Dental Management Of Patients Research Articles

EVALUATION OF IMMEDIATE BASAL IMPLANTS PLACEMENT IN MAXILLARY PREMOLAR REGION

Introduction: Dental implants have become an integral part of comprehensive management of dental patients. The clinical immediate replacement of lost teeth by osseointegrated implants have been one of the most significant advances in dentistry. Basal dental implants where developed for immediate use. Objectives: This study was designed to evaluate immediate placement of basal dental implants in maxillary premolar region. Materials and methods: Thirteen basal dental implants placed in ten adult patients having maxillary premolar tooth or remaining root indicated for extraction, all patients were operated under local anaesthesia, atraumatic extraction using a periotome was performed then the tooth was removed using the forceps, mesial and distal incisions were done, an osteotomy was done, the basal dental implant was placed then stability was measured by periotest, clinical evaluation and radiographic follow up using cone beam C.T ware done. Results: Thirteen implants were placed and followed up both clinically and radiographically for 6 months. In our study, the range of implant stability using periotest was -7.9 to +6.2 immediately, while after 6 months, the range of implant stability was -8.0 to +3.7. Conclusion: Basal dental implants are a reliable option for immediate placement after extraction of maxillary premolar teeth with good flap, suturing and reinforcing on maintaining good oral hygiene.

Advanced diagnostic aids in dental caries – A review

Dental caries is a result of shift in the balance of mineral loss and gain, leading to more changes in the tooth structure, which cannot be accepted as healthy but should be considered as pathological. This change of dental caries from a physiological process to pathology is continuous and affected by numerous variables and also there is a lack of a definite boundary line between health and disease. The progression of non cavitated lesions seems to be slower, allowing preventive strategies to be implemented when the lesions have the greatest opportunity to arrest. Thus, early and accurate detection and diagnosis of dental caries are an important component of the overall management of dental patient. Advanced diagnostic modalities available to clinicians today expand greatly on the foundation of a comprehensive visual assessment, which has been and will be the cornerstone of the diagnostic process.

What do we learn from brain imaging?—A primer for the dentists who want to know more about the association between the brain and human stomatognathic functions

The number of neuroimaging studies on the brain and oral sensorimotor functions has increased recently. Behind the dazzling "brain maps," what does the neuroimaging evidence truly tell us? What can dentists learn from it to improve clinical practice? We summarise the pros and cons of applying magnetic resonance imaging (MRI)-based neuroimaging to study oral behaviours of the dental patients. This is a narrative review of previous neuroimaging research of oral functions, focusing on MRI-related studies of human subjects. MRI has gained popularity in dental research due to its non-invasive nature, its approachability and its versatility in quantifying a variety of brain signatures. We argue that MRI-based neuroimaging is suitable for investigating the association between the between-individual variations in brain structure (eg grey matter volume)/brain functions (eg brain activation) and oral behaviours of the patients. Two specific topics of the daily dental practice, mastication and dental fear and anxiety, are discussed to exemplify the potential of neuroimaging methods. The methodological and interpretive limitations of MRI techniques are highlighted, and most importantly, we emphasise that the neuroimaging findings should be carefully interpreted given these limitations. MRI-based neuroimaging techniques can provide a better evaluation of the association between the brain and stomatognathic functions, which could be pivotal to the evidence-based clinical management of dental patients.

Perception of dental professionals towards dental management of patients using antithrombotic medications in Saudi Arabia: A cross-sectional survey.

Objectives:To assess dental professionals' perception and knowledge about dental management of patients on antithrombotics and determine if the treatment approach is according to the international guidelines.Methods:This cross-sectional survey was conducted in Saudi Arabia during January 2014-December 2015 and included licensed dentists and hygienists from different dental institutions and Saudi's annual dental conference attendees. Data were collected by using a self-administered questionnaire, with questions about dental management of patients on antithrombotics. Data analysis was done using Statistical Package for Social Sciences statistical software, version 22.Results:Of the 305 participants, 302 completed the survey (dentists: 94.7% and dental hygienists: 5.3%). For traditional antithrombotics, familiarity was higher for Warfarin and Aspirin compared to Clopidogrel. However, for new oral anticoagulants (NOACs), familiarity was significantly less for Rivaroxaban (P = 0.042). A significant number of participants responded that they were unsure as to how to treat patients [Enoxaparin (P < 0.001), Rivaroxaban (P < 0.037), and Dabigatran (P < 0.027)]. Furthermore, the management of patients on traditional or NOACs was not under guidelines (ranging: 8.2%-42.2%).Conclusion:Dental professionals have limited familiarity with antithrombotics, especially NOACs. Therefore, awareness about NOACs and their impact on dental procedures is needed among dentists in primary healthcare settings, to facilitate proper and timely management.

Manejo estomatológico del paciente pediátrico con hemofilia: reporte de casos.

La hemofilia es un trastorno genético que altera los factores de coagulación, en el cuál, al no coagular la sangre de manera correcta, puede causar una hemorragia espontánea. No existe cura para erradicar este padecimiento. Sin embargo, los profesionales del área de salud han elaborado guías de práctica clínica y manuales para el manejo de pacientes con trastornos de la coagulación con integración multidisciplinaria para realizar tratamientos preventivos y curativos, donde plantean la administración de terapia de remplazo juntamente con medidas alternas de hemostasia en el tratamiento odontológico, reduciendo los riesgos de caries múltiples y enfermedades periodontales.&#x0D; El propósito de este trabajo fue describir el manejo odontológico de pacientes con Hemofilia a través de una serie de casos, donde se pudo realizar procedimientos dentales preventivos y restaurativos empleando medidas alternas de hemostasia y reduciendo la administración de terapia de remplazo.

Clinical practices and education of intravenous moderate/deep sedation in Japan

Safety and comfort during dental procedures are the key factors for high quality dentistry and fundamentals for patient satisfaction. Systemic managements such as general anesthesia and moderate/deep sedation are widely applied to dental outpatients for safe and comfortable dentistry by dentists in Japan. For intravenous moderate sedation, midazolam, propofol and their combination are common choices for dental outpatients. Sometimes deep sedation is required especially in patients with intellectually disability, severe fear/anxiety or severe gaging reflex. Some of these patients may undergo general anesthesia instead of intravenous sedation. The Japanese Dental Society of Anesthesiology (JDSA) established “Practice Guidelines for Intravenous Conscious Sedation in Dentistry” in 2017, and these guidelines become standard for routine clinical practices. In Japan, dental school has 6-year curriculum. Lectures and preclinical practices are given to 4th grade students and clinical practices are to 5th grade students. They learn wide range of knowledge and skills for systemic management of dental patients. JDSA has two board systems for dental anesthesiologists; Japanese Board of Dental Anesthesiology (JBDA) and Board Certified Dental Anesthesiology Specialist (BCDAS). BCDAS is authorized by the Ministry of Health, Labour and Welfare, Japan since 2006. The author would expect the development of dental anesthesiology field in Russia and the progress of anesthesiology collaboration system in dental and medical field.

Management of Dental Patients taking Warfarin

Warfarin is an anticoagulant involved in the production of vitamin K dependent blood clotting factors. Dentists should be familiar with the appropriate assessment methods and considerations for the treatment of patients taking warfarin. Dental surgery with the moderate risk of bleeding can be performed without stopping the drug through preoperative examination of the INR(international normalized ratio) value and evaluation. When performing a surgery with a high risk of bleeding, it is necessary to evaluate whether the drug can be discontinued, what the duration is, and the risk of discontinuation. Hemostasis can be obtained by local methods in most cases of postoperative bleeding in patients taking appropriately adjusted doses of warfarin.

Hemorrhagic Complications and Dental Management of Patients with Anticoagulant Therapy: Case Report.

Introduction: There are different protocols for the management of anticoagulated patients that can be used when performing oral surgical procedures. Objective: To report the previous evaluation and management of a hemorrhagic complication in the maxillofacial region in a patient undergoing oral anticoagulant therapy and the recommendations described in the literature for these patients. Clinical Case: Sixty-eight year old male patient, hospitalized in the cardiology unit due to heart failure, pending surgery for valve replacement. Treating physician requests evaluation for dental infection foci by a maxillofacial surgeon. Prior to medical examination and corresponding blood tests, four carious teeth are extracted, controlling hemostasis with local measures. During the night of the same day, the patient is referred again to the dental unit because of an alveolorrhagia, being treated and controlled with new local measures; new standard blood tests are performed. Forty-eight hours later the patient presents an increase of volume in the right mandibular region compatible with hematoma and ecchymosis. It is decided to perform treatment, removing sutures, collagen and draining through the alveolus. Subsequently, new local measures are performed and the anticoagulant is suspended for 24 hrs. Conclusion: There are different care protocols for patients undergoing anticoagulant treatment in the literature, so each patient should be studied in advance to define what is the best therapeutic procedure to prevent complications.

Perioperative Dental Management of Patients in The Background of Antithrombotic Use

Objectives: Treatment and perioperative dental management in patients on antithrombotic medications poses a serious challenge to dental professionals due to perceived risk of bleeding complications. This article aims to study the anticoagulant / antiplatelet drugs currently available on the market, review contemporary oral anti-thrombotic treatment and offer management guidelines in such situations based on the review of pertinent literature. Material and Methods: Science Direct and Ovid databases, PubMed, Scopus and product literature were accessed to review relevant literature with respect to current anti-thrombotic drugs, indications for their use in medical conditions, complications related to their use and drug interactions. The search covered studies published in medical and dental journals in English with a relevant impact factor over a period of 10 years. Meta analyses, systematic reviews, randomized trials, cohort based and case-control studies and society-based guidelines were considered. Key words utilized in the search criteria included Warfarin, Coumarin, Aspirin, P2Y12 inhibitors, Prasugrel, Clopidogrel, Ticagrelor, Hemorrhage, Anti-thrombin, Platelet aggregation inhibitors and International Normalized Ratio (INR) and were validated by the MeSH dictionaries. Results: Dental practitioners today, are faced with the challenge of conducting surgical procedures on patients who are on anti-thrombotic medications for a variety of medical/ surgical co-morbid conditions. Although there is consensus amongst various studies regarding continuation of warfarin in therapeutic ranges for dento-alveolar surgery, there is insufficient evidence to reach a consensus in those groups who are at intermediate or high risk of bleeding. However, most studies and published literature do agree that there is no real increased risk of bleeding complications during conduct of these procedures if the patient’s INR is less than 3.5 along with adequate haemostatic measures. Conclusion: Regardless of the procedure to be performed, every case needs to be titrated on its individual merit based on both patient and surgical factors. Further, it is recommended that INR values should be established at least 72 hours prior to the surgery, which admits a margin of safety for dose modification if necessary. A meticulous case history with complementary hemostatic tests and adoption of adequate local hemostatic measures hold the key to not having the necessity to modify the antiplatelet or anticoagulation treatment in most cases. Additionally, the advent of newer anticoagulants and antiplatelets have raised the requirement of dedicated Randomized Clinical Trials to answer the specific clinical questions of bleeding risk versus thrombo-embolic complications in the perioperative management of such patients.

Laporan Kasus: Manajemen Perawatan Gigi pada Pasien dengan Periodontitis Kronis disertai Diabetes Mellitus

Diabetes mellitus is a metabolic disease in which blood sugar levels are abnormally because the body does not produce enough insulin (type 1) and insulin deficiency (type II). The condition of diabetes can worsen the periodontal tissue. Purpose of this case report is to explain the characteristics, oral manifestations and dental management of patients with diabetes. A 53-year-old request to made aartificial denture. Intraoral examination presented loss of teeth 35, 36, 37, 46, 47 and dental roots 23, 24, 27, 38, 48. Patients have a history of diabetes with Metformin 500 mg oral therapy and have consumed it since 2016. The treatment plan is education, plaque control with supragingival scaling then extraction of the roots dental and making of removable partial dentures. Based on the results of lab tests showed blood glucose levels in October 177 mg / dl. Patients were instructed to maintain oral hygiene with mouthwash prescriptions and to continue diabetes treatment. Dental care in patients with diabetes must consider various things such as the patient's condition, stress reduction, dietary modifications, prophylactic medications, and routine monitoring of blood glucose levels

Department of Veterans Affairs Consensus: Preradiation dental treatment guidelines for patients with head and neck cancer.

Few protocols have been published for the dental management of patients with head and neck cancer to prevent complications from head and neck radiation therapy. Radiation therapy not only affects the tumor cells targeted, but also the dentition, bone, salivary gland, and oral soft tissue structures. A comprehensive dental evaluation prior to head and neck radiation therapy can help prevent many complications. The following clinical guidelines were established by a workgroup of oral health providers within the Department of Veterans Affairs. This workgroup focused on developing a set of recommendations regarding dental care prior to the initiation of head and neck radiation therapy based on the best clinical evidence and expert consensus. A systematic algorithm was developed for the evaluation including pre-exam data gathering, examination, education, and treatment, followed by maintenance and postradiation dental follow-up. This document is evidence-based, patient-centered, consistent with accepted practices of care and safety, and in accordance with applicable statutes and regulations.

A Review on the Dental Management of specially abled patients with a systematic approach towards the Dental management of patients with Cardiovascular Disorders – An Evidence Based Decision Tree Analysis

The American Academy of Pediatric Dentistry (AAPD) defines special care needs as “any physical, developmental, mental, sensory, behavioral, cognitive or emotional impairment that requires medical management, health care intervention and/or use of specialized services or programs. The condition may be congenital, developmental or acquired through disease, trauma or environmental cause and may impose limitations in performing daily self-maintenance activities or substantial limitations in a major life activity”. [1] Special care dentistry works on meeting the dental needs of a wide spectrum of specially abled patients who may be medically compromised, those with learning and physical disabilities, mentally challenged, pregnant, geriatric, anxious and petrified patients and referrals from head and neck oncology who are under radiotherapy, chemotherapeutic drugs for management of head and neck carcinomas. Hence it is very important for the dentists to have a thorough knowledge and undergo additional training for managing these patients during dental treatment. Cardio vascular disorders comprise of a group of diseases of the heart and vascular system. It has been reported in literatures that sometimes dental professionals play a key role in diagnosing various cardiovascular pathologies during routine dental examination. In this article, a review on the dental management of special care patients and an emphasis on the dental treatment protocol for patients with cardiovascular diseases through a decision tree analysis has been done.

Dental management of patients taking antiplatelet, oral anticoagulant and novel anticoagulant medications

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The precedence and viability of yoga in the lives of D3-dental students, dental practitioners, and dental patients.

Dentistry as a profession is quite demanding and challenging and is also associated with occupational hazards like musculoskeletal disorders and stress-related problems. The practice of yoga has been proven to be efficacious in management of quite a lot of stress and lifestyle disorders. It strengthens one physically, mentally, and emotionally. Moreover, yoga can also be used in the management of dental patients for stress-related oral conditions like lichen planus, burning mouth syndrome, aphthous ulcers, etc., Yoga has also been found to have antiinflammatory, antianxiety effect, and also a lot of other beneficial effects. This review emphasizes on the relevance of yoga in the dental profession, from the practitioners, students, and patients viewpoint. Data pertaining to the subject was obtained after a thorough search of the PubMed literature and Google search engine.

ЭПИДЕМИОЛОГИЧЕСКИЕ ПОКАЗАТЕЛИ И МОДЕЛЬ РАЗВИТИЯ, ПРОФИЛАКТИКИ И ЛЕЧЕНИЯ ВОСПАЛИТЕЛЬНЫХ ЗАБОЛЕВАНИЙ ПАРОДОНТА У КУРЯЩЕГО НАСЕЛЕНИЯ

Relevance. Methods for assessing the effectiveness of therapeutic and prophylactic measures for smoking groups of periodontal patients now require substantial material costs. They do not take full account of the rapidly changing epidemiological situation, as well as system-wide patterns of development, prevention and treatment of periodontal inflammatory diseases based on a temporary or permanent smoking cessation. At present, they are imperfect as models for the development, progression, prevention and treatment of periodontal inflammatory diseases in smokers, and methods that predict the condition of periodontal disease with a view to quitting smoking. Purpose ― search of perspective ways of substantiation of complex medical-prophylactic measures on the basis of epidemiological analysis of periodontological morbidity in the smoking population Materials and methods. 401 smokers and 400 non-smokers were examined. The examination was carried out according to a standard procedure in compliance with clinical recommendations for the management of dental patients. The smoking group included patients with a smoking experience of more than 3 years. The fact of smoking was confirmed by the data of the concentration of carbon monoxide in the exhaled air using a portable gas analyzer. The design of the study included the development of a model for the development, prevention and treatment of chronic generalized periodontitis in the smoking population, taking into account temporary or permanent quitting. Results. The epidemiological analysis of periodontological morbidity in the smoking population of the city of St. Petersburg on the basis of its own clinical studies and data from the federal service of state statistics was carried out. A model has been developed which makes it possible to promptly predict the periodontal status of the smoking population, taking into account anti-tobacco measures, without significant expenditures. Conclusions. An improved model of chronic generalized periodontitis is proposed. Dentists are advised to identify and differentiate groups of smokers using portable gas analyzers. Along with complex periodontal measures for such groups of patients, it is necessary to conduct direct medical and preventive measures, including using nicotine replacement therapy.

Oral lesions as a clinical sign of systemic lupus erythematosus

Background: Oral lesions represent one of the most important clinical symptoms of systemic lupus erythematosus (SLE), an autoimmune disease with a high degree of clinical variability rendering it difficult to arrive at a prompt and accurate diagnosis. There are many unknown causes and multiple organ systems involved, with the result that permanent organ damage may occur before treatment commences. Purpose: The purpose of this case report is to discuss the importance of recognizing the lesions related to SLE which may help dentists to make an early diagnosis. Case: A 17-year-old female patient was referred by the Internal Medicine Department with a suspected case of SLE. Prior to admittance to the hospital, the patient was diagnosed with tuberculosis. A subsequent extraoral examination revealed ulceration with a blackish crust on the upper lip. An intraoral examination showed similar ulceration covered with a blackish crust on the labial mucosa accompanied by central erythema in the hard palate. Blood tests indicated decreased levels of hemoglobin, hematocrit and platelets, but increased levels of leukocytes. A diagnosis of oral lesions associated with SLE and angioedema was formulated. Case management: The patient was given 1% hydrocortisone and vaseline album for extraoral lesions, while 0.2% chlorhexidine gluconate and 0.1% triamcinolone acetonide was used to treat intraoral lesions. An improvement in the oral lesions manifested itself after two weeks of treatment. Conclusion: Early detection of oral lesions plays a significant role in diagnosing SLE. It is important for the dentist to recognize the presentation of diseases that may be preceded by oral lesions. A multidisciplinary approach and appropriate referrals are necessary to ensure comprehensive medical and dental management of patients with SLE.

The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention.

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents; it is a potentially painful and debilitating condition that can considerably affect the quality of life of patients. Furthermore, even if its epidemiology and pathogenesis have still not been fully clarified, several risk factors related to MRONJ have been recognized in prevention protocols. Three main risk factors are as follows: (i) the type of ONJ-related medications: antiresorptive (e.g., Bisphosphonates, Denosumab) and antiangiogenic drugs (e.g., Bevacizumab, Sunitinib); (ii) the category of patient at MRONJ risk: cancer versus non-cancer patient; (iii) the typologies and timing of dental treatments (e.g., before, during, or after the drug administration). The aim of this paper is to describe the new paradigm by the Italian Society of Oral Pathology and Medicine (SIPMO) on preventive dental management in patients at risk of MRONJ, prior to and during/after the administration of the aforementioned ONJ-related drugs. In reducing the risk of MRONJ, dentists and oral hygienists are key figures in applying a correct protocol of primary prevention for pre-treatment and in-treatment patients. However, the necessity of a multidisciplinary standardized approach, with a sustained dialogue among specialists involved, should be always adopted in order to improve the efficacy of preventive strategies and to ameliorate the patient's quality of life.

Dental management of patient with dual antiplatelet therapy: a meta-analysis.

It is more common to need dual antiplatelet therapy (DAPT) for patients who had recently inserted coronary artery stent. However, the postoperative bleeding risk of patients in DAPT could significantly increase. The dental management of patients with antithrombotic therapy has always been a controversial problem. Focusing on this issue, this review discussed the available evidence to provide optimal strategy for patients taking dual antiplatelet agents in the dental setting. We searched the PubMed, Embase, ScienceDirect, Web of Science (WOS), Cochrane Library, and China National Knowledge Infrastructure (CNKI) which was performed in May 2018. Relevant articles were included according to our inclusion and exclusion criteria. Meta-analysis was conducted with fixed effects models. Subgroup analysis was used due to different dental surgeries. Our meta-analysis included ten studies (continue DAPT vs. placebo, 535 patients vs.2907 patients). The quantitative results indicated that the risk of postoperative bleeding with continuing DAPT experienced significantly increase (RR = 1.95 95% CI [1.07, 3.54]; p = 0.03). There was no statistically significant difference between the postoperative bleeding rate and different dental surgeries (p = 0.72). On the current studies, postoperative hemorrhage is exacerbated with DAPT, but it could be controlled by enhancing hemostasis methods. We recommend continuing long-term DAPT before tooth extraction. In this work, we systematically evaluated and summarized the results of small clinical trials after reviewing the present literatures on this topic, so that we could propose more objective and more accurate evidence-based recommendations on dental management for patient with dual antiplatelet therapy.

Management of dental patients taking direct oral anticoagulants: Dabigatran.

Direct oral anticoagulants (DOACs) are increasingly used as alternatives to warfarin because of the superior pharmacokinetic properties. Clinical guidelines on the influences of DOACs for dental procedures have emerged, but all of necessity based on low-quality available evidence. Herein, we share our experience with a case series, and propose a protocol regarding the management of dental patients taking DOACs.

Oral Manifestations and Dental Management of Patients with Chronic Renal Failure on Hemodialysis

Oral Manifestations and Dental Management of Patients with Chronic Renal Failure on Hemodialysis