Knowledge of medical and dental practitioners towards dental management of patients on anticoagulant and/or anti-platelet therapy

The practices and beliefs of dental professionals regarding the management of patients taking anticoagulant and antiplatelet drugs

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.

Assessment of Bleeding in Patients on Antiplatelets Undergoing Dental Implants

Introduction

Antiplatelet drugs are used for the secondary prevention of cardiac and cerebrovascular diseases. Clopidogrel and Aspirin are the most commonly prescribed drugs for these patients. Physicians and dentists have to weigh bleeding risks versus thrombotic risks in interrupting antiplatelet regimen. The balance of these risks for an individual patient is the primary consideration in management of dental patients who are taking antiplatelet drugs and require dental implants. The study was undertaken to assess the risk of bleeding in patients on single and dual antiplatelets undergoing dental implants.

Materials and method

65 patients were assessed for bleeding after placement of dental implants. They were divided into 2 groups: group I included 48 patients on single antiplatelets (Aspirin) and group II included 17 patients on dual antiplatelets (Aspirin and Clopidogrel) based upon the timing of coronary intervention. Bleeding was evaluated intra-operatively and post-operatively.

Results

Significant difference in bleeding was noted between group I and group II based on the Visual Analog Scale (VAS) for bleeding severity after implant placement both intra-operatively (P = 0.000) and post-operatively (P = 0.004) within 24 h. However, post-operative complication after 24 h was non-significant (P = 0.277).

Conclusion

Dental implants can be safely placed in patients on single antiplatelet drugs without discontinuing them. In patients on dual antiplatelets, risk of bleeding is mild to moderate if the drugs are continued. Consultation with treating cardiologist is a must before any kind of dental invasive surgery in patients on antiplatelets.

Risk of postoperative bleeding following dental extractions in patients on antithrombotic treatment

Introduction

The risk of bleeding after dental extractions in patients taking antithrombotic medication is not well known. This study aims to investigate the incidence of postoperative bleeding following dental extractions in adult patients taking antithrombotic medication in Saudi Arabia.

Methods

This retrospective study included 539 patients aged 18–93 years who attended 840 appointments for dental extractions from January 2012 to June 2016 at a tertiary care hospital in Saudi Arabia. Patients who returned with a complaint of bleeding were treated with local hemostatic measures as outpatients.

Results and Conclusion: Only 1.7% of extraction appointments were associated with postoperative bleeding. The highest risk of bleeding was noted in patients receiving warfarin (3.88%), whereas those on clopidogrel had no significant risk of bleeding. Women were found to have the highest rate of bleeding, particularly those on newer oral anticoagulant medications.

Dental extractions can be safely done in adults receiving antithrombotic treatment, provided established guidelines are followed; therefore, dental professionals must exercise caution when planning invasive dental treatment for patients on continued antithrombotic therapy.

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.

Knowledge, attitude, and practice of senior dental students toward management of complications in exodontia

Introduction

Dental graduates have a professional responsibility of being competent in managing the complications in exodontia, a very commonly performed procedure.

Aim

The aim of this paper was to assess the knowledge, attitude, and practice of senior dental students toward the management of complications in exodontia.

Materials and Methods

Four hundred dental students participated in the study voluntarily. Verbal consent was obtained after elaborating the purpose of the study. A short validated questionnaire consisting of 12 close-ended multiple choice questions was distributed to all the students. The questionnaires were collected back and results from fully filled questionnaires were tabulated in Microsoft Excel 2007.

Results

Nearly 93.4% of the students perform extractions in their practice on a routine basis. Among those 32.5% of the students have encountered complications, out of which only 20% of the students are confident in managing them. The remaining 64.8% of students who have not encountered complications are not confident in managing the same.

Conclusion

This study revealed the need for increase in cases which will in turn help the students to transfer their theoretical knowledge into professional skills.

'Parallel universes'? The interface between GPs and dentists in primary care: a qualitative study

BACKGROUND

Patient care by GPs and dentists is organizationally separated in many health systems. Studies on how dentists and GPs cooperate and interact in daily care are scarce.

OBJECTIVE

We aimed to explore the experiences of GPs and dentists as well their views and opinions regarding the inter-professional interface.

METHODS

Qualitative semi-structured interviews were conducted with GPs (n = 8) and dentists (n = 8). The pre-developed interview guideline included questions concerning participant's experiences with the other specialty, important interdisciplinary medical issues and diseases and potential for improvement of cooperation. Interviews were transcribed verbatim and analyzed with qualitative content analysis.

RESULTS

GPs and dentists perceived knowledge deficits in members of the other specialty and frequently criticized aspects of each other's patient management. Cooperation worked better if based on local networks of personally known colleagues. Participants reported many medical situations and diseases of common concern, most frequently diabetes and oral anticoagulation. There seemed to be considerable uncertainty about the management of anticoagulant therapy in patients undergoing invasive dental procedures in members of both specialties, despite existing guidelines. The separation of medical and dental university education and the lack of joint training were suggested by interviewees as reasons for the lack of interdisciplinary thinking.

CONCLUSION

Except in cases of personal contact, interaction between GPs and dentists is often limited and sometimes difficult-despite numerous inter-professional issues. Interdisciplinary approaches in continuing education, medical and dental school teaching and guideline development are potentially promising for promoting cooperation.

A Focus Group on Dental Pain Complaints with General Medical Practitioners: Developing a Treatment Algorithm

Objective. The differential diagnosis of pain in the mouth can be challenging for general medical practitioners (GMPs) as many different dental problems can present with similar signs and symptoms. This study aimed to create a treatment algorithm for GMPs to effectively and appropriately refer the patients and prescribe antibiotics. Design. The study design is comprised of qualitative focus group discussions. Setting and Subjects. Groups of GMPs within the Gold Coast and Brisbane urban and city regions. Outcome Measures. Content thematically analysed and treatment algorithm developed. Results. There were 5 focus groups with 8-9 participants per group. Addressing whether antibiotics should be given to patients with dental pain was considered very important to GMPs to prevent overtreatment and creating antibiotic resistance. Many practitioners were unsure of what the different forms of dental pains represent. 90% of the practitioners involved agreed that the treatment algorithm was useful to daily practice. Conclusion. Common dental complaints and infections are seldom surgical emergencies but can result in prolonged appointments for those GMPs who do not regularly deal with these issues. The treatment algorithm for referral processes and prescriptions was deemed easily downloadable and simple to interpret and detailed but succinct enough for clinical use by GMPs.