Management of patients on oral anticoagulants in dental practice

Dental Update ◽  
2020 ◽  
Vol 47 (11) ◽  
pp. 912-922
Author(s):  
Shrina Nathwani
Keyword(s):  
Best Practice ◽  
Dental Treatment ◽  
Oral Anticoagulants ◽  
Quality Care ◽  
Current Evidence ◽  
Ageing Population ◽  
Oral Surgical Procedures ◽  
Dental Patients ◽  
Dental Practitioners ◽  
The Uk

The UK has an increasingly ageing population and, inevitably, the prevalence of anticoagulation among dental patients will grow. This same group of patients are retaining their natural teeth longer and will potentially require dental treatment and oral surgical procedures and so, general dental practitioners will need to be aware of the implications of anticoagulant drugs. Equally, to comply with requirements set by the General Dental Council's ‘Standards for the Dental Team’ it is imperative to ensure that, as clinicians, we put patients' interests first, and provide quality care based on current evidence. CPD/Clinical Relevance: It is important that dentists have knowledge and expertise to consult and treat medically compromised patients for patient safety and to adhere to best practice guidelines.

scholarly journals Exploring Dentist Opinions on the Provision of Intravenous Sedation in Primary Dental Care for UK Armed Forces Personnel

2019 ◽  
Vol 185 (7-8) ◽  
pp. e1187-e1192
Author(s):  
Dave Edwards ◽  
Richard Ramsey ◽  
John Breeze ◽  
Mark Dermont
Keyword(s):  
Dental Care ◽  
Dental Treatment ◽  
Dental Anxiety ◽  
Armed Forces ◽  
Operational Experience ◽  
Aeromedical Evacuation ◽  
Routine Treatment ◽  
Dental Practitioners ◽  
The Uk ◽  
Military Patients

Abstract Introduction: Anxiety toward dental treatment can lead to preventable morbidity, most notably oral pain and infection. This is of concern to the UK Armed Forces (UK AF), as dental care may not be immediately accessible during deployments and exercises, necessitating aeromedical evacuation. Current Defence Policy states that serving UK AF personnel requiring sedation to tolerate routine dental treatment are to have their Joint Medical Employment Standard (JMES) reviewed to restrict their deployability and employability. This article explores current sedation delivery, dentist opinion, and adherence to policy. Materials and Methods: The total number and type of intravenous (IV) sedation appointments over a 6-month period was assessed using surgical logbooks. Questionnaires were sent to all dentists in primary care responsible for treating military patients to ascertain their attitudes toward the requirement for sedation in support of recruitment and deployability. Ten-year retrospective data analyses were used to identify current trends in sedation use in the UK AF. Results: Responses were received from 117/137 (85%) dentists. All of the responding Civilian Dental Practitioners felt that there was a requirement for IV sedation in contrast to the Royal Navy (RN), where over a quarter (28%) disagreed. The majority, 48 (81%), of Army dentists felt that military patients unable to tolerate routine treatment under local anesthesia alone should not deploy on operations, compared with 7 (63%) of their civilian counterparts. Overall, 72 (62%) respondents felt that patients unable to tolerate routine treatment without sedation should not be recruited. Conclusions: Civilian Dental Practitioners in the sample indicated that they were less likely to recommend a patient for JMES review, less likely to prevent patients from deploying and less likely to believe that individuals requiring sedation for routine treatment should not be recruited into the UK AF. These attitudes are contrary to current Defence direction and could increase the risk of UK AF personnel experiencing morbidity on deployment requiring aeromedical evacuation. Over the longer term, civilianization of Defence dentistry is likely to reduce collective operational experience and Defence must ensure that clinicians understand the management of anxious patients in the military context and their responsibilities in relation to JMES. Furthermore, policy limiting the recruitment of personnel with significant dental anxiety is not being robustly adhered to. Based on the number of dental procedures undertaken under IV sedation in the UK AF, consistent application of this policy would not affect recruitment at an organizational level, but would limit the risk of deploying these personnel. Further work is required to understand dental anxiety within the UK Armed Forces so that the operational morbidity risks can be quantified and provision appropriately planned.

The Management of Dental Patients Taking New Generation Oral Anticoagulants

2014 ◽  
Vol 3 (4) ◽  
pp. 54-58 ◽  
Author(s):  
Alun Scott ◽  
John Gibson ◽  
Alexander Crighton
Keyword(s):  
Health Planning ◽  
Oral Anticoagulants ◽  
Invasive Procedure ◽  
Medical Practitioner ◽  
Therapeutic Agents ◽  
National Guidelines ◽  
Dental Patients ◽  
Dental Practitioners ◽  
The Individual ◽  
New Generation

Recently, new oral anticoagulants have been introduced as alternatives to warfarin. While national guidelines for treatment of dental patients taking warfarin as an anticoagulant are well-established, no such information is available for these novel therapeutic agents. At present, the local guidance available is contradictory between different health boards/health planning units, and liaison with the medical practitioner managing the individual patient's anticoagulation is imperative if any invasive procedure is proposed. This paper examines the available evidence regarding these drugs and sets out proposals for clinical guidance of dental practitioners treating these patients in primary dental care.

Population-based end-of-life care

2019 ◽  
pp. 739-762
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Quality Care ◽  
Population Based ◽  
Ageing Population ◽  
Life Care ◽  
Care Services ◽  
The Face ◽  
The Uk ◽  
Developed Nations

This chapter describes the changing face of end-of-life care in the face of demographic changes and the need for a population-based approach in providing end-of-life care in a meaningful manner. Building on the major advances in palliative or end of life care across the world over recent decades, there now seems to be radical groundswell of change in this area, as we face the major challenge of meeting the needs the ageing population. This challenge, most noted in the developed nations, now places specific and seemingly overwhelming unprecedented demands on all our health and social care services. Some would argue that a new approach is needed, building on lessons learnt, to care for the rising numbers of people nearing the last stage of life within our population—in other words, a population approach to end-of-life care. Using examples from the Gold Standards Framework in the UK, the chapter explores the importance of enabling generalists to deliver high quality care across a population, citing a variety of examples and programmes promoting person-centred care at the end of life.

Assessment and management of dementia in the general hospital setting

2014 ◽  
Vol 24 (3) ◽  
pp. 205-218 ◽  
Author(s):  
Inderpal Singh ◽  
Amrita Varanasi ◽  
Kathryn Williamson
Keyword(s):  
General Hospital ◽  
Staff Training ◽  
Medical Training ◽  
Oldest Old ◽  
Quality Care ◽  
Hospital Setting ◽  
Ageing Population ◽  
People With Dementia ◽  
The Uk ◽  
Training And Support

SummaryPopulations are ageing worldwide. The prevalence of dementia will rise exponentially with the oldest old the most rapidly growing segment of society. Caring for this ageing population with dementia, many of whom will have multiple chronic and disabling diseases, will be a challenge to healthcare systems, particularly general hospitals. At any one time, a quarter of acute hospital beds in the UK are in use by people with dementia. Delivery of high-quality care to this growing and vulnerable population must be high on any health service agenda.Current medical training not only generates relatively low numbers of geriatricians and specialists with interest in dementia, but also there is a lack of appropriate training in assessment and management of dementia. There remains huge need for better staff training and support to provide safe, holistic and dignified dementia care. Here we explore various key features for non-specialist assessment and management of older people with dementia in the general hospital setting.

scholarly journals Assessment of factors affecting parent’s preference of general anesthesia for performing pedodontic procedures in a university hospital set up

2020 ◽  
Vol 11 (SPL3) ◽  
pp. 915-922
Author(s):  
Geethika B ◽  
Jessy ◽  
Manjari
Keyword(s):  
Dental Treatment ◽  
University Hospital ◽  
Factors Affecting ◽  
Dental Patients ◽  
Dental Practitioners ◽  
Full Mouth Rehabilitation ◽  
Dental Diseases ◽  
Spss Software ◽  
Set Up ◽  
Children Under 5

Dental practitioners should use their knowledge and skills and be able to identify and effectively treat dental diseases in children. The child’s and family’s response should be taken into account for providing safe and effective treatment for the paediatric patients. The present study aims to analyse the preference of GA by parents for children under 5 years of age. This retrospective study was conducted among the paediatric dental patients under 5 years of age visiting  Saveetha Dental College and Hospitals. The data of the 154 patients who were indicated for GA procedure were collected. The collected data was statistically analysed using IBM SPSS Software (20.0). The results proved that the majority (72.08%) of the parents did not accept the GA procedure. Parents of 3 year old children were the most accepting (44.2%) of GA procedure. Among gender,parents of female children show a slightly higher percentage of acceptance (51.2%) when compared to the parents of the male children (48.8%). Most common reason for acceptance was parents of children undergoing full mouth rehabilitation procedures(55.8%). Majority of the parents who  accepted the GA procedure were educated (83.7%) which shows that educational qualification plays an important role. Therefore it is important to bring the positive attitude among parents for delivering safe and quality dental treatment.

scholarly journals Implications of anticoagulant and antiplatelet therapy in patients presenting with hip fractures: a current concepts review

2018 ◽  
Vol 28 (3) ◽  
pp. 227-233 ◽  
Author(s):  
Vivek Gulati ◽  
Simon Newman ◽  
Kenneth J Porter ◽  
Luis C S Franco ◽  
Tom Wainwright ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Best Practice ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Femoral Fractures ◽  
Perioperative Period ◽  
Antiplatelet Agents ◽  
Reversal Agents ◽  
Hip Fracture Surgery ◽  
The Uk

The increasing use of anticoagulant and antiplatelet therapy for the prevention of thromboembolic disease poses a significant challenge to orthopaedic surgeons treating elderly patients presenting with proximal femoral fractures. Early surgical intervention is known to be beneficial from a clinical perspective and has been encouraged in the UK through the introduction of best practice tariffs providing increased remuneration for prompt treatment. An understanding of the necessary delay to surgery or reversal options for each type of antiplatelet or anticoagulant agent is therefore important. A number of professional bodies have recently produced guidelines that help clinicians manage these patients during the peri-operative period. We review the guidelines relating to antiplatelet and anticoagulant agents during the perioperative period with respect to hip fracture surgery. Antiplatelet agents should not interfere with timing of surgery, but may affect the choice of anaesthetic performed. The action of warfarin should be reversed to expedite surgery. Newer direct oral anticoagulants are more problematic and surgical delay may be necessary, though reversal agents are becoming available.

scholarly journals Safe prescribing in general dental practice – challenges and solutions

Dental Update ◽  
2019 ◽  
Vol 46 (9) ◽  
pp. 828-835
Author(s):  
Julie Mason ◽  
Hannah Vallance ◽  
Sarah Pontefract ◽  
Jamie J Coleman
Keyword(s):  
Dental Treatment ◽  
Improve Patient Safety ◽  
Drug Market ◽  
Access To Medicines ◽  
Ageing Population ◽  
Dental Practice ◽  
Medication Regimen ◽  
Over The Counter ◽  
Treatment Regimens ◽  
Dental Practitioners

All dental practitioners will treat patients who take medicines. An ageing population, combined with improved management of patients with multiple long-term co-morbidities, has seen a rise in complex medication regimens. Healthcare specialization, a widening drug market and better access to medicines has also contributed to more patients taking multiple medicines for conditions, often managed by a variety of specialists. Whether these medicines are prescribed or bought over-the-counter, dental practitioners must understand the implications that these treatment regimens can have on dental care. CPD/Clinical Relevance: Prescribing medicines is a small but essential part of dental practice. This paper describes various aspects of prescribing, the potential implications of dental treatment to a patient's medication regimen, and important considerations to reduce the risk of medication errors and improve patient safety.

Occlusal Concepts and Considerations in Fixed Prosthodontics

2019 ◽  
Vol 8 (3) ◽  
pp. 20-27
Author(s):  
Kiran Amin ◽  
Joseph Vere ◽  
Naren Thanabalan ◽  
Abdulrahman Elmougy
Keyword(s):  
Primary Care ◽  
Clinical Outcomes ◽  
Tooth Wear ◽  
Ageing Population ◽  
Fixed Prosthodontics ◽  
Dental Practitioners ◽  
The Uk ◽  
Clinical Cases

The UK has an increasingly ageing population, many of whom are retaining more of their own teeth. This has led to an increase in the prevalence of tooth wear and the need to replace pre-existing failing restorations. In many cases this will be achieved by fixed prosthodontics. This paper provides a brief overview of important occlusal concepts that should be considered when providing non-implant fixed prosthodontics using either a conformative or reorganised approach. The aim is to give general dental practitioners the confidence to provide these types of restorations in primary care. Clinical cases demonstrate how the occlusion can be controlled to optimise clinical outcomes.

scholarly journals A Study on HIV, Hepatitis B and Hepatitis C among Dental Patients Screened from Different Districts of Kashmir Valley

2021 ◽  
Vol 8 (5) ◽  
pp. 19-23
Author(s):  
Sonia Gupta ◽  
Suheel Hamid Latoo
Keyword(s):  
Risk Factors ◽  
Hepatitis C ◽  
Hepatitis B ◽  
Viral Infections ◽  
Dental Treatment ◽  
Oral Pathology ◽  
Geographic Region ◽  
Cross Sectional ◽  
Dental Patients ◽  
Dental Practitioners

Background: Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) are the most common chronic viral infections worldwide. They are blood borne infections and share common routes of transmission, but they differ in efficiency by which certain types of exposures transmit them and their prevalence by geographic region. Aims and objective: To evaluate the prevalence of HIV, hepatitis B and hepatitis C in patients screened from different districts, to increase the awareness among dental practitioners and the patients attending dental clinics as well as to evaluate the risk factors for infection with these viruses in order to reduce the burden of these diseases in the community. Materials and method: A descriptive cross-sectional study was carried out on 2150 subjects (1230 males and 920 females) reported in the Department of Oral Pathology, GDC & H Srinagar for routine serological investigations. All the screened patients referred from different departments of this institution were enrolled. Results: The prevalence of HBV and HCV among dental patients was 0.65% and 0.51% respectively but HIV positive cases had not been reported. In the present study, majority of the HBV positive cases were from Anantnag district and most common risk factors for infections were dental treatment and blood transfusion. Conclusion: Prevention is an important aspect in controlling the spread of this viral infection as an epidemic. Hence, control programs for the prevention of these diseases that threaten public health must be planned and implemented. Keywords: Hepatitis B, HIV, Seroprevalence, Dental treatment, Transmission, Prevention.

Frailty: Tackling the crisis

2020 ◽  
Vol 13 (2) ◽  
pp. 80-86
Author(s):  
Temitope O Ajayi ◽  
Simon P Conroy
Keyword(s):  
Primary Care ◽  
General Population ◽  
Older People ◽  
Best Practice ◽  
Medical Service ◽  
Frailty Index ◽  
General Medical Service ◽  
Evidence Based ◽  
Ageing Population ◽  
The Uk

The UK has an ageing population and this is reflected in increasingly higher rates of consultations with GPs; these consultations often relate to complex and interdependent needs. Older people are more likely to be frail, relative to the general population, and the General Medical Service contract aims for a proactive identification of older people with moderate or severe frailty, and then their risk stratification using an evidence-based tool: the electronic frailty index. This article reflects on best practice in the assessment of older people in primary care and what interventions are in place to improve their outcomes.

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