross-sectional study was conducted at the Department of Oral Medicine and Radiology, Sumandeep Vidyapeeth, Vadodara, Gujarat, India between October 2022 and June 2023. A total of 100 CBCT volumes showing the mandibular anterior region were evaluated for the presence or absence of a mandibular lingual canal. The canals were further evaluated for their number, diameter, length, thickness of the buccal cortical plate, and the remaining bone above and below the canal. The evaluation was done by two separate investigators. The data were entered into Microsoft Excel and subjected to statistical analysis. Data collected were tested statistically using the Chi-square test. Results: A total of 59 males and 41 females’ mandibular CBCT volumes were evaluated, out of which 93 CBCT volumes showed the mandibular lingual canal. The maximum number (n=57) of individuals showed three canals, followed by two canals (n=26) and one canal (n=10). There was no statistical significance between genders regarding canal number, diameter, length, thickness of the buccal cortical plate, and the remaining bone above and below the canal. Conclusion: Three-canal morphology was the most common anatomical form of MLC found in the Western Indian population.

Analysis of the anatomical relationship between the roots of three lower molars with the lingual bone plate and the mandibular canal using cone beam computed tomography

Odontectomy of the inferior wisdom teeth is considered to be one of the most frequently performed dental surgeries. It is certain that in order to prevent possible complications, the oral surgeon must have extensive knowledge regarding the anatomy of the region, possible intra– and postoperative risks, as well as treatment methods that would minimize the occurrence of complications. Of course, a key aspect in choosing the treatment technique and method is represented by the paraclinical investigations, and currently CBCT is considered to be the “golden” standard in visualizing the relationship of the third inferior molars to the neighboring anatomical structures, a fact that significantly contributes to the optimization the provision of dental surgical assistance. The purpose of this study was to reveal the role of the CBCT paraclinical radiological examination in the pre–surgical evaluation of the anatomical relationships of the roots of the lower third molars with the neighboring anatomical elements for the prophylaxis of postextractional complications. Material and methods. The prospective clinical study was based on the visualization of tomographic sections of 116 CBCTs, with a total of 160 inferior wisdom teeth, analyzing various study variables such as the relationship of the inferior wisdom teeth roots to the mandibular canal, to the lingual bony plate, root morphology, etc., with their subsequent statistical analysis. Results and discussion. The extraction of the lower wisdom teeth can be associated with the occurrence of various complications such as the association of postoperative infection, dislodging the teeth into the neighboring spaces, nerve damage. It is important to use preoperatively both the predictability scale of the difficulty of extraction of inferior third molar and the three–dimensional paraclinical investigations in order to plan a treatment plan involving low risks of intra– and postoperative complications. Conclusions. The use of three–dimensional paraclinical investigations such as CBCT are absolutely necessary both for visualizing the relationship between anatomical structures and for planning complex clinical cases.

Electrophoretically Co-Deposited Collagen-Lactoferrin Membranes with Enhanced Pro-Regenerative Properties for Oral Soft Tissue Regeneration.

The quality of soft tissue defect regeneration after dental surgeries largely determines their final success. Collagen membranes have been proposed for the healing of such defects, but in some cases, they do not guarantee a sufficient volume of the regenerated tissue and vascularization. For this purpose, lactoferrin, a protein with natural pro-regenerative, anti-inflammatory, and pro-angiogenic activity, can be added to collagen. In this article, we used a semipermeable barrier-assisted electrophoretic deposition (SBA-EPD) method for the production of collagen-lactoferrin membranes. The membrane structure was studied by SEM, and its mechanical properties were shown. The lactoferrin release kinetics were shown by ELISA within 75 h. When tested in vitro, we demonstrated that the collagen-lactoferrin membranes significantly increased the proliferation of keratinocytes (HaCaT) and fibroblasts (977hTERT) compared to blank collagen membranes. In vivo, on the vestibuloplasty and free gingival graft harvesting models, we showed that collagen-lactoferrin membranes decreased the wound inflammation and increased the healing rates and regeneration quality. In some parameters, collagen-lactoferrin membranes outperformed not only blank collagen membranes, but also the commercial membrane Mucograft®. Thus, we proved that collagen-lactoferrin membranes produced by the SBA-EPD method may be a valuable alternative to commercially used membranes for soft tissue regeneration in the oral cavity.

The effect of mindfulness meditation on dental anxiety during implant surgery: a randomized controlled clinical trial

Dental implant surgery is almost always associated with patient anxiety. Anxiety during dental surgical procedures triggers an increase in sympathetic activity. Mindfulness meditation (MM) is often associated with high levels of relaxation in the form of increased parasympathetic tone and decreased sympathetic activity. However, the effect of MM on dental anxiety is not clear. The current study aimed to show the effects of a MM as a sedative technique during dental implant surgery by examining the State-Trait Anxiety Inventory (STAI-S), bispectral index (BIS), cortisol levels (CL), systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR) and saturation (SpO2) parameters. HR, SBP, DBP, SpO2, BIS score and CLs were compared at the baseline, immediately before-, during-, and immediately after surgery between the test and control groups. We found that the MM resulted in significant decrease in BIS together with positive effects on hemodynamic parameters (decrease of HR, SBP, DBP and increase of SpO2), psychological findings (improvement on STAI-S scores) and biochemical outcomes (decreased CL). In conclusion, the results demonstrate that MM appeared to be a reliable strategy for managing stress during dental implant operation with benefits in psychological, physiological and biochemical outcomes.

Utilization of health insurance by patients admitted for dental surgical procedures at a tertiary care hospital in Coastal Karnataka: a retrospective study.

Background: There are various medical insurance options available in India. However, unlike many other countries, dental insurance plans are rare. The aim of this study was to assess the utilization of various government and private health insurance schemes by patients admitted for dental surgical procedures at a tertiary care hospital in coastal Karnataka, India. Methods: A study was conducted retrospectively to gather data on the socio-demographics, bill details, insurance, and benefits claimed by patients admitted to the Department of Oral and Maxillofacial Surgery at a tertiary care hospital from May 2016 to September 2022. Results: Out of 1750 patients, only 856 (48.9%) patients had availed of insurance, 395 patients (22.6%) utilized government health insurance policies, and 461 patients (26.3%) availed of private health insurance plans. Among Government schemes, primarily Ayushman Bharat-Arogya Karnataka was used by 262 (30.6%) patients, followed by Employees' State Insurance Scheme by 110 (12.9%) patients. Among private schemes, 212 (24.8%) patients used the policies purchased by them, 19 (2.2%) patients' medical expenses were paid by their employers, 105 (12.3%) patients utilized Manipal Arogya Suraksha and 124 (14.5%) patients used Medicare provided by the hospital. Bivariate linear regression confirmed that the total bill amount, out-of-pocket expenditure by the patient, and insurance amount reimbursed to the hospital were significantly associated with the type of insurance (government vs. private). The study noticed a gradual rise in insured patients every year. Conclusion: Greater utilization of health insurance should be encouraged because the cost of dental treatment has always hindered the use of oral health services worldwide. This study highlights that the benefit available to the patients were mainly through general health insurance schemes, not specifically dental health insurance. Insurance schemes covering dental must be promoted more aggressively in the media, highlighting their available benefits, merits, and demerits.

Pre-Operative Coagulation Test Results Do Not Correlate with Self-Bleeding Assessment Tool (Self-BAT) Scores

Background: Elective surgical procedures are planned hemostatic challenges and laboratory coagulation testing is often the typical approach to pre-operative hemostatic assessments. This is unfortunate as the prothrombin time [PT] and activated partial thromboplastin time [aPTT] are of suboptimal predictive value for surgical bleeding risk and are have limited screening ability for inherited bleeding disorders. To the contrary, personal and family history of bleeding are important predictors of inherited bleeding disorders, and thus also likely predictive of perioperative bleeding risk. Quantitative bleeding assessment tools (BATs) have been developed to standardize the patient bleeding history, and a patient self-administered BAT (Self-BAT) has been validated for the diagnosis of type 1 von Willebrand disease. As part of a large, multicentre prospective cohort study to assess the accuracy of the Self-BAT in predicting peri-operative bleeding, we aimed to determine the correlation between results of coagulation assays and the Self-BAT score in patients undergoing elective surgery. Methods: We enrolled adult patients with no previously identified bleeding disorder who were undergoing general elective surgery between 2017 to 2018. We excluded patients with any prior history of therapeutic dose antithrombotic use, and those undergoing cardiac, vascular, emergency, ophthalmologic, or dental surgeries. Bloodwork was drawn at the pre-operative visit, and included aPTT, PT, von Willebrand factor (VWF) antigen, VWF GP1b (ristocetin calibrated) activity, factor VIII activity, platelet function assay (PFA)-100 closure times. The pre-operative Self-BAT and all laboratory tests were analyzed at the same site . We used Spearman's correlation coefficient to determine the relationship between results of laboratory testing and the Self-BAT scores. An abnormal Self-BAT score was defined as ≥6 for women and ≥4 for men. R v4.3.1 was used to perform the analysis. Results: A total of 368 were enrolled in the study, the mean age was 56 years old (standard deviation: 14.4) and 64.3% were women. A total of 12 individuals (3.3%) had a first degree relative with a bleeding disorder. The most common planned procedure was orthopedic (61%), followed by neurosurgery (14.4%), and general surgery (8.2%). The median Self-BAT score for women was 2 (interquartile range [IQR]: 1-4.3) and 1 (IQR: 0-2) for men. Of the 236 women and 131 men, 42 (17.8%) and 17 (13%) had abnormal Self-bat score. We found no significant correlations between the aPTT PT, Factor VIII, VWF panel nor PFA-100 and the Self-BAT score (Table 1). There was also no correlation found for sex stratified analyses. Conclusions: Our findings confirm that unselected ‘routine’ and specialized coagulation test results do not correlate with an individual's bleeding history. Thus, indiscriminate testing should not be used as surrogate screening tests for bleeding disorders in the pre-operative setting. Specialized coagulation testing should be reserved for when a hemostatic defect is suspected based on a positive personal or family bleeding history. We look forward to the results of the primary objective of the larger cohort study; enrollment is more than half completed to determine if the Self-BAT score itself is an accurate predictor of peri-operative bleeding.

Surgical Procedures and Hemostatic Outcome in Patients with Hemophilia Receiving Concizumab Prophylaxis during the Phase 3 explorer7 and explorer8 Trials

Introduction Concizumab is an anti-tissue factor pathway inhibitor monoclonal antibody that has been developed for once-daily subcutaneous prophylactic treatment for hemophilia of all subtypes. The phase 3 explorer7 (NCT04083781) and explorer8 trials (NCT04082429) investigated the efficacy and safety of concizumab prophylaxis in patients with hemophilia A or B with (HAwI/HBwI, explorer7) or without (HA/HB, explorer8) inhibitors. Aim To provide an overview of any surgical procedures at the 56-week cut-off performed on patients who received concizumab prophylaxis in the explorer7 and explorer8 trials. Methods Patients in both explorer7 and explorer8 trials were exposed to no prophylaxis (arm 1) or concizumab prophylaxis (arms 2-4) based on their treatment regimen before the trial. After the main part of the trial, all patients (arms 1-4) could continue in the extension part of the trial receiving concizumab for up to 136 weeks. Informed consent/ethics committee approvals were obtained as appropriate. Minor surgical procedures (defined as any invasive operative procedure where only the skin, mucous membranes or superficial connective tissue is manipulated) were permitted during the explorer7 and explorer8 trials, and management of minor surgeries was at the investigator's discretion. Planned major surgery was not permitted, and for any cases of acute major surgery, a concizumab pause was recommended. Data regarding both minor and major surgeries undertaken in patients were collected at the 56-week cut-off of the trials. Local/topical use of anti-fibrinolytics was permitted during surgical procedures in both trials (single systemic doses allowed following benefit-risk evaluation) and patients undergoing minor surgical procedures continued to receive concizumab prophylaxis during the perioperative period (with no change to the dosage they received). Results During both trials, a total of 278 patients received concizumab prophylaxis. Of these, 30 patients underwent a minor surgical procedure, including 6 (20.0%) adolescents (aged 12-17 years) and 24 (80.0%) adults (aged 18-64 years). Nine patients who underwent a minor procedure had HA (30.0%), 10 had HB (33.3%), 7 had HAwI (23.3%) and 4 had HBwI (13.3%). Four patients underwent both major and minor surgeries and 2 patients underwent major surgeries only. In total, 44 surgical procedures were undergone in 32 patients. The surgical procedures that were performed in patients who received concizumab included a range of minor surgeries in both trials (including tooth extractions and other dental procedures, port removal, colonoscopy, arthrodesis and urethral augmentation). Overall, 6 cases of major surgery were reported during the explorer7 and explorer8 trials (left hip arthropathy, hematoma drainage, right femoral neck fracture, total knee arthroplasty, right ankle arthropathy and diagnostic laparoscopy with removal of blood from the abdominal cavity) in 1 patient with HA, 2 patients with HB, 1 patient with HAwI and 2 patients with HBwI respectively. Bleeding episodes related to minor and major surgical procedures (n=30) were reported in 24 patients and in 15 of these a total of 17 bleeding episodes were treated. The majority of patients (n=12) who reported a treated surgical-related bleeding episode had undergone a dental surgical procedure. Other minor surgical procedures with associated bleeding episodes included port removal, and venesection. The number and type of minor surgical procedures are further described in Table 1. Conclusion Minor surgical procedures were conducted in approximately 11% of patients who received treatment with concizumab during the phase 3 explorer7 and explorer8 trials. Most minor surgeries that took place were dental procedures and the majority of surgical-related bleeding episodes were mild or moderate. Overall, minor surgeries could be performed on patients with hemophilia under concizumab prophylaxis.