Tooth Extraction In Patients Research Articles

Guided Bone Regeneration in a Periodontally Compromised Individual with Autogenous Tooth Bone Graft: A Radiomics Analysis.

Autogenous tooth bone graft material (AutoBT) has been advocated as a bone substitute when conducting alveolar ridge preservation. This study is aimed at using a radiomics approach in order to evaluate and testify whether AutoBT can stimulate bone growth during socket preservation in severe periodontal cases. For this study, 25 cases with severe periodontal diseases were selected. The patients' AutoBTs were inserted into the extraction sockets and covered with Bio-Gide® collagen membranes. 3D CBCT scans and 2D X-rays were taken of the patients before surgery and after 6 months post-surgery. For the retrospective radiomics analysis, the maxillary and mandibular images were compared in different groups. Maxillary bone height was analyzed at the buccal, middle, and palatal crest sites, while the mandibular bone height was compared at the buccal, center, and lingual crest sites. In the maxilla, the alveolar height was increased by -2.15 ± 2.90 mm at the buccal crest; -2.45 ± 2.36 mm at the center of the socket, and -1.62 ± 3.19 mm at the palatal crest, while the height of the buccal crest was increased by 0.19 ± 3.52 mm, and the height at the center of the socket was increased by -0.70 ± 2.71 mm in the mandible. The three-dimensional radiomics analysis demonstrated significant bone growth in the local alveolar height and high density. Based on clinical radiomics analysis, AutoBT could be used as an alternative bone material in socket preservation after tooth extraction in patients with severe periodontitis.

Correction to: A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ?

Correction to: A multicenter retrospective study of the risk factors associated with medication-related osteonecrosis of the jaw after tooth extraction in patients receiving oral bisphosphonate therapy: can primary wound closure and a drug holiday really prevent MRONJ?

Evaluation of oroantral communication potential risk during maxillary teeth extraction in patients with different types of facial skeleton

Relevance. Tooth extraction is the most common operation in oral surgery practice. For oroantral communication (OAC) treatment and prevention as one of the surgery complications, it is paramount to study the prevalence of anatomical risk factors for OAC in patients based on their facial sk eleton type.Materials and Methods. We analyzed 1629 cone-beam CT scans of patients aged 18 to 85 years of both sexes to determine the potential risk of OAC in patients with different types of the facial skeleton.Results. The overall assessment of OAC potential risk demonstrated a high risk in 29.7% of cases (4514 teeth) (p < 0.01). The high-risk group determined teeth most often in patients with a mesoprosopic type of facial skeleton – 31.2% of cases (2912 teeth), in euryprosopic – 29.46% (914 teeth), in leptoprosopic – 24.96% of cases, (688 teeth), (p < 0.01). The potential risk of the first and second molar OAC was the highest of all teeth in all facial skeleton types (p < 0.01).Conclusion. A potentially high OAC risk of about 30% can be related to the upper teeth, located in the maxillary sinus floor area in patients with any facial skeleton type, though the risk is higher in meso- and euryprosopic types (p < 0.01). Among all groups of teeth, the highest potential risk of OAC (up to 40%, p < 0.01) is in the maxillary 1st and 2nd molar region in any facial sk eleton type.

Local application of collagen sponge Alvokon after tooth extraction surgery

After tooth extraction, it is necessary to create favorable conditions for the healing of the hole of the removed tooth. Dynamic observation of the patient by the attending physician is generally accepted to assess the condition of the postoperative wound and the patient’s implementation of recommendations for oral care. However, patients often note the presence of pain and swelling of the mucous membrane of the well of the removed tooth.Stude – a comparative assessment of the course of the early postoperative period in patients with local application of collagen sponges Alvokon and Alvostaz.Materials and methods. A prospective randomized study of 80 patients aged 20 to 59 years was conducted. The patients underwent a tooth extraction operation under local anesthesia. The patients were divided into 4 groups of 20 people. In patients of the first group, a collagen sponge Alvocon No. 3 was placed in the hole of the removed tooth, in patients of the second group – a collagen sponge Alvocon No. 5 in patients of the third group – a hemostatic collagen sponge «Alvostaz». Local medicines were not used in patients of the fourth group after tooth extraction. In the postoperative period, the presence of pain and the condition of the hole of the removed tooth were assessed.Results. Wound healing proceeded by secondary tension without complications in all patients. Comparing the nature of the course of the early postoperative period, pain after tooth extraction in patients of different groups varied from 5 to 50% of cases, and the presence of edema of the wound edges – from 5 to 100% of cases.Conclusions. Pain in the early postoperative period is expressed 2 times less when using the collagen sponge Alvokon No. 5. Edema of the marginal gum of the well of the removed tooth was 1.1 times less when using the collagen sponge Alvokon, 1.2 times when using the hemostatic collagen sponge Alvostaz in comparison with the group of patients without the use of a sponge.

Management of Tooth Extraction in Patients Taking Antiresorptive Drugs: An Evidence Mapping Review and Meta-Analysis

Medication-related osteonecrosis of the jaw (MRONJ) is a well-known severe adverse reaction of antiresorptive, antiangiogenic or targeted therapies, and usually occurs after tooth extraction. This review is aimed at determining the efficacy of any intervention of tooth extraction to reduce the risk of MRONJ in patients taking antiresorptive drugs, and present the distribution of evidence in these clinical questions. Primary studies and reviews were searched from nine databases (Medline, EMBase, Cochrane Library, Scopus, WOSCC, Inspec, KCI-KJD, SciELO and GIM) and two registers (ICTRP and ClinicalTrials.gov) to 30 November 2022. The risk of bias was assessed with the ROBIS tool in reviews, and the RoB 2 tool and ROBINS-I tool in primary studies. Data were extracted and then a meta-analysis was undertaken between primary studies where appropriate. Fifteen primary studies and five reviews were included in this evidence mapping. One review was at low risk of bias, and one randomized controlled trial was at moderate risk, while the other eighteen studies were at high, serious or critical risk. Results of syntheses: (1) there was no significant risk difference found between drug holiday and drug continuation except for a subgroup in which drug continuation was supported in the reduced incidence proportion of MRONJ for over a 3-month follow-up; (2) the efficacy of the application of autologous platelet concentrates in tooth extraction was uncertain; (3) there was no significant difference found between different surgical techniques in any subgroup analysis; and (4) the risk difference with antibacterial prophylaxis versus control was -0.57, 95% CI -0.85 to -0.29. There is limited evidence to demonstrate that a drug holiday is unnecessary (and may in fact be potentially harmful) in dental practice. Primary closure and antibacterial prophylaxis are recommended despite limited evidences. All evidence have been graded as either of a low or very low quality, and thus further high-quality randomized controlled trials are needed to answer this clinical question.

Which one is the most preferred anesthesia type in dental treatments of patients with special needs: sedation or general anesthesia?

Aim: Patients with special needs, who have mental, physical or medical disabilities, were reported to have worse oral hygiene than their healthy peers. Disabled patients are usually uncooperated, and dental treatments of these patients are completed under several anesthesia types. Our aim was to compare anesthesia types in dental treatments of patients with special needs. Material and Method: The study included review of uncooperated patients, who had physical or mental disabilities, between June 1, 2021 and June 1, 2022. Patients were divided into three groups due to their anesthesia types; sedation (Group S), laryngeal mask airway (LMA) (Group L), and nasotracheal intubation (Group N). Results: In total 80 patients were analyzed; 4 patients excluded, 45 patients were in Group S, 19 patients were in Group L, and 12 patients were in Group N. Anesthesia times were significantly different between groups; 20 min in Group S, 25 min in Group L, and 45 min in Group N. Propofol use was significantly low (p<0.001) and ketamine use was significantly high in Group S (p=0.002). Number of tooth extractions was not significantly different between groups, but number of filling tooth was significantly high in Group N (p=0.002). Conclusion: Sedation was the most preferred anesthesia type in dental treatment of patients with special needs. Although all three types of anesthesia can be used safely in dental treatments, we suggest that sedation can be considered as the first choice in tooth extraction in patients deemed appropriate by the anesthesiologist and dentist.

Is Chitosan Dental Dressing Better Than Cotton Gauze in Achieving Hemostasis in Patients on Antithrombotics?

Tooth extraction leads to bleeding which may be longer in patients on antithrombotics. This study was aimed to evaluate the hemostatic and wound healing efficacy of chitosan-based dressing in comparison to the cotton pressure pack after tooth extraction in patients receiving single or dual antithrombotics. This is a prospective, randomized split mouth study. Patients undergoing tooth extractions taking either single or dual antithrombotics, with an international normalized ratio (INR) value≤3 were enrolled at JSS Dental College & Hospital, Mysuru, India during February 2020 to January 2022. The study compared the efficiency of chitosan dressing in achieving quicker hemostasis in comparison to cotton pressure pack. The primary outcome was time to achieve hemostasis and the secondary outcomes were alveolar clinical healing index and alveolar osteitis. The covariates were gender, age, reason for extraction, INR, type of antithrombotic therapy, and the disease condition. Of the 54 enrolled subjects, 39 were males and 15 were females, aged between 33 and 86years. Thirty six patients were on single antithrombotics, whereas 18 patients were on dual antithrombotics. The reason for extraction was periodontitis in 37 patients and dental caries in 17 patients. The time to achieve hemostasis was lesser with chitosan dental dressing when compared to cotton pressure packs (96±4 and 797±23seconds; P<.001). In the chitosan group, the time to hemostasis was similar irrespective of single or dual antithrombotic therapy (90±6 and 109±8seconds, respectively). On the contrary, in the cotton pressure pack group, patients on dual antithrombotics had longer time to achieve hemostasis compared to those on single antithrombotics (940±20 and 726±26seconds; P<.001). The time to achieve hemostasis was dependent on INR only in cotton pressure pack group (r2=0.7756). The alveolar clinical healing index was better in 88.9% with chitosan and only 3.7% with cotton pressure packs. None of the patients treated with chitosan presented with alveolar osteitis, as opposed to 3.7% of patients with cotton pressure packs. When compared to cotton pressure packs, chitosan-based dressing was more effective in controlling postoperative bleeding in patients treated with single and dual antithrombotic therapy.

Peri-operative hemostatic management of tooth extraction in patients with hemophilia A, with and without inhibitors, receiving emicizumab prophylaxis.

Emicizumab treatment may allow patients with hemophilia A without (PwHA) and with inhibitors (PwHA-I) to undergo some minor surgeries, such as tooth extraction, without peri-operative factor infusions. However, criteria for determining the necessity of factor infusions before minor surgeries are unknown. We report the peri-operative hemostatic management and outcomes of emicizumab-treated PwHA and PwHA-I cases who underwent tooth extractions using our institutional protocol. We retrospectively evaluated PwHA and PwHA-I who underwent tooth extraction with emicizumab prophylaxis at our institution. Local bleeding risk was assessed based on the method, number, and site of tooth extraction. Hemostasis was monitored peri-operatively by rotational thromboelastometry (ROTEM). Hemostatic agents and a mouth splint were used. Twenty-nine extractions (17 interventions) were performed in eight PwHA and two PwHA-I. Based on ROTEM, pre-operative factor infusions were used in ten PwHA and four PwHA-I interventions. Among nine low local bleeding risk interventions, three (33.3%) each received no infusions, one dose of factor infusion pre-operatively, and pre- and post-operative factor infusions. All eight high local bleeding risk interventions involved planned factor infusions. Absorbable hemostats were used in all extractions. A mouth splint was used in 21/25 (84.0%) PwHA and in 4/4 (100%) PwHA-I extractions. No post-extraction bleeding or thrombotic events occurred. Use of a systemic hemostatic treatment plan according to the local bleeding risk, peri-operative coagulation status assessment using ROTEM, filling the extraction socket with hemostats, and use of a mouth splint can achieve effective and safe hemostatic management in emicizumab-treated PwHA and PwHA-I.

Comparing effectiveness of infiltration, and inferior alveolar nerve anesthesia for extraction of posterior mandibular teeth

The present study compares the effectiveness of inferior alveolar nerve block and infiltration in the extraction of posterior mandibular teeth. 90 patients were divided into two groups. Group 1 included 45 patients and for each tooth, two injections (0.6 ml out of 1.8 ml of 2% lidocaine from one dental cartridge with 1:80000 adrenaline) were administered, one Local Anesthetic injection was given parallel to the long axis of the tooth in the depth of buccal sulcus with short needle and dental syringe. The second injection was delivered to the lingual vestibule of the mouth's floor to anaesthetize the soft and hard lingual tissue with short needle and dental syringe, whereas Group 2 included 45 patients and were given Inferior Alveolar Nerve Block (1.5 ml of 2% Lidocaine) and Long Buccal nerve Infiltration (0.3ml of 2% Lidocaine). In our study, we found 78% patients was pain free and 22% was feeling pain during tooth extraction in patients who were given infiltration, whereas patients in which Inferior alveolar nerve block was given, 89% patients was pain free and 11% were feeling pain during tooth extraction. 94% of males and 85% of females experienced no pain, whereas 6% of males and 15% of females felt pain during the extraction. The present study suggests that Infiltration can be used as an alternative approach to inferior alveolar nerve block during the extraction of Mandibular posterior teeth.

Potential relationship between the dosage of prednisolone and delayed healing at tooth extraction: A retrospective study

Background/purposeDelayed healing of the extraction socket is not uncommon when tooth extraction is performed on patients taking prednisolone. This study aimed to identify specific dosage of prednisolone and factors associated with delayed healing of the extraction socket in patients taking prednisolone. Materials and methodsThis single-center retrospective study included 80 patients who underwent tooth extraction under local anesthesia and were taking prednisolone orally. Patients were divided into the nondelayed healing group (n = 50) and delayed healing group (n = 30), and their background and dosage of prednisolone were compared. ResultsThe dosage of prednisolone was significantly higher in the delayed healing group than in the nondelayed healing group. A receiver operating characteristics curve analysis resulted in moderate accuracy when the cutoff value was set at 8.0, with 67% sensitivity, 76% specificity, and 0.765 area under the curve. The multivariate logistic regression analysis revealed that prednisolone dosage >8.0 mg/day (odds ratio [OR], 10.8; 95% confidence interval [CI], 2.79–41.6) and osteosclerotic changes beyond the alveolar bone around the tooth to be extracted (OR, 10.3; 95% CI, 2.81–37.8) in X-ray imaging had significant effects on delayed healing. ConclusionThe results of this study suggested that delayed healing following tooth extractions in patients taking prednisolone was related to a dosage of 8.0 mg/day or higher and osteosclerotic changes.

Incidence and Risk of Anti-Resorptive Agent-Related Osteonecrosis of the Jaw after Tooth Extraction: A Retrospective Study.

Bone-modifying agents (BMA) such as bisphosphonates and denosumab are frequently used for the treatment of bone metastases, osteoporosis, and multiple myeloma. BMA may lead to anti-resorptive agent-related osteonecrosis of the jaw (ARONJ). This study aimed to clarify the risk factors for and probabilities of developing ARONJ after tooth extraction in patients undergoing BMA therapy. In this study, the records of 505 target sites of 302 patients undergoing BMA who presented with mandibular fractures at the Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, from March 2014 to January 2022, were retrospectively analyzed for the onset of ARONJ after tooth extraction. The following variables were investigated as attributes: anatomy, health status, and dental treatment. The correlation coefficient was calculated for the success or failure of endodontic surgery for each variable, the odds ratio was calculated for the upper variable, and the factors related to the onset of ARONJ were identified. The incidence rate of ARONJ was found to be 3.2%. Hypoparathyroidism was an important factor associated with ARONJ development. Thus, systemic factors are more strongly related to the onset of ARONJ after tooth extraction than local factors.

Experts' consensus on perioperative management of tooth extractions in patients receiving oral antithrombotic treatment.

Thromboembolic diseases, which comprise venous thromboembolic diseases and arterial thromboembolic diseases, have become the number one cause of death worldwide. To prevent or treat thrombosis, patients with thromboembolic diseases need to take antithrombotic drugs, which would increase the risk of bleeding during and after surgery. Tooth extraction is the most common operation in oral and maxillofacial surgery clinics. Although patients given oral antithrombotic drugs do not need to undergo drug withdrawal, the perioperative management of such patients remains confusing to most clinicians. Moreover, the potential risk factors for bleeding warrant further study. To improve the clinicians' knowledge of perioperative management for patients subjected to tooth extractions with oral antithrombotic drugs, experts have drafted this consensus focusing on preoperative bleeding risk assessment, intraoperative operating norms, and postoperative care to summarize the points needing attention.

A multicenter prospective study on the development of BRONJ after tooth extraction in patients treated with bisphosphonates

A multicenter prospective study on the development of BRONJ after tooth extraction in patients treated with bisphosphonates

Medication-related osteonecrosis of the jaw after tooth extraction in patients receiving pharmaceutical treatment for osteoporosis: A retrospective cohort study

Background/purposeBone resorption inhibitors, such as bisphosphonates (BPs) and anti-receptor activator of nuclear factor kappa B ligand antibodies (denosumab; Dmab), are used to treat osteoporosis and effectively reduce the risk of fracture. However, medication-related osteonecrosis of the jaw (MRONJ) has been reported as a rare adverse effect. Invasive tooth extraction procedures are reportedly a factor in the development of MRONJ. In this study, we aimed to retrospectively observe and clinically examine the effect of medication status on MRONJ development after tooth extraction in patients receiving drug treatment for osteoporosis. Materials and methodsThis study was conducted among patients who visited our hospital between December 2015 and December 2021. We collected and analyzed the medical information of patients who underwent dental extractions while using osteoporosis medications, including oral and injectable BPs and Dmab. ResultsAmong antiresorptive medication users, 40 patients (70 teeth) underwent extraction. The mean duration of BP/Dmab use was 40.4 months, and the mean duration of drug holiday was 6.9 months. MRONJ after tooth extraction was not seen in BP users, but we observed two cases in Dmab users. A significant difference in MRONJ development was confirmed with the use of injectable compared with oral medication administration (odds ratio＝5.01). ConclusionThe use of injectable bone resorption inhibitors was associated with a higher risk of developing MRONJ. The route of administration, duration of medication, and withdrawal period should be carefully considered to prevent MRONJ after tooth extraction.

Frequency of hemorrhage after tooth extraction in patients treated with a direct oral anticoagulant: A multicenter cross-sectional study.

ObjectiveFew studies have compared the frequency of hemorrhages after tooth extraction between patients taking direct oral anticoagulants (DOACs) and those taking warfarin or no anticoagulants. Further, the effects of the timing of DOAC administration and tooth extraction on the frequency of post-extraction hemorrhage have not been demonstrated. Therefore, we compared the frequency of post-extraction hemorrhages in patients in these different conditions and examined the effects of the timing of DOAC administration and tooth extraction on the frequency.DesignProspective multicenter studySettingEighty-six Japanese hospitals.ParticipantsIn total, 182 teeth extracted from 145 individuals (119 teeth from adult males) receiving dabigatran and 88 teeth from individuals (62 teeth from adult males) receiving rivaroxaban were included.InterventionTooth extraction was followed by a 7-day observational period between November 1, 2008 and December 31, 2015. Dabigatran was administered twice daily; rivaroxaban was administered once a day.Primary outcome measureHemorrhage after tooth extraction.ResultsThe frequency of hemorrhage after tooth extraction was 1.65%, 3.41%, and 3.63% in those treated with dabigatran, rivaroxaban, and warfarin, respectively, and 0.39% in those who did not receive anticoagulants. Hemorrhages after tooth extraction were significantly higher in the rivaroxaban group than in patients who did not receive anticoagulants (P = 0.008). These frequencies did not differ significantly in the dabigatran and rivaroxaban groups compared to the warfarin group (P = 0.221 and P = 1.000, respectively).ConclusionsThe frequency of hemorrhaging after tooth extraction appeared to be similar in patients receiving continuous dabigatran or rivaroxaban and in those receiving continuous warfarin.

Pattern and causes of tooth extraction in patients reporting to GVPIHC and MT, Visakhapatnam, Andhra Pradesh

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Teeth help us in masticatory function, phonetics and aesthetics. Loss of teeth may affect quality of life and has significant socioeconomic, psychological consequences. Its important to analyse the reasons and patterns of tooth loss to know their impact on the remaining dentition and oral health. Thus, the present study was designed to understand the pattern and causes of tooth extraction in a targeted population. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This retrospective study analysed 972 records of patients who underwent 1092 dental extractions in the department of dentistry at Gayatri Vidya Parishad Institute of Health Care and Medical Technology-Visakhapatnam from January 2021 to December 2021. Various aspects like the causes of extraction, type of teeth extracted, type of dentition involved and site of extraction were evaluated. The collected data was then tabulated and subjected to statistical analysis. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 1092 extractions were evaluated and noticed only 7% cases involving primary dentition. Caries (65.8%) was the most common cause of dental extractions followed by periodontitis. Majority of extractions were noticed in maxillary posterior region. First molars (27.4%) were often extracted followed by second molars. Least number of extractions involved canine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Dental caries and periodontitis were the most common causes of dental extraction. Most extractions involved secondary dentition. Maxillary and posterior regions had maximum number of extractions. First molars were commonly extracted followed by second molars. It is necessary to implement preventive dental care programs and improve the oral hygiene awareness in public.&lt;/p&gt;

Clinical study of medically compromised patients undergoing tooth extraction while receiving antithrombotic therapy

AbstractBackgroundThe frequency of surgical treatments in older adult patients undergoing antithrombotic therapy is increasing; hence, appropriate measures should be undertaken to ensure a safe treatment. This study aimed to evaluate the outcomes of tooth extraction in patients undergoing antithrombotic therapy and confirm an evidence‐based approach for such procedures based on relevant guidelines.Materials and methodsThis study included 165 patients (184 cases) receiving antithrombotic therapy while undergoing outpatient tooth extraction. Medical records of these patients were examined to obtain data on patients' clinical and demographic characteristics and characteristics of the tooth extraction procedure.ResultsWarfarin was used in 25 patients (26 cases). A total of 26 (33 cases) and 91 (101 cases) patients received direct oral anticoagulants (DOACs) and antiplatelet drugs, respectively. Dual antiplatelet therapy with the concomitant use of anticoagulants was administered to 15 (16 cases) patients. Drug therapy was suspended in five cases. A total of 14 cases had post‐extraction bleeding, accounting for 7.1% of the total cases. Among patients with suspended drug administration, only suturing was performed for those taking DOAC.ConclusionsThis study indicated that it is tend to require local hemostatic agents in the patients involving DOACs especially. In addition, we reconfirmed that tooth extraction in patients undergoing antithrombotic therapy should be conducted in compliance with guidelines.

Osteonecrosis development by tooth extraction in zoledronate treated mice is inhibited by active vitamin D analogues, anti-inflammatory agents or antibiotics

Invasive dental treatment such as tooth extraction following treatment with strong anti-bone resorptive agents, including bisphosphonates and denosumab, reportedly promotes osteonecrosis of the jaw (ONJ) at the extraction site, but strategies to prevent ONJ remain unclear. Here we show that in mice, administration of either active vitamin D analogues, antibiotics or anti-inflammatory agents can prevent ONJ development induced by tooth extraction during treatment with the bisphosphonate zoledronate. Specifically, tooth extraction during treatment with zoledronate induced osteonecrosis in mice, but administration of either 1,25(OH)2D3 or ED71, both active vitamin D analogues, significantly antagonized osteonecrosis development, even under continuous zoledronate treatment. 1,25(OH)2D3 or ED71 administration also significantly inhibited osteocyte apoptosis induced by tooth extraction and bisphosphonate treatment. Administration of either active vitamin D analogue significantly inhibited elevation of serum inflammatory cytokine levels in mice in response to injection of lipopolysaccharide, an infection mimetic. Furthermore, administration of either anti-inflammatory or antibiotic reagents significantly blocked ONJ development following tooth extraction and zoledronate treatment. These findings suggest that administration of active vitamin D, anti-inflammatory agents or antibiotics could prevent ONJ development induced by tooth extraction in patients treated with zoledronate.

Efficacy of Platelet Rich Fibrin Versus Gelatin Sponge or Tranexamic Acid on Hemostasis and Wound Healing Following Tooth Extraction in Patients On Anticoagulant Therapy

Efficacy of Platelet Rich Fibrin Versus Gelatin Sponge or Tranexamic Acid on Hemostasis and Wound Healing Following Tooth Extraction in Patients On Anticoagulant Therapy

MANAGEMENT OF TOOTH EXTRACTIONS IN PATIENTS RECEIVING THE NEW ORAL ANTICOAGULANTS

Introduction: High bleeding risk procedures pose a serious challenge for dental practitioners treating patients taking some of the novel oral anticoagulants. Aim: The aim of the present study was to assess clinically the bleeding risk in a typical tooth extraction in patients on monotherapy with one of the new oral anticoagulants rivaroxaban (Xarelto), apixaban (Eliquis), and dabigatran (Pradaxa). Materials and methods: The study included 30 patients on these anticoagulants who underwent a typical tooth extraction. Local hemostasis was achieved using Surgicel, Haemocollagen or Gelaspon, and suturing the edges of the wound. Clinical evaluation of the bleeding was performed at 10 and 30 minutes, and 24 hours after the extraction. Anticoagulants were discontinued for the day of extraction. Results: Post-extraction bleeding in the first 10 minutes was observed in 17 patients (56.66%). Bleeding within 30 minutes was observed in 11 patients (36.66%). Two (6.66%) patients reported having only mild oozing within 24 hours. No additional haemostasis was required for any of the patients. Bleeding in a typical tooth extraction is of capillary origin. Bleeding sites are easily accessible and local hemostatic agents are effective enough to control the bleeding. Discontinuation of the anticoagulant on the day of extraction is sufficient to prevent any adverse events. No abnormal post-extraction bleeding was observed in our study. Conclusions: If tooth extraction is required in patients taking the new oral anticoagulants rivaroxaban (Xarelto), apixaban (Eliquis) or dabigatran (Pradaxa), the patient can cease the reception of the drug only for the day of the procedure.