scholarly journals Antiplatelet drugs: a review of pharmacology and the perioperative management of patients in oral and maxillofacial surgery

2020 ◽  
Vol 102 (1) ◽  
pp. 9-13
Author(s):  
H Mahmood ◽  
I Siddique ◽  
A McKechnie
Keyword(s):  
Antiplatelet Therapy ◽  
Oral Surgery ◽  
Safety Concern ◽  
Maxillofacial Surgery ◽  
Antiplatelet Agents ◽  
Antiplatelet Drugs ◽  
Current Evidence ◽  
Bleeding Complications ◽  
Oral And Maxillofacial Surgery ◽  
Number Of Patients

Introduction An increasing number of patients are taking oral antiplatelet agents. As a result, there is an important patient safety concern in relation to the potential risk of bleeding complications following major oral and maxillofacial surgery. Surgeons are increasingly likely to be faced with a dilemma of either continuing antiplatelet therapy and risking serious haemorrhage or withholding therapy and risking fatal thromboembolic complications. While there are national recommendations for patients taking oral antiplatelet drugs undergoing invasive minor oral surgery, there are still no evidence-based guidelines for the management of these patients undergoing major oral and maxillofacial surgery. Methods MEDLINE and EMBASE databases were searched to retrieve all relevant articles published to 31 December 2017. Findings A brief outline of the commonly used antiplatelet agents including their pharmacology and therapeutic indications is discussed, together with the haemorrhagic and thromboembolic risks of continuing or altering the antiplatelet regimen in the perioperative period. Finally, a protocol for the management of oral and maxillofacial patients on antiplatelet agents is presented. Conclusions Most current evidence to guide decision making is based upon non-randomised observational studies, which attempts to provide the safest possible management of patients on antiplatelet therapy. Large randomised clinical trials are lacking.

scholarly journals Advances in Antiplatelet Therapy for Dentofacial Surgery Patients: Focus on Past and Present Strategies

Materials ◽  
2019 ◽  
Vol 12 (9) ◽  
pp. 1524 ◽  
Author(s):  
Gabriele Cervino ◽  
Luca Fiorillo ◽  
Ines Paola Monte ◽  
Rosa De Stefano ◽  
Luigi Laino ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Oral Surgery ◽  
Case Reports ◽  
Case Series ◽  
Antiplatelet Agents ◽  
Preventive Therapy ◽  
Antiplatelet Drugs ◽  
Risk Of Bleeding ◽  
The Past ◽  
Increased Risk

Background: Nowadays, patients involved in antiplatelet therapy required special attention during oral surgery procedures, due to the antiplatelet drugs assumption. The motivations of the assumption may be different and related to the patient’s different systemic condition. For this reason, accordingly to the current international guidelines, different protocols can be followed. The aim of this work is to analyze how the dentist’s approach to these patients has changed from the past to the present, evaluating the risk exposure for the patients. Methods: This review paper considered different published papers in literature through quoted scientific channels, going in search of “ancient” works in such a way as to highlight the differences in the protocols undertaken. The analyzed manuscripts are in the English language, taking into consideration reviews, case reports, and case series in such a way as to extrapolate a sufficient amount of data and for evaluating the past therapeutic approaches compared to those of today. Results: Colleagues in the past preferred to subject patients to substitution therapy with low molecular weight anticoagulants, by suspending antiplatelet agents to treatment patients, often for an arbitrary number of days. The new guidelines clarify everything, without highlighting an increased risk of bleeding during simple oral surgery in patients undergoing antiplatelet therapy. Conclusion: Either patients take these medications for different reasons, because of cardiovascular pathologies, recent cardiovascular events, or even for simple prevention, although the latest research shows that there is no decrease of cardiovascular accidents in patients who carry out preventive therapy. Surely, it will be at the expense of the doctor to assess the patient’s situation and risk according to the guidelines. For simple oral surgery, it is not necessary to stop therapy with antiplatelet agents because the risk of bleeding has not increased, and is localized to a post-extraction alveolus or to an implant preparation, compared to patients who do not carry out this therapy. From an analysis of the results it emerges that the substitutive therapy should no longer be performed and that it is possible to perform oral surgery safely in patients who take antiplatelet drugs, after a thorough medical history. Furthermore, by suspending therapy, we expose our patients to more serious risks, concerning their main pathology, where present.

scholarly journals Effect of educational intervention on the appropriate use of oral antimicrobials in oral and maxillofacial surgery: a retrospective secondary data analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Junya Kusumoto ◽  
Atsushi Uda ◽  
Takeshi Kimura ◽  
Shungo Furudoi ◽  
Ryosuke Yoshii ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Oral Surgery ◽  
Maxillofacial Surgery ◽  
Antibiotic Use ◽  
Oral And Maxillofacial Surgery ◽  
Third Generation ◽  
Oral Antibiotics ◽  
Appropriate Use ◽  
Before And After ◽  
Third Generation Cephalosporins

Abstract Background In Japan, oral third-generation cephalosporins with broad-spectrum activity are commonly prescribed in the practices of dentistry and oral surgery. However, there are few reports on the appropriate use of antibiotics in the field of oral surgery. This study aimed to evaluate the appropriateness of antibiotic use before and after an educational intervention in the Department of Oral and Maxillofacial Surgery, Kobe University Hospital. Methods The use of oral antibiotics was investigated among inpatients and outpatients before and after an educational intervention conducted by the antimicrobial stewardship team. Additionally, the frequency of surgical site infection after the surgical removal of an impacted third mandibular molar under general anesthesia and the prevalence of adverse effects of the prescribed antibiotics were comparatively evaluated between 2013 and 2018. Results After the educational intervention, a remarkable reduction was noted in the prescription of oral third-generation cephalosporins, but increased use of penicillins was noted among outpatients. There was reduced use of macrolides and quinolones in outpatients. Although a similar trend was seen for inpatients, the use of quinolones increased in this population. Despite the change in the pattern of antibiotic prescription, inpatients who underwent mandibular third molar extraction between 2013 and 2018 did not show a significant increase in the prevalence of surgical site infections (6.2% vs. 1.8%, p = .336) and adverse effects of drugs (2.1% vs. 0%, p = .466). Conclusions This study suggests that the judicious use of oral antibiotics is possible through conscious and habitual practice of appropriate antibiotic use. However, further investigation is required to develop measures for appropriate use of oral antibiotics.

scholarly journals Rare Iatrogenic Oronasal Communication after Superior Canine Odontectomy Attempt

2021 ◽  
Vol 2020 (2) ◽  
pp. 1
Author(s):  
Ciprian Roi ◽  
Emilia Ianeș ◽  
Diana Nica ◽  
Alexandra Roi ◽  
Laura Cristina Rusu ◽  
...  
Keyword(s):  
Case Report ◽  
Scientific Literature ◽  
Oral Surgery ◽  
Healing Process ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
Unsuccessful Attempt ◽  
One Year ◽  
General Dentist

(1) Background: Oronasal communication is described in the scientific literature as a common complication that occurs after a cleft palate surgery. In some cases, it can also be a consequence of oral surgery procedures; the main problem of this type of rare accident is related to the correct healing process and treatment option. (2) Case report: A patient with oronasal communication caused by an unsuccessful attempt of a superior canine odontectomy presented at the Emergency Department of the Oral and Maxillofacial Surgery Hospital, Timișoara. The case management is described from the first consult to one-year follow-up. We consider that this pathology was optimally treated surgically, and the results are more than satisfactory, taking into consideration the high rates of recurrence. (3) Conclusion: This case report can be a useful to a general dentist who is trying to decide whether to perform the canine odontectomy or refer to a specialist surgeon due to the accidents and complications of this procedure.

scholarly journals A szellemi fogyatékosok fogászati-szájsebészeti ellátásának múltja, jelene és remélt jövője Magyarországon

2019 ◽  
Vol 160 (35) ◽  
pp. 1380-1386
Author(s):  
Ilona Szmirnova ◽  
Emese Gellérd ◽  
Gábor Tamás Pintér ◽  
György Szmirnov ◽  
Zsolt Németh ◽  
...  
Keyword(s):  
Dental Care ◽  
Oral Surgery ◽  
Demographic Data ◽  
Maxillofacial Surgery ◽  
Mental Disability ◽  
Oral And Maxillofacial Surgery ◽  
Disabled People ◽  
Care Needs ◽  
Mentally Disabled ◽  
The Past

Abstract: Introduction: Dental care for mentally disabled people poses a growing challenge for healthcare. In Hungary, the number of mentally disabled people needing special dental care is ca. 100 000. Aim: The aim of our retrospective analysis is to provide a summary of the demographic data and the treatment outcomes of patients with mental disorders treated at the Department of the Oral and Maxillofacial Surgery of the Semmelweis University in the past five years. Method: Dental care for patients with a severe level of mental disability can be carried out in general anaesthesia only. At Semmelweis University, in the Oral and Maxillofacial Department, 1717 mentally disabled adults received dental care during the past five years. (Patients included people with a mild, medium or severe level of mental disability, patients with Down’s syndrome, autism, epilepsy or panic disorder.) Results: The single biggest achievement seems to be the fact that the issue of acute dental care and oral surgery has basically been settled. A workable relationship has been forged with foundations and organizations dealing with the problems of these patients. It has been realized, however, that in the case of mentally disabled patients there is an enormous need for prevention and ongoing care. Conclusions: Up to now no survey has been carried out in Hungary with the aim of objectively revealing the dental care needs of these patients. Internationally, however, several surveys have been published. It can be stated on the basis of these that both caries frequency and the presence of parodontal diseases increase in correlation with age and the level of disability. Oral hygiene is insufficient, patients or their caretakers do not get proper information, only a few of them receive adequate training and they are not motivated to keep up oral health. Dental care, except for tending acute cases, is not satisfactory. For the sake of prevention, cooperation is needed with non-governmental organizations, foundations, special education teachers and psychiatrists specialized in this field. Orv Hetil. 2019; 160(35): 1380–1386.

Stent-Assisted Coiling of Wide-Necked Aneurysms in the Setting of Acute Subarachnoid Hemorrhage

Neurosurgery ◽  
2011 ◽  
Vol 70 (6) ◽  
pp. 1415-1429 ◽  
Author(s):  
Peter S. Amenta ◽  
Richard T. Dalyai ◽  
David Kung ◽  
Amy Toporowski ◽  
Sid Chandela ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Antiplatelet Therapy ◽  
Stent Thrombosis ◽  
Antiplatelet Agents ◽  
Bleeding Complications ◽  
Anterior Circulation ◽  
Fatal Hemorrhage ◽  
Ischemic Complications ◽  
Acute Subarachnoid Hemorrhage ◽  
Grade Iii

Abstract BACKGROUND: Stent-assisted coiling in the setting of subarachnoid hemorrhage remains controversial. Currently, there is a paucity of data regarding the utility of this procedure and the risks of hemorrhagic and ischemic complications. OBJECTIVE: To assess the utility of stent-assisted coil embolization and pretreatment with antiplatelet agents in the management of ruptured wide-necked aneurysms. METHODS: A retrospective study of 65 patients with ruptured wide-necked aneurysms treated with stent-assisted coiling. Patients with hydrocephalus or a Hunt and Hess grade ≥ III received a ventriculostomy before endovascular intervention. Patients were treated intraoperatively with 600 mg of clopidogrel and maintained on daily doses of 75 mg of clopidogrel and 81 mg of aspirin. The Glasgow outcome scale (GOS) score was recorded at the time of discharge. We identified major bleeding complications secondary to antiplatelet therapy and cases of in-stent thrombosis that required periprocedural thrombolysis. RESULTS: Of the aneurysms, 66.2% arose within the anterior circulation; 69.2% of patients presented with hydrocephalus or a Hunt and Hess grade ≥ III and required a ventriculostomy. A good outcome (GOS of 4 or 5) was achieved in 63.1% of patients, and the overall mortality rate was 16.9%. There were 10 (15.38%) major complications associated with bleeding secondary to antiplatelet therapy (5 patients, 7.7%) or intraoperative in-stent thrombosis (5 patients, 7.7%). Three (4.6%) patients had a fatal hemorrhage. CONCLUSION: Our findings suggest that stent-assisted coiling and routine treatment with antiplatelet agents is a viable option in the management of ruptured wide-necked aneurysms.

Use of Platelet-Rich Plasma and Platelet-Rich Fibrin in Dentistry and Oral Surgery: Introduction and Review of the Literature

2019 ◽  
Vol 36 (2) ◽  
pp. 109-123 ◽  
Author(s):  
Kristina Feigin ◽  
Bonnie Shope
Keyword(s):  
Soft Tissues ◽  
Oral Surgery ◽  
Platelet Rich Plasma ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
Platelet Concentrates ◽  
Platelet Rich Fibrin ◽  
Wide Range ◽  
Comprehensive Examination ◽  
And Function

Platelet concentrates, mostly represented by platelet-rich plasma and platelet-rich fibrin, have gained significant interest in various medical and oral disciplines because of their potential to stimulate and boost regeneration of hard and soft tissues. Prepared from the patient’s own blood, they have been tested and used in various different surgical fields including oral and maxillofacial surgery. The effects of these biomaterials are described to be a result of the large concentration of platelets which contain a wide range of growth factors. The aim of this article is to introduce the principle and function of these platelet concentrates, to review their preparation, and to provide a comprehensive examination of the published oral and maxillofacial literature on this subject.

Life on Mars: a personal OMFS comment on the oral surgery debate

2013 ◽  
Vol 4 (3) ◽  
pp. 110-111 ◽  
Author(s):  
Bernie Speculand
Keyword(s):  
Oral Surgery ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
Dental Surgery ◽  
Life On Mars

The April issue of the FDJ was devoted to a series of articles about the specialty of oral surgery (OS), relating to both work and workforce. A twin track response by UK oral and maxillofacial surgeons may be summarised as a feeling that the debate so far has been rather one-sided and has not included any contribution from oral and maxillofacial surgeons, and a feeling that the Faculty of Dental Surgery (FDS) is less interested in and supportive of the specialty of oral and maxillofacial surgery (OMFS) than it used to be (regardless of whether this is true).

scholarly journals Diode laser in the surgical treatment of inflammatory fibrous hyperplasia: Case report and literature review

2018 ◽  
Vol 32 (3) ◽  
pp. 154
Author(s):  
Fernando De Oliveira Andriola ◽  
Leonardo Matos Santolim Zanettini ◽  
Ricardo Giacomini De Marco ◽  
Camila Kunz ◽  
Cássia Dos Santos Machado Vaz ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diode Laser ◽  
Oral Surgery ◽  
Maxillofacial Surgery ◽  
Complete Healing ◽  
Oral And Maxillofacial Surgery ◽  
Surgical Removal ◽  
Tissue Mass ◽  
Patient Reported ◽  
School Of Dentistry

OBJECTIVE: This article presents a case of inflammatory fibrous hyperplasia (IFH) treated by diode laser surgery, as well as a review of the literature about this pathology.CASE DESCRIPTION: A 55-year-old woman was referred to the Department of Oral and Maxillofacial Surgery, Pontifical Catholic University of Rio Grande do Sul, School of Dentistry, complaining of a discomfort on swallowing due to a soft-tissue mass in the oral cavity that had been developing for approximately 3 years. Intraoral examination revealed multiple exophytic, pedunculated lesions with a smooth surface and pinkish in color, affecting almost the entire right cheek mucosa. The lesion turned out to be a IFH by histopatology. Surgical removal of IFH of the oral mucosa using a diode laser was performed. The lesion was removed in 3 sessions. The patient reported no local symptoms after each irradiation. The clinical appearance 10 months after the last irradiation session demonstrated complete healing and no signals of recurrence.CONCLUSION: Based on the results obtained, we can conclude that diode laser radiation contributes significantly to the advancement of oral surgery and should be considered a valuable resource for the treatment of soft-tissue lesions in the field of oral and maxillofacial surgery.

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