Invasive Dental Treatment Research Articles

Risk of Postoperative Bleeding Following Dental Extractions in Patients on Antithrombotic Treatment

Background: Risk of bleeding post dental extractions in patients on the anticoagulant medication is not well-established. The aim of the study is to investigate the incidence of postoperative bleeding following dental extractions in adult patients on antithrombotic medication in Saudi Arabia. Methods: A retrospective study of 539 patients aged 18 to 93 years of age, attended 840 visits for dental extractions from January 2012 to June 2016 at a tertiary care hospital in Saudi Arabia. All returning patients were treated as outpatients with local hemostatic measures. Results: Only 1.7% of the visits were associated with post-operative bleeding following dental extractions. The highest risk of bleeding occurred in patients on Warfarin (3.88%), while those on Clopidogrel had no risk associated with bleeding. Women were found to have the highest rate of bleeding associated with dental extractions especially those on new oral anticoagulant medications. Conclusion: Dental extractions can be safely performed on adults receiving antithrombotic treatment provided established guidelines are followed. Health care professionals must exercise caution when planning invasive dental treatment for patients on continued antithrombotic therapy. Disclosures No relevant conflicts of interest to declare.

OSTEONECROSIS OF THE MAXILARIES ASSOCIATED WITH USE OF BIPHOSPHONATE

Introduction: Bisphosphonates (BF) are inhibitors of reabsorption bone and are indicated for the treatment of Osteoporosis, Bone Metastasis, Multiple Myelomas and Paget's Disease. They are pyrophosphate analogs, which have high affinity for bone tissue inhibiting the action of osteoclasts. Although it has benefits for patients with of such diseases by assisting, for example, in the pain control prolonged use may lead to osteonecrosis of the jaws.
 Objectives: This article aims to review themedical literature on the use of bisphosbonates and dental surgeries.
 Materials and Methods: The indexed articles google academico and PubMed were scanned and the articles with the highest impact factor were selected. Results: We found 350 articles and selected 20 with the highest impact factor.
 Conclusion: Bisphosphonates are substances that can cause oteonecrosis in patients undergoing invasive dental treatments.

Osteonecrosis of the maxilaries associated with use of biphosphonate

Introduction: Bisphosphonates (BF) are inhibitors of reabsorption bone and are indicated for the treatment of Osteoporosis, Bone Metastasis, Multiple Myelomas and Paget's Disease. They are pyrophosphate analogs, which have high affinity for bone tissue inhibiting the action of osteoclasts. Although it has benefits for patients with of such diseases by assisting, for example, in the pain control prolonged use may lead to osteonecrosis of the jaws. Objectives: This article aims to review themedical literature on the use of bisphosbonates and dental surgeries. Materials and Methods: The indexed articles google academico and PubMed were scanned and the articles with the highest impact factor were selected. Results: We found 350 articles and selected 20 with the highest impact factor. Conclusion: Bisphosphonates are substances that can cause oteonecrosis in patients undergoing invasive dental treatments. KEY WORDS: Osteonecrosis, bisphosphonate, necrosis of the jaws

Molecular markers relevant to myocardial injury following dental extraction in patients with and without coronary artery disease

ObjectivesThe aim of this study was to characterize biological changes following dental extractions in patients with and without coronary artery disease (CAD).Materials and methodsForty-five patients (36 males and 9 females) referred for dental extraction underwent treatment and provided blood samples before, immediately after, and 24 h after the procedure. A broad array of biomarkers was employed to assess myocardial injury (highly sensitive troponin T, hs-TnT), bacterial burden (LPS endotoxin activity), and systemic inflammation (CRP, fibrinogen, IFN-γ, IL-1β, IL-6, IL-8, IL-10, IL-12, and TNF-α).ResultsDental extraction in patients with and without CAD was associated with rises in hs-TnT (p = 0.013), hs-CRP (p < 0.001), fibrinogen (p = 0.005), endotoxin activity (p < 0.001), IFN-γ (p < 0.001), IL-6 (p < 0.001), IL-8 (p = 0.011), and IL-12 (p < 0.001) at 24 h compared with immediately post procedure. Changes in systemic inflammation and endotoxin activity were more evident in those with hs-TnT rise.ConclusionsSimple dental extractions may cause mild increase in hs-TnT, indicating minor myocardial injury in both patients with and without CAD. Acute systemic inflammation and endotoxemia could represent a possible link between invasive dental treatment and increased risk of acute cardiovascular events. These findings indicate that invasive dental treatment (as simple as a single dental extraction) may impact negatively on clinical outcomes in dental patients, especially those with CAD.

Correlation between caries history and laser fluorescence of sound tooth enamel in restored and unrestored dentition.

The aim of this study was to determine the correlation between laser fluorescence (LF) values of apparently sound tooth enamel and caries history. LF measurements were recorded from six sound enamel tooth surfaces in each of 346 subjects aged 8-25 years. Caries experience was evaluated using the decayed, missing, and filled tooth (DMFT) index and the International Caries Detection and Assessment System (ICDAS). To measure differences between the unrestored and restored tooth groups, an unpaired two-sample t-test was used. To assess the relationship between LF of sound enamel and caries experience based on the DMFT and ICDAS, Pearson's correlation coefficient and linear regression analyses were used. The LF values of sound dental enamel in subjects with no history of invasive dental treatment were highly correlated with caries experience, as measured by the DMFT index (R = 0.76) and ICDAS (R = 0.7). The LF values of sound enamel in subjects with a history of previous invasive dental treatment were weakly correlated with caries experience, as measured by the DMFT index (R = 0.33), and moderately correlated with the ICDAS values (R = 0.66). The LF value of clinically healthy tooth enamel correlates with caries status based on the DMFT or ICDAS.

Invasive Dental Treatment and Associated Risk of First Myocardial Infarction Episode

Invasive Dental Treatment and Associated Risk of First Myocardial Infarction Episode

Sedation with dexmedetomidine in elderly patients during dental surgery: a retrospective case series

ObjectivesThe number of elderly patients with systemic basal disease requiring invasive dental treatment has increased. Appropriate prediction of surgical invasiveness and combined use of psychosedation are thought to contribute to safe whole-body management. Dexmedetomidine (DEX) exhibits analgesic and anti-anxiolytic properties and causes mild respiratory depression. Studies regarding DEX use in elderly non-intubated patients are scarce. We aimed to use retrospective data to determine an effective dose of DEX to induce adequate sedation in elderly patients undergoing invasive dental surgery under local anesthesia.Materials and MethodsOne hundred two patients aged 70 to 96 years were presumably appropriately controlled with sedation. DEX was administered at an initial loading dose of 2.0 to 3.1 µg/kg/hr for 10 minutes. We divided the patients into five groups by age and compared their blood pressures and heart rates.ResultsIn all five groups, blood pressure decreased suddenly at approximately 15 and 20 minutes after DEX administration. A marked decrease in blood pressure was noted in patients aged 75 to 79 years.ConclusionFor elderly patients aged 75 years and above, the initial loading dose of DEX needs to be reduced to lower than half that required for young and middle-age adults.

Effect of Virtual Reality Distraction on Pain and Anxiety During Dental Treatment in 5 to 8 Year Old Children.

This study was aimed at assessing the impact of Virtual Reality (VR) distraction technique on pain and anxiety in 5-8-year-old children, during short invasive dental procedures. 120 children, aged 5-8 years, scoring less than 25 on the SCARED questionnaire, scheduled to undergo short invasive dental procedures, were randomly divided into a control (without VR distraction) and study group (with VR distraction) of 60 each. State anxiety levels were assessed in the children from both groups using revised version of Modified Child Dental Anxiety Scale, before and after dental treatment. Pain perceived during treatment was assessed using Wong Baker Faces pain rating scale at the end of treatment. Salivary cortisol levels were also assessed before, during and after the dental procedure, in all children. We observed a significant reduction in pain perception and state anxiety in children, using VR distraction (p<0.001, p=0.002). The decrease in salivary cortisol levels was significantly greater in children using VR distraction (p<0.001). Virtual Reality distraction can be used as a successful behavior modification method in children undergoing short invasive dental treatments.

Silver diamine fluoride to control severe early childhood caries in a child with epilepsy: a case report

Objetivo: o diamino fluoreto de prata (DFP) é um produto seguro, eficaz e indolor para controlar a cárie dentária. Como requer consultas de curta duração, seu uso em pacientes epiléticos pode reduzir o risco de convulsões. Relato de caso: uma paciente de dois anos de idade com cárie severa na primeira infância envolvendo seis incisivos decíduos foi encaminhada à Clínica da Universidade. Seu histórico médico revelou a presença de paralisia cerebral e epilepsia com o uso diário de medicamentos para controlar a doença. Devido à menor idade da paciente, ao risco de convulsões durante um tratamento odontológico invasivo e demorado, e para evitar uma possível anestesia geral, o DFP 30% foi escolhido para paralisar as lesões de cárie. Um questionário de qualidade de vida (B-ECOHIS) foi aplicado antes e após o tratamento. Conclusão: o tratamento com SDF foi eficaz na paralisação da cárie dentária em uma criança epiléptica jovem, sem alteração em sua qualidade de vida.

Change in Oral Health-Related Quality of Life Following Minimally Invasive Aesthetic Treatment for Children with Molar Incisor Hypomineralisation: A Prospective Study.

Molar incisor hypomineralisation (MIH) is a common enamel condition, presenting with incisor opacities, which may be of psychosocial concern to children. This clinical study sought to determine whether minimally invasive treatment, aiming to improve incisor aesthetics, would also improve children’s oral health-related quality of life (OHRQoL). 111 MIH patients, aged 7–16 years, referred to a UK Dental Hospital, were invited to complete the Child Oral Health Impact Profile (C-OHIP-SF19) prior to any intervention (T0) and again at one-month following the intervention (T1) for MIH. Treatment regimens included one or more of the following: Microabrasion; resin infiltration; tooth whitening; resin composite restoration. Data were obtained for 93 children with a mean age of 11 years. Mean total C-OHIP-SF19 score at T0 was 47.00 (SD = 9.29; range = 0–76) and this increased significantly at T1 to 58.24 (SD = 9.42; range = 0–76; p < 0.001, paired t-test), indicating a marked improvement in self-reported OHRQoL. There were no statistically significant differences according to gender. This is the first study to show that simple, minimally invasive dental treatment, to reduce the visibility of enamel opacities, in MIH, can have a positive impact on children’s wellbeing.

Risk of Myocardial Infarction and Ischemic Stroke after Dental Treatments

The association between invasive dental treatments (IDTs) and a short-term risk of myocardial infarction (MI) and ischemic stroke (IS) remains controversial. Bacterial dissemination from the oral cavity and systemic inflammation linked to IDT can induce a state of acute vascular dysfunction. The aim of study is to investigate the relation of IDTs to MI and IS by using case-only study designs to analyze data from a large Taiwanese cohort. A nationwide population-based study was undertaken by using the case-crossover and self-controlled case series design to analyze the Taiwanese National Health Care Claim database. Conditional logistic regression model and conditional Poisson regression model were used to estimate the risks of MI/IS. In addition, we used burn patients as negative controls to explore the potential effect of residual confounding. In total, 123,819 MI patients and 327,179 IS patients in the case-crossover design and 117,655 MI patients and 298,757 IS patients were included in the self-controlled case series design. Results from both study designs showed that the risk of MI within the first 24 wk after IDT was not significantly different from or close to unity except for a modest risk during the first week for patients without other comorbidities (odds ratios [95% confidence intervals] of 1.31 [1.08–1.58] and 1.15 [1.01–1.31] for 3 d and 7 d, respectively). We also observed no association between IDTs and IS, or the risk ratio was close to unity. IDTs did not appear to be associated with a transient risk of MI and IS in the Taiwanese population, with consistent findings from both case-only study designs. However, we cannot exclude that dental infections and diseases may yield a long-term risk of MI and IS.

Direct Oral Anticoagulants (DOAC) in oral implant surgery – a metaanalysis

Background As oral surgical procedures like implantations and augmentative procedures per se can lead to severe haemorrhagia, in particular patients on anticoagulants require appropriate management. The “Graz Considerations for Compromised Coagulation” (GCCC) have been introduced to international field specialists in Vienna, Austria, in 2005 and takes most of invasive dental treatments into account. The recent update of the GCCC has forwarded the optimal peri-procedural haemostatic strategy by. Material and Methods To identify relevant studies a comprehensive and systematic literature research in high-yield journals and the electronic database PubMed was conducted. The broad spectrum of information about perioperative hemostatic strategies was examined using the following search terms – “oral surgery“, “implant surgery“, “DOAC” and the agents’ proper names. In light of relevant international publications we evaluate our current findings in an ongoing study at our department. Results Characteristics of included studies are compared with the pertinent data of our study and listed in tabular form. Seven published papers were included in our critical evaluation. Two cohort studies tested continuation versus discontinuation of DOAC (Rivaroxaban, Xarelto®) for certain procedures in oral surgery. In one study group no significance for bleeding events of dental implantations was detected in comparison to normal population while another trial showed significance. Three work groups presented their protocols of temporary discontinuation of Dabigatran (Pradaxa®). In strict accordance with their periprocedural strategies the authors observed no significant difference of bleeding events. One working group provides detailed recommendations in a review, but had not assessed them in a clinical trial. An Australian study team recommends both continuation and discontinuation of Dabigatran according to the individual bleeding risk, nevertheless their results may not be represent. Conclusions and Clinical Implications Hematologists advise a minimum time-interval of last dose to intervention. In accordance with our clinical study results we found that continuation of DOAC therapy is advisable for simple implantation without increased risk of local haemorrhage. The DOACs’ temporary suspension may, however, show fewer bleeding events in procedures such as complex implantation. As limited data regarding bleeding in implant patients under DOAC therapy is available further studies are needed to determine.

Risk of Infective Endocarditis After Invasive Dental Treatments: Case-Only Study.

Invasive dental treatments (IDTs) can yield temporary bacteremia and have therefore been considered a potential risk factor of infective endocarditis (IE). It is hypothesized that, through the trauma caused by IDTs, bacteria gain entry to the bloodstream and may attach to abnormal heart valves or damaged heart tissue, giving rise to IE. However, the association between IDTs and IE remains controversial. The aim of this study is to estimate the association between IDTs and IE. The data in this study were obtained from the Health Insurance Database in Taiwan. We selected 2 case-only study designs, case-crossover and self-controlled case series, to analyze the data. The advantage of these methods is that confounding factors that do not vary with time are adjusted for implicitly. In the case-crossover design, a conditional logistic regression model with exposure to IDTs was used to estimate the risks of IE following an IDT with 4, 8, 12, and 16 weeks delay, respectively. In the self-controlled case series design, a conditional Poisson regression model was used to estimate the risk of IE for the risk periods of 1 to 4, 5 to 8, 9 to 12, and 13 to 16 weeks following an IDT. In total, 9120 and 8181 patients with IE were included in case-crossover design and self-controlled case series design, respectively. In the case-crossover design, 277 cases and 249 controls received IDTs during the exposure period, and the odds ratio was 1.12 (95% confidence interval, 0.94-1.34) for 4 weeks. In the self-controlled case series design, we observed that 407 IEs occurred during the first 4 weeks after IDTs, and the age-adjusted incidence rate ratio was 1.14 (95% confidence interval, 1.02-1.26) for 1 to 4 weeks after IDTs. In both study designs, we did not observe a clinically larger risk for IE in the short periods after IDTs. We also found no association between IDTs and IE among patients with a high risk of IE. Therefore, antibiotic prophylaxis for the prevention of IE is not required for the Taiwanese population.

Dental avoidance among adolescents – a retrospective case –control study based on dental records in the public dental service in a Swedish county

Objective: This study aimed to investigate the occurrence of missed dental appointments among 16–19-year-old adolescents in a Swedish county. A second aim was to explore associations between background and concomitant factors and missed appointments and to investigate if these associations differed between areas with different sociodemographic profiles.Materials and methods: A list of booked, and missed, appointments for 10,158 individuals during 2012 was used for assessments. Based on the total sample, 522 cases with, and 522 matched controls without, dental avoidance behavior in 2012 were identified. Data on previous missed and cancelled appointments, oral health status, dental treatment, fear or behavior problems, and medical, and, where available, psychosocial or lifestyle factors were extracted from the dental records using a preset protocol covering the period 2009–2012.Results: In 2012, 13.1% of 23,522 booked appointments were missed, with a higher proportion of missed appointments among boys than girls. Cases with avoidance behavior more often had a record of sociodemographic load and dental fear or behavior management problems. They also had more oral health problems, more invasive dental treatments, and, in the past, more missed and canceled appointments.Conclusion: To enable good oral health and continued regular dental care, we need to pay more attention to adolescents’ individual situation and be observant of early signs of avoidance.

Myasthenia gravis in dentistry

In a patient with myasthenia gravis, a life-threatening myasthenic crisis can occur, a complication of myasthenia gravis. The crisis can be triggered by, among other things, emotional stress, pain, infections and a reaction to medication. The policy for invasive dental treatment in a patient with myasthenia gravis must be aimed at preventing a crisis. Prior to the intervention, consultation with the neurologist in charge is necessary because sometimes optimisation of the medication or preventive measures are required. Treatment of a myasthenia gravis patient with amide local analgesic is possible; narcosis is also possible. Local anaesthesia (using amide local analgesic in minimal dosage) is preferred to narcosis. After the dental treatment, optimal pain management is crucial to limit the chance ofa crisis.

Minimally Invasive Dental Treatment Using Composites and Ceramics in GERD Diagnoses Patients

Specialty literature demonstrates the direct link between gastro-esophageal reflux diseases (GERD) and dental errosion (DE). Patients diagnosed with GERD often shown dental tissue loss in the enamel and dentine, somentimes going as far as opening the pulp chamber. Modern minimal invasive treatments make use of the current performance of cements and prosthetic materials (composites and ceramics) to conserve healthy enamel and dentine, in comparison to classic reconstruction methods.

Invasive Dental Treatment and Risk for a First Myocardial Infarction

Invasive dental treatment is suggested to be associated with an increased risk for the development of cardiovascular events. We tested the hypothesis that the incidence of a first myocardial infarction (MI) within 4 wk after invasive dental treatments is increased. A registry-based case-control study within nationwide health care and population registries in Sweden was performed. The case patients included 51,880 individuals with a first fatal or nonfatal MI between January 2011 and December 2013. For each case, 5 control subjects, free from prior MI and matched for age, sex, and geographic area of residence, were randomly selected from the national population registry through risk set sampling with replacement, resulting in 246,978 control subjects. Information on dental treatments was obtained from the Dental Health Register, and the procedures were categorized into invasive dental treatments or other dental treatments. Conditional logistic regression was used to estimate odds ratios (ORs) for MI with corresponding 95% confidence intervals (CIs). In addition to the matching variables, adjustments were made for the following confounders: diabetes, previous cardiovascular disease (CVD), CVD drug treatment, education, and income. The mean age for case patients and controls subjects was 72.6 ± 13.0 y and 72.3 ± 13.0 y, respectively. Case patients more often had previous CVD (49% vs. 23%; P < 0.001) and diabetes (19% vs. 11%; P < 0.001) and received more treatment with CVD drugs (68% vs. 56%; P < 0.001) than control subjects. There was no association between invasive dental treatments during the 4 wk preceding the MI index date (crude OR = 0.99; 95% CI, 0.92 to 1.06; adjusted for confounders OR = 0.98; 95% CI, 0.91 to 1.06). This study did not support the hypothesis of an increased incidence of MI after recent invasive dental treatment.

The prevalence and the risk factors for hepatitis C virus infection in Serbia.

The epidemiological characteristics of the hepatitis C virus (HCV) infection in Republic of Serbia have not been studied sufficiently so far. The aim of this study was to estimate the prevalence of anti-HCV positivity in the general population of Serbia and determine the risk factors for this infection. Estimation of the prevalence was done using the median ratio method with data from several regional countries to a previously determined prevalence of anti-HCV positivity among volunteer blood donors of 0.19%. In order to determine the risk factors a matched case-control study was conducted of 106 subjects with confirmed HCV infection from the Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia and the same number of hospital controls matched by sex and age. The estimated prevalence of anti-HCV positivity in the general population of Serbia was 1.13% (95% CI: 1.0-1.26%). The most important predictive risk factors of HCV infection were: intravenous drug use (OR = 31.0; 95% CI: 3.7-259.6), blood transfusions (OR = 3.7; 95% CI: 1.6-8.7), invasive dental treatment (OR = 3.1; 95% CI: 1.4-6.8), and low level of education (OR = 2.2; 95% CI:1.1-4.7). A total of 91.5% of the persons with hepatitis C had at least one of the significant risk factors. The prevalence of anti-HCV positivity ranks Serbia in the range of mid-endemic European countries. Preventive measures should be directed at preventing drug use, on education about getting the infection, creating safe conditions for blood transfusions, and strict adherence to adopted practices in dentistry.

Current knowledge among Japanese experienced general dentists regarding prevention of infective endocarditis.

Infective endocarditis (IE), a life-threatening condition predominantly occurring in patients with underlying heart disease, is mainly caused by bacteremia induced by invasive dental treatment. However, the amount of related information shared between cardiologists and dentists appears to be inadequate. In the present study, a survey regarding prevention of IE, composed of 13 major questions, 2 of which also allowed free comments, was sent to approximately 3000 dentists belonging to a prefectural dental association in Japan. Of the 13.6% who returned the forms, more than 80% were general dentists with more than 20years of experience. Approximately, 55% of the responders reported that they had opportunities to prescribe antibiotics prior to performing treatments with risk of IE, though noted difficulties with designation of which patients with heart disease were at risk. Most of the dentists considered that oral surgery procedures have a high risk for IE, whereas less invasive procedures were considered to be not associated with the disease. Approximately, 35% selected oral amoxicillin, with a dose of 2.0g (20%) or 500mg (27%) prescribed for adults, and 50mg (10%) or 30mg (12%) per kg of body weight for children. However, the timing of the antibiotics administration varied. The present results reveal current knowledge regarding prevention of IE among general dentists in Japan, and should be valuable for construction of a protocol to establish consensus between dentists and cardiologists.

The importance of hospital dentistry: oral health status in hospitalized patients

ABSTRACT Objective: This research study aimed to evaluate the oral health status and the need for dental treatment in hospitalized patients, analyzing the importance of dentistry in hospitals. Therefore, the goal of this research study was to evaluate the oral health status, the need for dental intervention and the patient’s opinion about the importance of having dental surgeons in hospital settings. Methods: 103 hospitalized patients were evaluated considering the DMFT index, gingival condition, visible biofilm index, and the need for invasive dental treatment. Volunteers were also asked about their opinion considering the importance of dentistry in hospital settings. Results: 68.9% of volunteers were male subjects and 31.1% female subjects. The mean DMFT was 17.9 and 96.1% of subjects had their oral hygiene kit with when came to hospital, 97.1% of subjects stated that the presence of dental surgeons is necessary in the hospital setting and 63.1% of subjects presented poor biofilm removal. The need for invasive dental treatment was as follows: restorations (68.9%), extractions (40.8%), endodontics (23.3%), dental pain (26.2%) and presence of abscess (7,8%). Conclusion: Oral health and hygiene status of patients were classified as poor and most of patients showed the need for invasive dental treatment. The majority of patients reported that dental care is very important in hospitals settings.