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The practices and beliefs of dental professionals regarding the management of patients taking anticoagulant and antiplatelet drugs. BDJ Open 2023; 9:1. [PMID: 36697382 PMCID: PMC9877031 DOI: 10.1038/s41405-022-00127-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 01/26/2023] Open
Abstract
AIM This study aimed to inform the implementation of the updated Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance, 'Management of Dental Patients taking Anticoagulant or Antiplatelet Drugs', and to determine training needs by investigating dental professionals' current practice and beliefs regarding management of patients taking these medications. METHODS Dental professionals were recruited via the NHS Education for Scotland Portal. The online questionnaire collected demographic information, data on current practice and information about beliefs regarding behaviours related to the management of patients on anticoagulant or antiplatelet medication. Quantitative data were analysed using SPSS and subjected to frequency calculations, t-tests, one-way ANOVA and linear regression. Qualitative data were collected via free text boxes and analysed using thematic analysis. RESULTS One hundred and fifty-seven participants responded to the questionnaire. The majority of respondents stated they were aware of the guidance and always based their practice on it. The majority of respondents always assessed the patient's individual bleeding risk prior to dental procedures. Most respondents felt that they did not know how to appropriately manage patients taking low doses of low molecular weight heparins (LMWH), and only 38% of respondents always followed SDCEP guidance about direct oral anticoagulants (DOAC) medication and procedures with a low associated risk of bleeding. DISCUSSION This study demonstrates a need for further educational support surrounding LMWHs and management of patients on DOAC medication. Time and remuneration represent barriers to guidance implementation in primary care. CONCLUSION There is good awareness and adherence to the guidance in primary care settings, however training needs were identified to support implementation.
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Feres MFN, Albuini ML, de Araújo Castro Santos RP, de Almeida-Junior LA, Flores-Mir C, Roscoe MG. Dentists' awareness and knowledge of evidence- based dentistry principles, methods and practices: a systematic review. Evid Based Dent 2022:10.1038/s41432-022-0821-2. [PMID: 36138157 DOI: 10.1038/s41432-022-0821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022]
Abstract
Introduction As an attempt to provide supporting evidence for the formulation of future educational strategies on knowledge translation, this systematic review assessed and synthesised the available evidence related to the dentists' awareness, perceived and actual knowledge of evidence-based dentistry (EBD) principles, methods and practices.Methods Primary studies that considered dentists' reports collected from interviews, questionnaires, or conversation sessions were selected. Studies enrolling students, dental hygienists, or other health professionals were not included. Reviews, editorials, letters, study protocols, articles presenting knowledge translation strategies and initiatives, examples of EBD approaches to specific clinical questions, and guidelines focused on EBD implementation were also excluded. Cochrane, Embase, PubMed, Scopus and Web of Science databases were searched. Grey literature was partially covered by the Google Scholar search and the reference lists of the pre-selected studies. The study search was concluded in February 2021. Descriptive data of the selected studies were synthesised, and the risk of bias was assessed according to the National Institutes of Health Quality Assessment Tool for observational cohort and cross-sectional studies.Results Twenty-one articles were included. High percentages of dentists were aware of EBD. Variable proportions of professionals declared to have some understanding of EBD, although few presented actual knowledge of principles, methods and practices.Discussion Methodologically, most studies presented limitations regarding sample representativity, participation rates, detailing of the outcome measures, and validation of the assessment tools. Additionally, extensive overall ranges of responses were often observed across the studies, possibly as a result of heterogeneity across samples and assessment tools. The authors thus suggest developing valid questionnaires including all dimensions (awareness, perceived knowledge and actual knowledge) within an assessment tool. This would contribute to establishing knowledge translation strategies to overcome specific gaps in EBD knowledge.
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Affiliation(s)
| | | | | | | | | | - Marina Guimarães Roscoe
- Department of Biomaterials and Oral Biology, School of Dentistry of Sao Paulo, University of Sao Paulo, Brazil
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Gaballah K, Hassan M. Knowledge and Practice of Dentists Managing Patients on Antithrombotic Medications: A Cross-Sectional Survey. Eur J Dent 2022; 16:775-780. [PMID: 35016232 DOI: 10.1055/s-0041-1739436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES In this article, we explored the level of knowledge and practice of licensed dentists in the United Arab Emirates regarding managing patients on antithrombotic medications. Moreover, to assess the need for educational intervention in this area is one of the objectives. MATERIALS AND METHODS A total of 502 dentists answered 22 close-ended questionnaires. The sample size was determined based on the registry of the Ministry of Health. RESULTS Only 5.6 and 5.9% showed satisfactory overall awareness about aspirin and plavix, respectively, as drugs may hamper hemostasis. A substantial proportion of dentists consider aspirin (63.1%) and clopidogrel (52.2%) discontinuation before treatment. More than one-third of the participants shall not consider extracting teeth before physician approval, and one-quarter to one-third of them refer patients on such medications to oral surgeons to perform tooth extraction. Most respondents did not adequately answer the questions about the additional hemostatic measures and postoperative analgesia. A significantly high number of participants (n = 440, 87.6%) want to attend updated courses on the dental management of such patients. CONCLUSIONS The dentists demonstrate a contrasting diversity of knowledge and practice approaches to patient management on antiplatelet agents. There is an apparent demand to raise understanding of the evidence-based management of a patient on such medications. It is vital to keep formalized training sessions and provide the necessary expertise to students and dentists to prevent unwanted complications.
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Affiliation(s)
- Kamis Gaballah
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, United Arab Emirates
| | - Mawada Hassan
- College of Dentistry, Ajman University, Ajman, United Arab Emirates
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Al-Mohaissen MA, Al-Mehisen R, Lee T, Al-Madi EM. Managing Cardiac Patients: Dentists' Knowledge, Perceptions, and Practices. Int Dent J 2021; 72:296-307. [PMID: 34256924 PMCID: PMC9275076 DOI: 10.1016/j.identj.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Dental patients may require invasive treatment, and awareness of their medical conditions is essential for optimal care. We assessed the knowledge, perceptions, and attitudes of dentists practicing in Saudi Arabia (SA) and their associations with managing patients with common cardiac conditions. METHODS A national survey of knowledge and attitudes of practicing dentists towards patients with common cardiac conditions was conducted from May 2019 to July 2020 in SA. The survey comprised a newly developed, validated, electronic, self-administered English questionnaire. RESULTS Overall, 282 dentists completed the survey, of whom 45.5% perceived cardiac patients as difficult to manage, while 64.5% stated that they refer these patients to cardiologists before dental intervention. Regarding knowledge about cardiac conditions, 72% achieved an overall knowledge score <55%; however, their infective endocarditis scores were better. Consultants and specialists (P < .001), those with a PhD/board certification (P = .013), dentists with prior education on cardiac patient management (P = .002), and those working with a cardiologist (P = .016) scored higher on knowledge. Conversely, private dentists (P = .003) and those referring patients to cardiologists before treatment (P = .003) scored lower. Dentists' knowledge of cardiovascular diseases in women was low; only those who believed women experience a greater risk of cardiac complications achieved a higher score. Approximately 90.1% wished to receive education regarding cardiac patient management. CONCLUSIONS Knowledge of cardiac patient management was suboptimal in this study. Dentists perceived cardiac patients as difficult to manage, but wished to learn more regarding optimal management. Thus, postgraduate education programmes that promote optimal dental management strategies for cardiac patients are necessary.
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Affiliation(s)
- Maha A Al-Mohaissen
- Department of Clinical Sciences, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
| | - Rabah Al-Mehisen
- Department of Cardiology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Ebtissam M Al-Madi
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Shah AH, Khalil HS, Alshahrani FA, Khan SQ, AlQthani NR, Bukhari IA, Kola MZ. Knowledge of medical and dental practitioners towards dental management of patients on anticoagulant and/or anti-platelet therapy. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.sjdr.2014.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Affiliation(s)
- Nuala B. Porteous
- Department of Comprehensive Dentistry; University of Texas Health Science Center at San Antonio Dental School
| | - Eamon Bizra
- University of Texas Health Science Center at San Antonio Dental School at the time of this study
| | - Annaliese Cothron
- University of Texas Health Science Center at San Antonio Dental School
| | - Chih-Ko Yeh
- University of Texas Health Science Center at San Antonio Dental School and Senior Research Scientist, Geriatric Research, Education, and Clinical Center at San Antonio; Audie Murphy Division; South Texas Veterans Health Care System
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Zoman HA, Jetaily SA, Robert AA, Baskaradoss JK, Al-Suwyed A, Ciancio S, Mubarak SA. Flapless Dental Implant Surgery for Patients on Oral Anticoagulants—The “WarLess Procedure”: A Report of 2 Cases. J ORAL IMPLANTOL 2013. [DOI: 10.1563/aaid-joi-d-11-00105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients with prosthetic heart valves are maintained on lifelong oral anticoagulant therapy. The optimal anticoagulant management of such patients during surgical dental procedures has been debated for a long time. Compared with conventional dental implant placement, a minimally invasive flapless approach has the potential to reduce bleeding and minimize surgical time, postoperative pain, soft tissue inflammation, and crestal bone. The purpose of these case reports is to show the clinical predictability of dental implant placement using a minimally invasive flapless approach without reducing the dosage of anticoagulants for patients on lifelong anticoagulant therapy. In this study, a 45-year-old woman and a 58-year-old man who had undergone cardiac surgery and were currently under a full therapeutic level of anticoagulation therapy (warfarin) were treated with flapless dental implant surgery without reducing their anticoagulant dosage. Postoperative clinical and radiographic assessment showed no abnormality, minimal signs of inflammation, and excellent healing. The combination of minimally invasive flapless dental implant surgery with no interruption in the normal dose of the anticoagulant medications could be an improved method for placing dental implants in patients on long-term anticoagulant therapy.
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Affiliation(s)
- Hamad Al Zoman
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Samer Al Jetaily
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Asirvatham Alwin Robert
- Research Center, Medical Affairs, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia
| | | | - Abdulaziz Al-Suwyed
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, NGHA, Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sebastian Ciancio
- Department of Periodontics and Endodontics, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Sultan Al Mubarak
- Research Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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A retrospective review of clinical international normalized ratio results and their implications. J Am Dent Assoc 2012; 142:1252-7. [PMID: 22041410 DOI: 10.14219/jada.archive.2011.0109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Warfarin is a key element in therapy for atrial fibrillation, deep venous thrombosis (DVT), stroke (cerebrovascular accident) and cardiac valve replacement. Often, patients' warfarin blood levels are not tightly controlled with regard to accepted therapeutic ranges, by virtue of the drug's unpredictable nature. METHODS The authors searched 16,017 active clinical charts for active patients of record from the three campuses of the School of Dentistry, Marquette University (MU), Milwaukee, for the years 2009 and 2010. Dental records of 315 patients contained entries including "INR," the abbreviation for the term "international normalized ratio." Only 247 of those records contained an indication of whether the patient's INR values were within therapeutic range. The authors found that 1.96 percent of the total MU dental clinic patient population had a history of warfarin use. RESULTS When the authors compared the INR values for patients with diagnoses of atrial fibrillation, DVT, stroke and cardiac valve replacement, they found that INR values for 107 of the 247 patients (43.3 percent) were not within therapeutic range for the respective diagnoses. For example, only 50 percent of the patients being treated for atrial fibrillation presented themselves for surgical dental treatment while their INR values were in tight control. CONCLUSION The INR values for a significant number of dental patients are not within the therapeutic range for their medical conditions. These patients need to seek follow-up care from their medical care providers. CLINICAL IMPLICATIONS Screening for INR in the dental office-especially before invasive dental treatment such as periodontal surgery, tooth extraction and dental implant placement-can help prevent postoperative complications. It also can aid the clinician in evaluating whether a patient's INR is within therapeutic range and, subsequently, whether the patient's physician needs to adjust the warfarin dosage.
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Martínez-Beneyto Y, López-Jornet P, Camacho-Alonso F, González-Escribano M. Dental Students’ Knowledge of and Attitudes Toward Anticoagulation Dental Treatment: Assessment of a One-Day Course at the University of Murcia, Spain. J Dent Educ 2012. [DOI: 10.1002/j.0022-0337.2012.76.4.tb05282.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Y. Martínez-Beneyto
- Department of Preventive and Community Dentistry, Faculty of Medicine and Odontology; University of Murcia; Spain
| | - P. López-Jornet
- Department of Oral Medicine, Faculty of Medicine and Odontology; University of Murcia; Spain
| | - F. Camacho-Alonso
- Department of Oral Medicine, Faculty of Medicine and Odontology; University of Murcia; Spain
| | - M. González-Escribano
- Department of Oral Medicine, Faculty of Medicine and Odontology; University of Murcia; Spain
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Balevi B. Should warfarin be discontinued before a dental extraction? A decision-tree analysis. ACTA ACUST UNITED AC 2010; 110:691-7. [DOI: 10.1016/j.tripleo.2010.03.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 02/17/2010] [Accepted: 03/14/2010] [Indexed: 11/30/2022]
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Hong CHL, Napeñas JJ, Brennan MT, Furney SL, Lockhart PB. Frequency of bleeding following invasive dental procedures in patients on low-molecular-weight heparin therapy. J Oral Maxillofac Surg 2010; 68:975-9. [PMID: 20144498 DOI: 10.1016/j.joms.2009.09.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 09/14/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to determine the frequency of bleeding complications after invasive dental procedures in patients on low-molecular-weight heparin (LMWH) therapy. MATERIALS AND METHODS A chart review of patients who underwent invasive dental procedures while on LMWH therapy was conducted. The following information was obtained: demographics, medical history, social history, medications, relevant laboratory values, postoperative bleeding events, and use of local hemostatic agents and blood products. RESULTS Forty-one patients (21 men) were identified with 42 dental appointments. The mean age was 48 years (range, 16 to 78 years). Thirty-seven patients (90%) were on LMWH therapy for deep venous thrombosis prophylaxis. Thirty-one patients (76%) were on concomitant medications that may potentiate bleeding. Multiple dental extractions (range, 2 to 14 teeth) were performed during 19 dental appointments. Twenty-one appointments were for single-tooth extraction and 2 were for soft tissue biopsies. Three patients (7%) had postextraction bleeding events. All 3 patients were on LMWH (enoxaparin) and warfarin therapy concurrently. One patient had persistent bleeding after extraction of 4 teeth (international normalized ratio, 1.6), which was successfully controlled with topical thrombin, administration of vitamin K and fresh frozen plasma, and discontinuation of enoxaparin and warfarin. Postoperative bleeding in the other 2 patients was managed successfully with local hemostatic measures and home care instructions. CONCLUSION Our study suggests that, although postoperative bleeding in patients on LMWH therapy alone is rare to nonexistent, patients on warfarin and LMWH may be at increased risk of bleeding after invasive dental procedures.
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Affiliation(s)
- Catherine H L Hong
- Pediatric Dentistry, Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC 28203, USA.
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Hannes K, Norré D, Goedhuys J, Naert I, Aertgeerts B. Obstacles to Implementing Evidence-Based Dentistry: A Focus Group-Based Study. J Dent Educ 2008. [DOI: 10.1002/j.0022-0337.2008.72.6.tb04539.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Karin Hannes
- Belgian Centre for Evidence-Based Medicine; Belgian Branch of the Cochrane Collaboration
| | - David Norré
- Department of Prosthetic Dentistry; Catholic University; Leuven
| | - Jo Goedhuys
- Academic Centre for General Practice; Catholic University; Leuven
| | - Ignace Naert
- Department of Prosthetic Dentistry; Catholic University; Leuven
| | - Bert Aertgeerts
- Catholic University; Leuven
- Belgian Centre for Evidence-Based Medicine; Belgian Branch of the Cochrane Collaboration
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Lim W, Wang M, Crowther M, Douketis J. The management of anticoagulated patients requiring dental extraction: a cross-sectional survey of oral and maxillofacial surgeons and hematologists. J Thromb Haemost 2007; 5:2157-9. [PMID: 17650083 DOI: 10.1111/j.1538-7836.2007.02700.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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