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Nanayakkara L, Yahaya N, Parreira M, Bajkin B. Dental management of people with complex or rare inherited bleeding disorders. Haemophilia 2024; 30 Suppl 3:128-134. [PMID: 38571337 DOI: 10.1111/hae.15005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
Advances in haematological therapies for people with complex or rare inherited bleeding disorders (IBD) have resulted in them living longer, retaining their natural teeth with greater expectations of function and aesthetics. Dental management strategies need to evolve to meet these challenges. Utilising low level laser diode therapy to reduce pre-operative inflammation to reduce the intraoperative and postoperative burden on haemostasis is described in a case series of 12 patients. For these individuals who previously required further medical management to support haemostasis or experienced such prolonged haemorrhage sufficient to warrant hospital admission, haemostasis was achieved in the dental surgery such that they were able to return home with no further medical intervention or overnight stays. Global inequities in accessing novel treatments for complex or rare IBD necessitates a comprehensive understanding of the local haemostatic agents available to dentists and the most commonly used agents and techniques are described including the use of single tooth anaesthesia (STA). STA is a computerised delivery mechanism that allows routine dental procedures that would previously have required block injections needing factor replacement therapy to be undertaken safely and effectively with no additional haemostatic intervention. The challenges of inhibitors in oral surgery are explained and discussed although more research and evidence is required to establish new treatment protocols. The importance of establishing good dental health in the quality of life of people with complex or rare IBD is highlighted with respect to the dental specific impact that more novel therapies may have on people with IBD.
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Affiliation(s)
- Lochana Nanayakkara
- Department of Restorative Dentistry, Royal London Hospital, BartsHealth NHS Trust, London, UK
- Institute of Dentistry Queen Mary University of London, London, UK
| | - Norjehan Yahaya
- Special Care Dentistry Unit, Department of Oral and Maxillofacial Surgery, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
| | - Miryam Parreira
- Dental Surgery Department, University of Buenos Aires, Buenos Aires, Argentina
- Foundation of Haemophilia, Buenos Aires, Argentina
| | - Branislav Bajkin
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Dental Clinic of Vojvodina, Novi Sad, Serbia
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Sundaresan PD, Kruger E, Lim M, McGeachie J, Tennant M. Dentistry for patients with haemophilia: Trialling a safe and economical change in management. Haemophilia 2024; 30:404-409. [PMID: 38379200 DOI: 10.1111/hae.14947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION While the dental management of patients with haemophilia has changed considerably in the last decade, haemophiliacs in Western Australia have continued to receive pre-operative factor support for dentistry regardless of the type of dental procedure. AIM To review the efficacy and safety of established dental protocols that reduce factor use in the dental management of patients with haemophilia and to estimate cost savings. METHODS Records of 11 patients with haemophilia that were seen in the pilot programme period were reviewed. These were cross-referenced with previous dental and haematology notes that stated the amount and type of pre-operative factor used. Cost savings were estimated using the Australian National Blood Authority's Product List. RESULTS All study participants were male, and included those with haemophilia A (n = 9), and B (n = 2). Mean age was 45 years (range 22-80). A variety of dental treatments were undertaken, and no pre-operative factor was used. Patients on prophylaxis (n = 6) received dental treatment the same day as their regular factor administration. It was estimated AUD$26,314 was saved by not using pre-operative factor. One patient had bleeding post-extraction and was seen the following day to achieve haemostasis using local measures. The remaining patients had no complaints of post-operative bleeding, and did not require any further haemostatic measures. CONCLUSION This pilot programme supports data that haemophiliacs can safely receive a variety of dental treatments without the need for pre-operative factor, and the significant cost savings of doing so. Further data is required to support this protocol for invasive dental procedures.
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Affiliation(s)
- Pritam Daniel Sundaresan
- School of Allied Health, The University of Western Australia, Perth, Australia
- Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Perth, Australia
- Sedation and Special Care Dentistry, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Estie Kruger
- School of Allied Health, The University of Western Australia, Perth, Australia
| | - Mathew Lim
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
- Dental Unit, The Alfred, Melbourne, Australia
- Maxillofacial Surgery, The Royal Melbourne Hospital, Melbourne, Australia
| | - John McGeachie
- School of Allied Health, The University of Western Australia, Perth, Australia
| | - Marc Tennant
- School of Allied Health, The University of Western Australia, Perth, Australia
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Andreeva TA, Zharkov PA, Zozulya NI, Zorenko VY, Konstantinova VN, Lavrentieva IN, Davydkin IL, Petrov VY, Polyanskaya TY, Soldatenkov VE, Shutov SA. [Methodological recommendations for surgical care in patients with hemophilia A receiving prophylactic therapy with emicizumab]. Khirurgiia (Mosk) 2024:3-20. [PMID: 38591217 DOI: 10.17116/hirurgia20240323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Methodological recommendations for surgical care in patients with hemophilia A receiving prophylactic therapy with emicizumab. Recommendations of the expert group. Moscow, 2024.
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Affiliation(s)
- T A Andreeva
- GBUZ "City Polyclinic #37", City Hemophilia Treatment Center, St. Petersburg, Russian Federation
| | - P A Zharkov
- FGBU "National Medical Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev", St. Petersburg, Russia
| | - N I Zozulya
- FGBU "National Medical Research Center of Hematology", Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - V Y Zorenko
- FGBU "National Medical Research Center of Hematology", Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - V N Konstantinova
- GBUZ "City Polyclinic #37", City Hemophilia Treatment Center, St. Petersburg, Russian Federation
| | - I N Lavrentieva
- GBUZ "Morozov Children's City Clinical Hospital of the Moscow City Health Department", Moscow, Russian Federation
| | - I L Davydkin
- FGBOU VO "Samara State Medical University", Ministry of Health of the Russian Federation, Samara, Russian Federation
| | - V Y Petrov
- GBUZ "Morozov Children's City Clinical Hospital of the Moscow City Health Department", Moscow, Russian Federation
| | - T Yu Polyanskaya
- FGBU "National Medical Research Center of Hematology", Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - V E Soldatenkov
- FGBU "Russian Research Institute of Hematology and Transfusiology FMBA", St. Petersburg, Russian Federation
| | - S A Shutov
- FGBU "National Medical Research Center of Hematology", Ministry of Health of the Russian Federation, Moscow, Russian Federation
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4
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Nomura S. Current Status and Challenges in Delivering Comprehensive Care for Patients with Hemophilia. J Blood Med 2023; 14:629-637. [PMID: 38125786 PMCID: PMC10730945 DOI: 10.2147/jbm.s446204] [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: 10/23/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
The importance of comprehensive care as a treatment strategy for patients with hemophilia is recognized worldwide. Comprehensive care entails addressing full spectrum of medical and psychological aspects impacting both patients and their families. The primary objective of comprehensive care for individuals with hemophilia is to enable them to lead their daily lives just as anyone else would. To achieve this goal, it is necessary to have a positive and collaborative approach across various healthcare disciplines. This extends beyond clinical specialists, encompassing pediatricians, hematologists, orthopedic surgeons, dental and oral surgeons, gynecologists, nurses, physical therapists, clinical psychologists, and other professionals from diverse fields. This review article discusses the current status and challenges associated with comprehensive care for patients with hemophilia. We categorize these challenges as follows: hemophilic arthritis, rehabilitation, oral care, transitioning from pediatric to adult care, addressing carrier issues, and providing psychological care. There is still substantial work to be undertaken in addressing these hurdles and advancing the quality of comprehensive care for hemophilia patients.
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Affiliation(s)
- Shosaku Nomura
- Center of Thrombosis and Hemostasis, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
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Guardieiro B, Santos-Paul MA, Furtado RHDM, Dalçóquio T, Salsoso R, Neves ILI, Neves RS, Cavalheiro Filho C, Baracioli LM, Nicolau JC. Comparison between two different local hemostatic methods for dental extractions in patients on dual antiplatelet therapy: a within-person, single-blind, randomized study. J Evid Based Dent Pract 2023; 23:101863. [PMID: 37689449 DOI: 10.1016/j.jebdp.2023.101863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) provides additional risk reduction of ischemic events compared to aspirin monotherapy, at cost of higher bleeding risk. There are few data comparing new techniques for reducing bleeding after dental extractions in these patients. PURPOSE This study investigated the effectiveness of the HemCon Dental Dressing (HDD) compared to oxidized cellulose gauze. MATERIALS AND METHODS This randomized study included 60 patients on DAPT who required at least two dental extractions (120 procedures). Each surgical site was randomized to HDD or oxidized regenerated cellulose gauze as the local hemostatic method. Intra-oral bleeding time was measured immediately after the dental extraction and represents our main endpoint for comparison of both hemostatic agents. Prolonged bleeding, platelet reactivity measured by Multiplate Analyser (ADPtest and ASPItest) and tissue healing comparison after 7 days were also investigated. RESULTS Intra-oral bleeding time was lower in HDD compared with control (2 [2-5] vs. 5 [2-8] minutes, P=0.001). Prolonged postoperative bleeding was observed in 7 cases (11.6%), all of them successfully managed with local sterile gauze pressure. More HDD treated sites presented better healing when compared with control sites [21 (36.8%) vs. 5 (8.8%), P=0.03]. There was poor correlation between platelet reactivity and intra-oral bleeding time. CONCLUSIONS In patients on DAPT, HDD resulted in a lower intra-oral bleeding time compared to oxidized cellulose gauze after dental extractions. Moreover, HDD also seems to improve healing conditions.
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Affiliation(s)
- Bruno Guardieiro
- Instituto do Coracao (InCor), Unidade de Odontologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Marcela Alves Santos-Paul
- Instituto do Coracao (InCor), Unidade de Odontologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Remo Holanda de Mendonça Furtado
- Instituto do Coracao (InCor), Unidade de Coronariopatia Aguda, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil; Academic Research Organization, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Talia Dalçóquio
- Instituto do Coracao (InCor), Unidade de Coronariopatia Aguda, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Rocío Salsoso
- Instituto do Coracao (InCor), Unidade de Coronariopatia Aguda, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Itamara Lúcia Itagiba Neves
- Instituto do Coracao (InCor), Unidade de Odontologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Ricardo Simões Neves
- Instituto do Coracao (InCor), Unidade de Odontologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Cyrillo Cavalheiro Filho
- Instituto do Coracao (InCor), Unidade de Coronariopatia Aguda, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - Luciano Moreira Baracioli
- Instituto do Coracao (InCor), Unidade de Coronariopatia Aguda, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil
| | - José Carlos Nicolau
- Instituto do Coracao (InCor), Unidade de Coronariopatia Aguda, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil.
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Leira Y, Cho H, Marletta D, Orlandi M, Diz P, Kumar N, D'Aiuto F. Complications and treatment errors in periodontal therapy in medically compromised patients. Periodontol 2000 2023; 92:197-219. [PMID: 36166645 DOI: 10.1111/prd.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
Patients who are medically compromised may be at an increased risk of complications and treatment errors following periodontal therapy. A review of the evidence on the topic is presented, in relation to the type of complication reported, of periodontal treatment, and of patients' medical status. Further, a framework for risk assessment and appropriate treatment modifications is introduced, with the aim of facilitating the management of patients with existing comorbidities and reducing the incidence of treatment complications.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Hana Cho
- Special Care Dentistry Unit, ENT & Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | | | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
| | - Pedro Diz
- Special Care Dentistry Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Navdeep Kumar
- Special Care Dentistry Unit, ENT & Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
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7
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Das S, Govind S, Jena D, Dash S, Jena SP, Yadav D, Karan S, Kancherla J, Jena A, Mishra L, Bal SCB, Pattanaik S. Local Anesthesia Onset and Pain Perception in Hemophilic and Thalassemic Conditions. J Clin Med 2023; 12:jcm12113646. [PMID: 37297841 DOI: 10.3390/jcm12113646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/16/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
The study aims to evaluate and compare the onset of local anesthesia (LA) and pain perception during endodontic treatment in hemophilic and thalassemic patients. Methods: The study included 90 patients with symptomatic irreversible pulpitis of the mandibular molars. Three groups (n = 30 in each group) were included. Group 1: hemophilic patients; group 2: thalassemic patients; and group 3: individuals without any systemic diseases. Onset of LA and visual analogue scale (VAS) scores was recorded immediately after the administration of local anesthesia, during the pulp exposure procedure, and during canal instrumentation, and were compared between the three groups. Frequency distribution, ANOVA, and linear regression analysis (p < 0.05) were applied. Results: The mean onset time was 46 ± 34 s in the hemophilic group, 42 ± 23 s in the thalassemic group, and 38 ± 12 s in controls, but the differences were statistically insignificant. After LA administration (LA-VAS), all three groups experienced a statistically significant reduction in pain (p = 0.048). On pulp exposure (PE-VAS) (p = 0.82) and during canal instrumentation (CI-VAS) (p = 0.55), there was no statistically significant difference in pain perception between the groups. The coefficients indicate a positive correlation between the VAS and onset time, indicating a positive reduction in the VAS following the administration of LA. Conclusions: Hemophilic patients exhibited a clinically longer average onset time for LA. However, the difference among the three groups with regard to the overall pain perception after LA administration, during and after pulp exposure, and during canal instrumentation was statistically insignificant.
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Affiliation(s)
- Supriya Das
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Shashirekha Govind
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Debkant Jena
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Sumit Dash
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Siba Prasad Jena
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Deepika Yadav
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Smita Karan
- Department of Dentistry, Shadan Institute of Medical Sciences Research Centre and Teaching Hospital, Himayat Sagar, Hyderabad 500086, Telangana, India
| | - Jyothsna Kancherla
- Department of Dentistry, Dr.V.R.K. Women's Medical College Teaching Hospital and Research Centre, Aziz nagar, Hyderabad 500075, Telangana, India
| | - Amit Jena
- Department of Conservative Dentistry and Endodontics, Sriram Chandra Bhanja Dental College & Hospital, Cuttack 753007, Odisha, India
| | - Lora Mishra
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Sourav Chandra Bidyasagar Bal
- Department of Public Health Dentistry, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Satabdi Pattanaik
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
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8
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Paul R, George C, Chandrasekhar A, Chacko R. Complications following dental treatment in a child with haemophilia A: lessons to be learnt. BMJ Case Rep 2023; 16:e254339. [PMID: 37055078 PMCID: PMC10105990 DOI: 10.1136/bcr-2022-254339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
A boy in his middle childhood with severe haemophilia reported with facial swelling following dental treatment for a carious upper primary molar done at a private dental clinic elsewhere. On presentation, he had a large, tense and tender swelling of the left cheek and a haematoma on the buccal mucosa adjacent to the treated tooth. The child was found to have a low haemoglobin level. He was taken for an emergency procedure under general anaesthesia for dental extraction with incision and drainage, and simultaneously underwent packed cells and factor replacement. He recovered in the ward postoperatively with no complications and with a gradual reduction of the swelling. This report highlights the importance of caries prevention in children, especially those with haemophilia. They need to be educated about restricting cariogenic foods in their diet and maintaining good oral hygiene. Management of such patients should be carefully coordinated to minimise undesirable outcomes.
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Affiliation(s)
- Rebecca Paul
- Dental and Oral Surgery I, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Christina George
- Dental and Oral Surgery I, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Ajit Chandrasekhar
- Oral and Maxillofacial Services-Dental and Oral Surgery I, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Rabin Chacko
- Dental and Oral Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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Sharma S, Shahi AK, Chandra S, Abdul NS, Singh B, Singh R, Shivakumar GC. State of Dental Health and Management Needs of Young Hemophilic Patients: A Case-control Study. Int J Clin Pediatr Dent 2023; 16:380-387. [PMID: 37519953 PMCID: PMC10373760 DOI: 10.5005/jp-journals-10005-2523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Background In particular, when it comes to systemic diseases like hemophilia, good dental health is crucial to a person's overall health and wellness. Through the means of this study, we aim to assess the prevalence of various dental anomalies in children suffering from hemophilia in comparison to healthy children and assess their treatment needs. Materials and methods This was a descriptive, case-control study with 400 subjects, 200 each in the study (hemophilic) and control (nonhemophilic) groups. The subjects' ages ranged from 5 to 15 years. Utilizing the oral hygiene index-simplified (OHI-S), the state of oral hygiene was documented (OHI-S). Using decaying extracted filled tooth (DEFT) and decayed, missing, and filled tooth (DMFT) for the primary and permanent dentition, respectively, teeth afflicted by dental caries and teeth restored/extracted as a result of dental caries were assessed. Statistical Package for the Social Sciences (SPSS) software (version 27.0) was used for statistical analysis. Results Hemophilic people had a considerably greater incidence of dental caries. Furthermore, even though their DMFT/DEFT and OHI-S scores were barely poorer than those of healthy people, children with hemophilia had a significantly larger percentage of dental treatment needs across all age categories than the other group. Conclusion The percentage of hemophilic children who needed dental treatment across different age groups was significantly higher than the other group, which supports our observations that the dental health status of hemophilic children was poor and treatment requirement was high among them as well. This is true even though the DMFT/DEFT scores and OHI-S scores in hemophilic children were only slightly worse than in healthy individuals. How to cite this article Sharma S, Shahi AK, Chandra S, et al. State of Dental Health and Management needs of Young Hemophilic Patients: A Case-control Study. Int J Clin Pediatr Dent 2023;16(2):380-387.
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Affiliation(s)
- Swati Sharma
- Department of Pedodontics & Preventive Dentistry, Dental College, RIMS, Ranchi, Jharkhand, India
| | - Ajoy K Shahi
- Department of Pedodontics & Preventive Dentistry, Dental College, RIMS, Ranchi, Jharkhand, India
| | - Subhash Chandra
- Department of Orthodontics & Dento-facial Orthopaedics, Dental College, RIMS, Ranchi, Jharkhand, India
| | - Nishath S Abdul
- Faculty of Oral & Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Bishnupati Singh
- Department of Prosthodontics, Dental College, RIMS, Ranchi, Jharkhand, India
| | - Rohit Singh
- Department of Pedodontics and Preventive Dentistry, Vananchal Dental College & Hospital, Garhwa, Jharkhand, India
| | - Ganiga C Shivakumar
- Department of Oral Medicine & Radiology, People's College of Dental Science and Research Center, People's University, Bhopal, Madhya Pradesh, India
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10
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Cho S, Perry AM, Cheng AM, Wang C, Rico JF. Advances in Hemophilia A Management. Adv Pediatr 2022; 69:133-147. [PMID: 35985706 DOI: 10.1016/j.yapd.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hemophilia A is an inherited insufficiency of Factor VIII (FVIII), one of the critical clotting factors. The gold standard for the management of moderate-to-severe hemophilia A is prophylaxis using regular replacement therapy with clotting factor concentrates. Compared with conventional treatment, extended half-life products reduce the burden of frequent factor replacement injections. Of note, up to 30% of patients with hemophilia A receiving prophylactic factor infusions develop "inhibitors," neutralizing anti-FVIII autoantibodies. Therapeutic options for patients with hemophilia A and inhibitors include the immune tolerance induction (ie, eradication of inhibitors) and the management of acute bleeds with bypassing agents and/or emicizumab. Emicizumab is a biphasic monoclonal antibody mimicking activated FVIII, approved for patients with hemophilia A with/without inhibitors. Gene therapy is an emerging therapy for hemophilia A, essentially curing patients with hemophilia A or transforming them to a milder phenotype by establishing continuous endogenous expression of FVIII after one-time treatment.
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Affiliation(s)
- Sukjoo Cho
- Division of Hematology/Oncology, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA
| | - Ashley M Perry
- Division of Hematology/Oncology, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA
| | - Anna M Cheng
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Carrie Wang
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL 33602, USA
| | - Juan Felipe Rico
- Division of Hematology/Oncology, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA.
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11
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George AM, Mayya A, Mayya A, Iszham AB, Rafi NHBM, Marius R, Mayya SS. Knowledge and Awareness regarding Dental Management of Hemophilic Patients among Students of a Malaysian University: A Cross-Sectional Study. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2205260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Improper management of bleeding disorders in the dental setting can lead to complications that can endanger the lives of such patients.
Objective:
This study aimed to assess the knowledge and awareness of dental management of hemophilia among undergraduate students of a Malaysian university.
Methodology:
A cross-sectional survey was conducted in the year 2018-2019 to collect the data. A 23-item questionnaire developed and validated by the authors was used to collect data on the knowledge and awareness regarding dental management of hemophilia patients. A total of 216 dental students participated in this research. Unpaired t-test and one-way ANOVA were used to compare the knowledge score between gender and academic year.
Results:
Only 21% of the participants were confident in treating a hemophilia patient. About 97% of the participants believed that the dental curriculum must be modified to emphasize the dental management of bleeding disorders. The overall mean of the knowledge score was 47.38% and awareness was 73.7% regarding the management of patients with hemophilia.
Conclusion:
The study revealed significant scope for improvement in the dental students' knowledge, which can be achieved by modifying the dental curriculum suitably to provide more emphasis on the management of bleeding disorders.
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12
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Champagne PA, Bourassa M, Desjardins MP, Cloutier S, Demers C, Singbo NU, Néron H, Pelland-Marcotte MC. Post-procedural bleeding rate and haemostatic treatment use for dental procedures before and after the implementation of a standardized protocol for people with inherited bleeding disorders. Haemophilia 2022; 28:806-813. [PMID: 35751905 DOI: 10.1111/hae.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Persons with inherited bleeding disorders are at a substantial risk of bleeding following dental procedures. AIM To compare the outcomes and use of haemostatic treatment pre- and post-implementation of a standardized protocol for dental procedures at a Hemophilia Treatment Centre. METHODS We conducted a retrospective cohort study of outpatient and inpatient dental procedures and maxillofacial surgeries sustained by people with bleeding disorders treated at a comprehensive Hemophilia Treatment Centre (2013-2020), comparing patients' outcomes before and after the introduction of the protocol in 2018. The protocol, built using a multidisciplinary approach, suggested haemostatic treatment based on the invasiveness of the dental procedure and the proposed anaesthesia. Our primary outcome was the rate of procedural bleeding leading to medical or dental reintervention within 10 days. Secondary outcomes included the use of systemic haemostatic treatment and treatment-related adverse effects. RESULTS Overall, 137 dental procedures in 95 patients (median age: 29 years; 78% males; 74% haemophilia, 14% von Willebrand disease, 12% other disorders) were included. Seventeen procedural bleedings were reported (12.4%). Procedural bleeding occurred in 14.8% and 8.9% of patients in the control and intervention groups (p = .304). No major bleeding occurred. Tranexamic acid was used more consistently after protocol implementation (72.8% vs. 89.3%, p = .019), while factor concentrates use decreased (65.4% vs. 44.6%, p = .016), and desmopressin use remained constant (46.4% vs. 32.1%, p = .100). No treatment-related adverse effects were reported. CONCLUSION The use of a standardized protocol increased the use of tranexamic acid, with a nonstatistically significant reduction in procedural bleeding rate.
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Affiliation(s)
| | - Michelle Bourassa
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Medicine and Dental Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada
| | - Marie-Pier Desjardins
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
| | - Stéphanie Cloutier
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Department of Hematology, CHU de Québec, Quebec City, Quebec, Canada
| | - Christine Demers
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Department of Hematology, CHU de Québec, Quebec City, Quebec, Canada
| | - Narcisse Ulrich Singbo
- Recherche Clinique et Évaluative, CHU de Québec Research Center, Quebec City, Quebec, Canada
| | - Hélène Néron
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada
| | - Marie-Claude Pelland-Marcotte
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Division of Pediatric Hematology-Oncology, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
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13
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Römer P, Heimes D, Pabst A, Becker P, Thiem DGE, Kämmerer PW. Bleeding disorders in implant dentistry: a narrative review and a treatment guide. Int J Implant Dent 2022; 8:20. [PMID: 35429255 PMCID: PMC9013394 DOI: 10.1186/s40729-022-00418-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/07/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Considering a high prevalence of congenital and especially acquired bleeding disorders, their heterogeneity and the multitude of possible treatments strategies, a review of the scientific data on this topic is needed to implement a treatment guide for healthcare professionals.
Methods A selective literature review was performed via PubMed for articles describing oral surgery / dental implant procedures in patients with congenital and acquired bleeding disorders. Out of the existing literature, potential treatment algorithms were extrapolated. Results In order to assess the susceptibility to bleeding, risk stratification can be used for both congenital and acquired coagulation disorders. This risk stratification, together with an appropriate therapeutic pathway, allows for an adequate and individualized therapy for each patient. A central point is the close interdisciplinary cooperation with specialists. In addition to the discontinuation or replacement of existing treatment modalities, local hemostyptic measures are of primary importance. If local measures are not sufficient, systemically administered substances such as desmopressin and blood products have to be used. Conclusions Despite the limited evidence, a treatment guide could be developed by means of this narrative review to improve safety for patients and practitioners. Prospective randomized controlled trials are needed to allow the implementation of official evidence-based guidelines.
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14
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Psillas G, Dimas GG, Papaioannou D, Savopoulos C, Constantinidis J. Epistaxis in dental and maxillofacial practice: a comprehensive review. J Korean Assoc Oral Maxillofac Surg 2022; 48:13-20. [PMID: 35221303 PMCID: PMC8890961 DOI: 10.5125/jkaoms.2022.48.1.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/05/2021] [Accepted: 04/20/2021] [Indexed: 11/07/2022] Open
Abstract
The lifetime incidence of epistaxis in dental and maxillofacial practice has been reported to be as high as 60% and can be caused by dental implant placement, Le Fort I osteotomy, intranasal supernumerary tooth, odontogenic tumors, blood disorders and maxillofacial trauma. Most epistaxis cases are minor and easily managed with direct compression on the nares for 10 minutes. For more significant or recurrent epistaxis, other techniques might include electrocautery, anterior or posterior nasal packing, or Foley catheter balloon. For patients with refractory epistaxis, cauterization of the sphenopalatine artery under endonasal endoscopy or embolization of the internal maxillary artery should be performed. Epistaxis control is required in patients diagnosed with inherited or acquired bleeding disorders or with drug-induced coagulopathies during dental procedures. In these cases, hemostatic system adjustment and hemostasis achieved by local and adjunctive methods are required. Dentists and maxillofacial surgeons must be aware that the nasal cavity is a potential source of perioperative hemorrhage. Depending on the invasiveness of the dental intervention, preoperative involvement of the hematologist and cardiologist is usually necessary to reverse anticoagulation or to cease anticoagulant therapy.
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Affiliation(s)
- George Psillas
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Grigorios Georgios Dimas
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Despoina Papaioannou
- School of Dentistry, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Jiannis Constantinidis
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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15
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Yee R, Duggal MS, Wong VYY, Lam JCM. An Update on the Dental Management of Children with Haemophilia. Prim Dent J 2022; 10:45-51. [PMID: 35088637 DOI: 10.1177/20501684211066241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children with haemophilia present a bleeding risk and a challenge for dentists. Guidelines on the dental management of haemophilia patients are largely based on expert consensus. Many existing guidelines also provide generic guidance mainly for adult patients, which have been adapted for children. However, children have unique needs that require additional considerations. With limited evidence available, it is important that dentists have an understanding of the principles of both medical and dental management and have a close collaboration with the haematologist at all times. Therefore, this paper provides some key principles related to various aspects of dental management of children with haemophilia. Furthermore, there has been a recent update to the World Federation of Haemophilia (WFH) Guidelines for the Management of Haemophilia,1 with references to novel medical therapies for haemophilia. Hence, this paper also aims to inform dentists with the standard and newer medical therapies for haemophilia, including a specific focus on the novel agent Emicizumab and the associated dental considerations.
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Affiliation(s)
- Ruixiang Yee
- Consultant Paediatric Dentist, Dental Service, KK Women's and Children's Hospital, Singapore
| | - Monty S Duggal
- Dean College of Dental Medicine, QU Health, Qatar University, Qatar
| | - Vivian Yung Yee Wong
- Dental Surgeon, Hougang Polyclinic Dental, National Healthcare Group Polyclinics, Singapore
| | - Joyce Ching Mei Lam
- Senior Consultant, Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore
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16
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Yu H, Zhou A, Liu J, Tang Y, Yuan Q, Man Y, Xiang L. Management of systemic risk factors ahead of dental implant therapy: A beard well lathered is half shaved. J Leukoc Biol 2021; 110:591-604. [PMID: 34231923 DOI: 10.1002/jlb.6mr0621-760rr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023] Open
Abstract
As the most successful therapy for missing teeth, dental implant has become increasingly prevalent around the world. A lot of papers have reported diverse local risk factors affecting the success and survival rate of dental implants, either for a short or a long period. However, there are also many types of systemic disorders or relatively administrated medicine that may jeopardize the security and success of dental implant treatment. Additionally, the coronavirus disease 2019 pandemic also poses a challenge to dental implant clinicians. Some of these risk factors are clinically common but to some extent unfamiliar to dentists, thus optimal measurements are often lacking when they occur in dental clinics. In this review, we analyze potential systemic risk factors that may affect the success rate of dental implants. Some of them may affect bone mineral density or enhance the likelihood of local infection, thus impeding osseointegration. Others may even systemically increase the risk of the surgery and threaten patients' life. In order to help novices receive high-risk patients who need to get dental implant treatment in a more reasonable way, we accordingly review recent research results and clinical experiments to discuss promising precautions, such as stopping drugs that impact bone mineral density or the operation, and addressing any perturbations on vital signs.
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Affiliation(s)
- Hui Yu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Anqi Zhou
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiayi Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yufei Tang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Quan Yuan
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Man
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lin Xiang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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17
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Jiménez‐Yuste V, Rodríguez‐Merchán EC, Matsushita T, Holme PA. Concomitant use of bypassing agents with emicizumab for people with haemophilia A and inhibitors undergoing surgery. Haemophilia 2021; 27:519-530. [PMID: 33988293 PMCID: PMC8359827 DOI: 10.1111/hae.14322] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Surgery in people with haemophilia and factor VIII inhibitors is typically managed with perioperative administration of haemostatic agents to prevent or control the occurrence of bleeding events. Practical experience of surgery in patients with inhibitors who are receiving treatment with emicizumab is growing; however, the novelty of the situation means that standardised guidelines are lacking with regard to the concomitant administration of haemostatic agents, including dose and laboratory monitoring. AIM To review approaches to haemostatic management during major and minor invasive procedures in patients with haemophilia A and inhibitors, and to provide recommendations for controlling bleeding events. METHODS A search was conducted, limited to the past 4 years (January 2016-April 2020), pertaining to published evidence of surgery for patients receiving emicizumab. Publications identified from the search were manually reviewed to determine studies and case reports relevant for inclusion. RESULTS Identified literature and practical experience of the authors were used to build a consensus of practical recommendations for the concomitant administration of haemostatic agents during the perioperative period for elective surgery in patients with inhibitors who are receiving emicizumab. CONCLUSIONS The current evidence base indicates that surgery can be successfully performed in patients with inhibitors who are receiving emicizumab and that bypassing agents can be used concomitantly. Data from prospective studies are required to further support recommendations for haemostatic management of surgery in patients receiving emicizumab.
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Affiliation(s)
- Victor Jiménez‐Yuste
- Department of HematologyLa Paz University Hospital‐IdiPaz, Autónoma UniversityMadridSpain
| | | | | | - Pål Andrè Holme
- Department of HematologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
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18
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Yagyuu T, Yata S, Imada M, Funayama N, Imai Y, Yada K, Nogami K, Kirita T. Risk factors for post-extraction bleeding in patients with haemophilia: a retrospective cohort study. Br J Oral Maxillofac Surg 2020; 59:341-346. [PMID: 33685775 DOI: 10.1016/j.bjoms.2020.08.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
Many guidelines and studies describe haemostatic management protocols for patients with haemophilia, but few have evaluated the risk factors for post-extraction bleeding. This retrospective cohort study was performed to investigate these risks among this group of patients. We used medical records to identify patients with haemophilia who underwent tooth extraction(s) between April 2006 and April 2019 in the Department of Oral and Maxillofacial Surgery at Nara Medical University Hospital, Nara, Japan, and conducted logistic regression analyses to identify risk or protective factors for post-extraction bleeding in procedures involving factor replacement therapy. Post-extraction bleeding was defined as bleeding that could not be stopped by biting down on gauze, and that required medical treatment between 30min and 14 days after the extraction. A total of 151 extractions (84 interventions) in 55 patients fulfilled the inclusion criteria (130 extractions (72 interventions) in 48 patients with haemophilia A, and 21 extractions (12 interventions) in seven patients with haemophilia B). Post-extraction bleeding was observed in nine patients (16.3%), 10 interventions (11.9%), and 12 extractions (7.9%). On average, it occurred six days after the intervention, and on the fifth postoperative day after extractions. Use of mouth splints significantly reduced the risk (odds ratio: 0.13; p=0.01) in patients on factor replacement therapy. We will conduct a prospective study to investigate the optimal type of splint and optimal splint-wearing period.
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Affiliation(s)
- Takahiro Yagyuu
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan.
| | - Sachiko Yata
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Mitsuhiko Imada
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Naoki Funayama
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Yuichiro Imai
- Department of Oral and Maxillofacial Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Koji Yada
- Department of Pediatrics, Nara Medical University, Kashihara, Japan; The Course of Haemophilia Education, Nara Medical University, Kashihara, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
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19
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Czajkowska S, Rupa-Matysek J, Gil L, Surdacka A. Practical Recommendations for Treatment of Dental Patients with Congenital Bleeding Disorders during the Covid-19 Pandemic: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7245. [PMID: 33023050 PMCID: PMC7579117 DOI: 10.3390/ijerph17197245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/23/2020] [Accepted: 10/01/2020] [Indexed: 12/15/2022]
Abstract
At the end of 2019, a new disease -COVID-19-was identified, and a few months later, the World Health Organization announced a pandemic. It is now known that SARS-CoV-2 is highly contagious and most confirmed infections are mild to moderate. The situation is particularly difficult for dentists due to the high risk of virus transmission in the dental surgery. Complications including, but not limited to, problems with the respiratory and cardiovascular systems have been reported in patients with SARS-CoV-2. Several changes in the coagulation system, such as lower platelet numbers or increased prothrombin time, as well as increased D-dimer and fibrinogen, were observed. This review is intended to systematize the knowledge on the treatment of patients with congenital bleeding disorders (CBD) during the SARS-CoV-2 pandemic. Extensive literature research was conducted into COVID-19 and the general medical and dental treatment of patients with CBD. Case studies, research results and recommendations of international societies were used in the study. The results of this research are presented in the form of recommendations for the treatment of patients with coagulopathies. It should be remembered that the impact of COVID-19 on the health condition of patients with CBD is unknown to date.
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Affiliation(s)
- Sylwia Czajkowska
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, Bukowska 70, 60-812 Poznan, Poland;
| | - Joanna Rupa-Matysek
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569 Poznan, Poland; (J.R.-M.); (L.G.)
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569 Poznan, Poland; (J.R.-M.); (L.G.)
| | - Anna Surdacka
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, Bukowska 70, 60-812 Poznan, Poland;
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20
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Cunliffe J, Ayub K, Darcey J, Foster-Thomas E. Intentional replantation - a clinical review of cases undertaken at a major UK dental school. Br Dent J 2020; 229:230-238. [PMID: 32855480 DOI: 10.1038/s41415-020-1988-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction Intentional replantation (IR) may offer a solution for persistent periapical lesions associated with endodontically treated teeth in select cases. This case series demonstrates the use of IR as an alternative treatment approach to both orthograde and surgical endodontic retreatment. The indications, contraindications, benefits and risks of IR are discussed, and the clinical procedure is outlined.Setting Restorative Department, University Dental Hospital of Manchester, UK.Case reports Of the 13 cases presented, the follow-up period before discharge ranged from 3-28 months. Only one tooth which presented intra-operative challenges required extraction three months after IR due to post-operative mobility.Conclusion In select cases, IR may provide a simple, less invasive and cost-effective alternative to both endodontic retreatment and extraction alone following appropriate training.
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Affiliation(s)
- Joanne Cunliffe
- Senior Lecturer/Honorary Consultant, University of Manchester, UK.
| | - Khawer Ayub
- Speciality Registrar in Restorative Dentistry, King's College Hospital and William Harvey Hospital, UK
| | - James Darcey
- Consultant and Honorary Lecturer in Restorative Dentistry, University Dental Hospital of Manchester, UK
| | - Emma Foster-Thomas
- Academic Clinical Fellow in Restorative Dentistry, University of Manchester, UK
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21
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Moosajee S, Rafique S. Dental Management of Patients With Acquired and Congenital Bleeding Disorders. Prim Dent J 2020; 9:47-55. [PMID: 32643575 DOI: 10.1177/2050168420923866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In an age when people are living longer and medical interventions are continually becoming more advanced, clinicians will need to be aware of systemic disorders and treatments that may cause complications in the dental setting. The Office for National Statistics' projections state that 26% of the UK population will be aged over 65 years by 2041.1 Therefore, clinicians may often encounter patients who complain of prolonged bleeding following certain procedures, most commonly dental extractions. In the majority of cases, the cause is often a local one, which can be managed using simple local measures. However, poor management can lead to potentially fatal consequences. The aim of this paper is to update clinicians on the dental management of patients with acquired or congenital bleeding disorders, and on how to decide the most appropriate setting for safe dental care. Patient safety in the NHS is a national priority with ever greater measures being put into place to avoid patient harm. Whilst most patients can be successfully treated in primary care, for the provision of safe dental treatment, the clinician may need to make a decision regarding referral to specialist services for all dental treatment, or share care between primary care and specialist services for selected procedures.
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Affiliation(s)
- Sukina Moosajee
- Department of Community Special Care Dentistry, Kings College Hospital NHS Foundation Trust, Denmark Hill
| | - Sobia Rafique
- Department of Community Special Care Dentistry, Kings College Hospital NHS Foundation Trust, Denmark Hill
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22
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Bajkin B, Dougall A. Current state of play regarding dental extractions in patients with haemophilia: Consensus or evidence-based practice? A review of the literature. Haemophilia 2020; 26:183-199. [PMID: 31962377 DOI: 10.1111/hae.13928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/17/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
Due to the global prevalence of oral disease, tooth extraction is the most common surgical procedure required in general population thus likely to be similarly common in patients with haemophilia, especially those in older age and those living in countries with restricted resources. There are little or no consensus about optimal level and duration of factor replacement (FRP) therapy required to prevent bleeding complication following surgery and low levels of evidence to inform protocols and guidelines. The goal of this article was to review the literature regarding haematological treatment protocols and to assess their effectiveness in prevention of bleeding complications during and after tooth extractions in people with haemophilia. A total number of 29 articles were identified. Only two of the studies were randomized controlled trials, and meta-analysis was not possible. Significant heterogeneity regarding haematological regimes, dental surgical procedures, disease severity and sample size of published studies which are unable to reliably inform the provision of safe dental surgery was noted. Based on the haematological regimens, all studies were classified into one of three groups: pre- and postoperative FRP or DDAVP, single preoperative FRP or DDAVP, and no FRP treatment. The overall reported bleeding rate in case of both pre- and postoperative FRP and single dose FRP preoperative is similar, 11.9% and 11.4%, respectively, indicating that minimizing the use of clotting factor concentrate is possible if proper local haemostatic measures are provided. Strictly designed prospective studies with higher number of patients are necessary to get firm conclusions about optimal FRP treatment required to prevent bleeding complications during and after oral surgery in patients with haemophilia.
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Affiliation(s)
- Branislav Bajkin
- Faculty of Medicine Novi Sad, University of Novi Sad, Dental Clinic of Vojvodina, Novi Sad, Serbia
| | - Alison Dougall
- Special Care Dentistry Division of Child and Public Dental Health, School of Dental Science, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
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23
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Wongpang D, Makeudom A, Sastraruji T, Khongkhunthian S, Krisanaprakornkit S, Supanchart C. Anesthetic efficacies of intrapapillary injection in comparison to inferior alveolar nerve block for mandibular premolar extraction: a randomized clinical trial. Clin Oral Investig 2019; 24:619-629. [PMID: 31115690 DOI: 10.1007/s00784-019-02954-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/06/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Intrapapillary injection (IPI) has been suggested to improve pulpal anesthesia of mandibular teeth and to avoid complications from inferior alveolar nerve block (IANB). This study aimed to determine and compare clinical efficacies and prostaglandin E2 (PGE2) levels between IPI and IANB. MATERIALS AND METHODS IANB was randomly selected for mandibular premolar anesthesia on one side of 40 patients, whereas IPI was locally administered to the contralateral premolar. Pulpal anesthesia, pain during injection and extraction, patients' satisfaction, and complications were assessed from 30 patients. Gingival crevicular fluid from ten patients was collected for PGE2 quantification by ELISA. RESULTS Of 30 patients, 18 preferred IPI after injection due to significantly faster mean onset of pulpal anesthesia (p < 0.001) and lower mean score of injection pain (p = 0.017) than IANB, but 21 preferred IANB instead after extraction due to less postoperative pain, consistent with the significantly lower median PGE2 level on the IANB side than that on the IPI at 30 min (p = 0.047). However, there was no difference in the mean satisfaction score between the two techniques. Ulcerated epithelium and sloughing tissues were found at the IPI site in some patients with complete healing within 2 weeks. CONCLUSIONS The anesthetic efficacies of IPI for mandibular premolar extraction are comparable to those of IANB. However, postoperative pain and local complications at the IPI site should be considered. CLINICAL RELEVANCE IPI may be used for dental procedures that require only a short anesthetic duration to avoid failure of pulpal anesthesia, complications, and discomfort from IANB.
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Affiliation(s)
- Duangkamon Wongpang
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Anupong Makeudom
- Center of Excellence in Oral and Maxillofacial Biology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Thanapat Sastraruji
- Center of Excellence in Oral and Maxillofacial Biology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Sakornrat Khongkhunthian
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Suttichai Krisanaprakornkit
- Center of Excellence in Oral and Maxillofacial Biology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.,Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Chayarop Supanchart
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand. .,Center of Excellence in Oral and Maxillofacial Biology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.
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24
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Elad S, Zadik Y, Caton JG, Epstein JB. Oral mucosal changes associated with primary diseases in other body systems. Periodontol 2000 2019; 80:28-48. [DOI: 10.1111/prd.12265] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sharon Elad
- Department of Oral MedicineEastman Institute for Oral Health Rochester New York USA
- Hospital DentistryStrong Memorial Hospital Rochester New York USA
| | - Yehuda Zadik
- Oral Medicine for Hematologic and Oncologic PatientsDepartment of Oral Medicine, Sedation and Maxillofacial ImagingHebrew University‐Hadassah School of Dental Medicine Jerusalem Israel
- Department of Oral MedicineOral and Maxillofacial InstituteMedical CorpsIsrael Defense Forces Tel Hashomer Israel
| | - Jack G. Caton
- Department of PeriodontologyEastman Institute for Oral Health Rochester New York USA
| | - Joel B. Epstein
- Samuel Oschin Comprehensive Cancer InstituteCedars‐Sinai Medical Center Los Angeles California USA
- Division of Otolaryngology and Head and Neck Surgery City of HopeCity of Hope National Medical Center Duarte California USA
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Jackson S, Santoro C, Gue D, Ferretti A, Gaglioti D, Squire S, Mazzucconi MG, Hermans C. Clinical practice of personalized prophylaxis in hemophilia: Illustrations of experiences and benefits from two continents. Clin Case Rep 2019; 7:689-694. [PMID: 30997065 PMCID: PMC6452482 DOI: 10.1002/ccr3.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/07/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022] Open
Abstract
These cases of people with hemophilia (PWH) illustrate the importance of understanding the patient's expectations and desires and adapting treatment to meet these needs, in addition to traditional clinical targets. Population PK modeling and FVIII products with improved PK profiles provide the opportunity to individualize care and improve long-term outcomes.
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Affiliation(s)
- Shannon Jackson
- Inherited Bleeding Disorders Program of BC – Adult DivisionSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Division of Hematology, Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cristina Santoro
- Division of Hematology, Department of Cellular Biotechnologies and HematologySapienza University of Rome, Policlinico Umberto IRomeItaly
| | - Deborah Gue
- Inherited Bleeding Disorders Program of BC – Adult DivisionSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Antonietta Ferretti
- Division of Hematology, Department of Cellular Biotechnologies and HematologySapienza University of Rome, Policlinico Umberto IRomeItaly
| | - Domenico Gaglioti
- Clinical Unit of Oral Lesion SurgerySapienza University of Rome, George Eastman Institute, Policlinico Umberto IRomeItaly
| | - Sandra Squire
- Inherited Bleeding Disorders Program of BC – Adult DivisionSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Maria Gabriella Mazzucconi
- Division of Hematology, Department of Cellular Biotechnologies and HematologySapienza University of Rome, Policlinico Umberto IRomeItaly
| | - Cedric Hermans
- Hemostasis and Thrombosis Unit, Division of HematologyCliniques Universitaires Saint Luc, Université Catholique de LouvainBrusselsBelgium
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26
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Calvo-Guirado JL, Romanos GE, Delgado-Ruiz RA. Infected tooth extraction, bone grafting, immediate implant placement and immediate temporary crown insertion in a patient with severe type-B hemophilia. BMJ Case Rep 2019; 12:12/3/e229204. [PMID: 30904898 DOI: 10.1136/bcr-2019-229204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Haemorrhagic disorders combined with soft tissue inflammation and infection may lead to severe bleeding complications before, during or after dental treatment. In selected cases, a combined therapeutic approach involving clinical therapies and systemic and local medication could improve the treatment outcomes and the patient's quality of life. This clinical case report, presents for the first time a successful combined approach, completed in a 38-year-old male patient with severe type-B haemophilia in which an infected tooth was extracted, an immediate implant was inserted, bone grafting was performed and early implant loading was successfully applied. In addition to the clinical therapy, medication was provided orally, systemically and locally, thus preventing the haemorrhagic complications and improving the patient's quality of life.
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Affiliation(s)
- Jose Luis Calvo-Guirado
- International Dental Research Cathedra Department of Oral Surgery, Universidad Catolica San Antonio de Murcia Facultad de Ciencias de la Salud, Murcia, Murcia, Spain
| | - Georgios E Romanos
- Department of Periodontology, Stony Brook University, Stony Brook , New York, USA.,Department of Oral Surgery and Implant Dentistry, Johann Wolfgang Goethe University, Frankfurt, Germany
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Dougall A, Apperley O, Smith G, Madden L, Parkinson L, Daly B. Safety of buccal infiltration local anaesthesia for dental procedures. Haemophilia 2019; 25:270-275. [PMID: 30817070 DOI: 10.1111/hae.13695] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 11/30/2022]
Abstract
AIM To assess the safety of buccal infiltration local anaesthetic (LA) without additional factor replacement in patients with haemophilia (PWH) and association with clinical experience of the operator. METHODS A consecutive sample of participants with mild, moderate and severe haemophilia scheduled to have dental treatment were recruited from a comprehensive care centre in Ireland. Infiltration LA was administered using a standard technique. Safety was defined as any adverse event at time of administration, immediate postoperative, or postoperative period. Clinical experience was dichotomized into fewer or greater than three years clinical experience. RESULTS N = 135 buccal infiltration LAs without additional factor replacement were provided to N = 71 participants with mild (n = 20; 28%) and moderate to severe haemophilia (n = 51; 72%). Successful local anaesthesia was achieved in n = 133 cases (99%). No (0%) adverse bleeding events were recorded for any participants at time of administration of LA or during follow-up. Three out of 135 (2.2%) LAs recorded superficial bleeding 30 seconds after administration of LA, all of which resolved within 2 minutes with application of pressure; 4 out of 135 (3%) LAs produced a superficial haematoma at the site of injection no greater than 2 mm all of which resolved at 4 minutes. There were no differences in bleeding rates between clinicians by level of experience (P = 0.435) or by severity of bleeding disorder (P = 1.0). CONCLUSION Local anaesthetic is safe to administer via buccal infiltration for people with mild, moderate and severe haemophilia without additional factor cover. This finding holds true regardless of operator experience.
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Affiliation(s)
- Alison Dougall
- Dublin Dental University Hospital, School of Dental Science, Trinity College Dublin, Special care dentistry Division of Child and Public Dental Health, Dublin, Ireland
| | - Olivia Apperley
- Hospital Dental Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Gillian Smith
- Dublin Dental University Hospital, School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Louise Madden
- Dublin Dental University Hospital, School of Dental Science, Trinity College Dublin, Special care dentistry Division of Child and Public Dental Health, Dublin, Ireland
| | - Laura Parkinson
- Dublin Dental University Hospital, School of Dental Science, Trinity College Dublin, Special care dentistry Division of Child and Public Dental Health, Dublin, Ireland
| | - Blanaid Daly
- Dublin Dental University Hospital, School of Dental Science, Trinity College Dublin, Special care dentistry Division of Child and Public Dental Health, Dublin, Ireland
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Rahman A, Nizarali N, Dougall A, Daly B. U.K. hemophilia treaters' knowledge of risk assessment for prolonged bleeding associated with dental procedures. SPECIAL CARE IN DENTISTRY 2019; 39:173-179. [PMID: 30773677 DOI: 10.1111/scd.12359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/25/2018] [Accepted: 01/18/2019] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Optimal delivery of dental care for adults with congenital bleeding disorders (CBD) requires close collaboration between hemophilia treaters and dentists. AIM To explore U.K. hemophilia treaters' knowledge of dental procedures and associated hemostatic management in adults with CBD. METHOD Staff (N = 180) from N = 60 hemophilia facilities in the United Kingdom were invited to participate in a questionnaire-based study using a web-based tool. The questionnaire assessed participants' knowledge, adherence and appropriateness of application of U.K. guidance on hemostatic management of common dental procedures. RESULTS The response rate was 23% of treaters (n = 41) from 62% (n = 32) hemophilia facilities. Individual participants (87%; n = 34) reported they adhered to guidelines, though knowledge of guidance was poor with only 36% (n = 15) applying guidance appropriately in 3 common dental scenarios. There was a tendency for participants to assign the use of systemic hemostatic measures independent of the agreed bleeding risk associated with the proposed dental procedure. CONCLUSION AND RECOMMENDATIONS While hemophilia treaters were aware of current guidelines, their knowledge of the guidelines and ability to risk assess dental procedures was poor. There was a tendency to overprescribe systemic hemostatic measures for dental procedures. Education initiatives to aid decision making are needed.
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Affiliation(s)
- Aza Rahman
- Specialist Dentist in Sedation and Special Care Dentistry, Kurdistan Ministry of Health, General Directorate of health sulaymanaiyah, Iraq
| | - Najla Nizarali
- Consultant in Special Care Dentistry, Guys and St Thomas' NHS Foundation Trust, London
| | - Alison Dougall
- Assistant Professor and Consultant in Special Care Dentistry , Division of Public & Child Dental Health, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Lincoln Place, Dublin 2
| | - Blánaid Daly
- Professor and Consultant in Special Care Dentistry , Division of Public & Child Dental Health, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Lincoln Place, Dublin 2
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Escobar MA, Brewer A, Caviglia H, Forsyth A, Jimenez-Yuste V, Laudenbach L, Lobet S, McLaughlin P, Oyesiku JOO, Rodriguez-Merchan EC, Shapiro A, Solimeno LP. Recommendations on multidisciplinary management of elective surgery in people with haemophilia. Haemophilia 2018; 24:693-702. [PMID: 29944195 DOI: 10.1111/hae.13549] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/23/2022]
Abstract
Planning and undertaking elective surgery in people with haemophilia (PWH) is most effective with the involvement of a specialist and experienced multidisciplinary team (MDT) at a haemophilia treatment centre. However, despite extensive best practice guidelines for surgery in PWH, there may exist a gap between guidelines and practical application. For this consensus review, an expert multidisciplinary panel comprising surgeons, haematologists, nurses, physiotherapists and a dental expert was assembled to develop practical approaches to implement the principles of multidisciplinary management of elective surgery for PWH. Careful preoperative planning is paramount for successful elective surgery, including dental examinations, physical assessment and prehabilitation, laboratory testing and the development of haemostasis and pain management plans. A coordinator may be appointed from the MDT to ensure that critical tasks are performed and milestones met to enable surgery to proceed. At all stages, the patient and their parent/caregiver, where appropriate, should be consulted to ensure that their expectations and functional goals are realistic and can be achieved. The planning phase should ensure that surgery proceeds without incident, but the surgical team should be ready to handle unanticipated events. Similarly, the broader MDT must be made aware of events in surgery that may require postoperative plans to be changed. Postoperative rehabilitation should begin soon after surgery, with attention paid to management of haemostasis and pain. Surgery in patients with inhibitors requires even more careful preparation and should only be undertaken by an MDT experienced in this area, at a specialized haemophilia treatment centre with a comprehensive care model.
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Affiliation(s)
- M A Escobar
- McGovern Medical School and the Gulf States Hemophilia and Thrombophilia Center, University of Texas Health Science Center, Houston, TX, USA
| | - A Brewer
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - H Caviglia
- Orthopedics and Traumatology Department, "Juan A. Fernandez" Hospital, Buenos Aires, Argentina
| | - A Forsyth
- REBUILD Program/Diplomat Specialty Infusion Group, Cincinnati, OH, USA
| | - V Jimenez-Yuste
- Department of Haematology, La Paz University Hospital - IdiPaz, Madrid, Spain
| | - L Laudenbach
- London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - S Lobet
- Haemostasis and Thrombosis Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - P McLaughlin
- Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK
| | - J O O Oyesiku
- Haemophilia, Haemostasis and Thrombosis Centre, Basingstoke & North Hampshire Hospital, Basingstoke, UK
| | - E C Rodriguez-Merchan
- Department of Orthopaedic Surgery, La Paz University Hospital - IdiPaz, Madrid, Spain
| | - A Shapiro
- Indiana Hemophilia & Thrombosis Center, Indianapolis, IN, USA
| | - L P Solimeno
- IRCCS Cà Granda Foundation, Maggiore Hospital of Milan, Milan, Italy
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Campos FHDO, Ferreira LB, Romano MM, Moreira MS, Eduardo CDP, Ramalho KM. Immediate laser-induced hemostasis in anticoagulated rats subjected to oral soft tissue surgery: a double-blind study. Braz Oral Res 2018; 32:e56. [PMID: 29898023 DOI: 10.1590/1807-3107bor-2018.vol32.0056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 05/07/2018] [Indexed: 11/22/2022] Open
Abstract
Given the growing trend towards medical indications for continuous use of anticoagulants, the number of patients on these medications continues to rise. The management of patients on oral anticoagulants requiring oral surgical procedures has aroused much controversy. Changes in an anticoagulation regimen are associated with an increased risk of thromboembolism. However, it seems logical and advantageous for the patients' health if surgery could be performed without any change to the anticoagulation therapy. In dentistry, high-power lasers have been poorly explored in this field. The hemostatic properties of high-power lasers could be helpful during oral soft tissue surgeries in anticoagulated patients. The aim of this study was to compare bleeding time in anticoagulated rats after lingual frenectomy performed with a scalpel or diode laser with bleeding time in healthy animals. Twenty-four male Wistar rats were assigned to four groups (n = 6): (CS) Control-Scalpel Surgery; (AS) Anticoagulated-Scalpel Surgery; (CL) Control-Laser (diode laser 810 nm/1.5 W) Surgery; and (AL) Anticoagulated-Laser Surgery (diode laser 810 nm/1.5 W). Warfarin administration was used to induce anticoagulation. Blood was blotted every 30 seconds with filter paper until bleeding stopped to verify bleeding time. Two blinded researchers performed the surgeries and collected the bleeding time data. Diode laser surgery led to complete hemostasis in rats during and after lingual frenectomy. Zero bleeding was assessed during surgeries and after diode laser surgeries in anticoagulated rats. Laser-induced hemostasis offered an alternative solution to the controversial issue of intraoperative and postoperative bleeding control in patients on anticoagulation therapy.
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Affiliation(s)
| | - Lorraine Braga Ferreira
- Universidade de São Paulo - USP, School of Dentistry, Department of Biomaterials, São Paulo, SP, Brazil
| | - Marcelo Munhoes Romano
- Universidade de São Paulo - USP, School of Dentistry, Department of Stomatology, São Paulo, SP, Brazil
| | | | - Carlos de Paula Eduardo
- Universidade de São Paulo - USP, School of Dentistry, Department of Restorative Dentistry, São Paulo, SP, Brazil
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Giangrande PLF, Hermans C, O'Mahony B, de Kleijn P, Bedford M, Batorova A, Blatný J, Jansone K. European principles of inhibitor management in patients with haemophilia. Orphanet J Rare Dis 2018; 13:66. [PMID: 29703220 PMCID: PMC5921290 DOI: 10.1186/s13023-018-0800-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/06/2018] [Indexed: 12/11/2022] Open
Abstract
Background In spite of recent major advances in the understanding and treatment of inhibitor development in patients with haemophilia, multidisciplinary management of many of these patients remains suboptimal and highly heterogenous across Europe. Methods Following a series of multidisciplinary meetings and a review of the literature, the European haemophilia community of health professionals and patients jointly defined practical optimum standards for ensuring and harmonizing treatment and care for patients with an inhibitor. Results Ten complementary principles for the management of inhibitors in haemophilia have been developed, emphasizing the importance and benefits of a centralized, multidisciplinary, expert and holistic approach. Conclusions This document will serve as a benchmark to improve the multidisciplinary and practical management of patients with inhibitor. Implementation and adherence to each of these principles should have a major positive impact on the management and outcomes of patients developing an inhibitor.
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Affiliation(s)
- P L F Giangrande
- European Haemophilia Consortium, Rue de l'Industrie, B-1000, Brussels, Belgium. .,University of Oxford, Oxford, UK.
| | - C Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - B O'Mahony
- European Haemophilia Consortium, Rue de l'Industrie, B-1000, Brussels, Belgium.,Trinity College, Dublin, Ireland
| | - P de Kleijn
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Bedford
- Canterbury Christ Church University, Kent, UK
| | - A Batorova
- National Hemophilia Center, Department of Hematology and Transfusion Medicine, School of Medicine of Comenius University and University Hospital, Bratislava, Slovakia
| | - J Blatný
- Children's University Hospital Brno, Brno, Czech Republic
| | - K Jansone
- European Haemophilia Consortium, Rue de l'Industrie, B-1000, Brussels, Belgium
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Bleeding during and after dental extractions in patients with liver cirrhosis. Int J Oral Maxillofac Surg 2018; 47:1543-1549. [PMID: 29705406 DOI: 10.1016/j.ijom.2018.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/01/2018] [Accepted: 04/08/2018] [Indexed: 02/06/2023]
Abstract
Little is known about the prevention and management of acquired coagulopathies, such as those affecting cirrhotic patients. The objective of this analytic retrospective observational study was to evaluate patients on the liver transplant waiting list according to the following outcomes: (1) presence of unusual intraoperative bleeding (>10min after routine haemostatic procedures); and (2) presence of postoperative haemorrhagic complications. The outcomes were analysed according to clinical and laboratory variables. A total of 190 visits were performed for extraction of 333 teeth (ranging from 1 to 9 teeth per visit), with platelet count ranging from 16,000 to 216,000 and international normalized ratio (INR) below 3. Twelve cases (6.31%) had unusual intraoperative bleeding and 12 had postoperative haemorrhagic complications. All the events were controlled by local measures. Intraoperative bleeding was associated with low count of platelets (P=0.026). However, this counting could explain only 16% (adjusted R2=0.16) of the cases of bleeding (P=0.44), meaning that platelet function changes might be involved. Our results show that cirrhotic patients presenting platelet count above 16,000 and INR below 3 need no previous blood transfusion, with local measures being enough to manage haemorrhagic events.
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Kumbargere Nagraj S, Prashanti E, Aggarwal H, Lingappa A, Muthu MS, Kiran Kumar Krishanappa S, Hassan H. Interventions for treating post-extraction bleeding. Cochrane Database Syst Rev 2018; 3:CD011930. [PMID: 29502332 PMCID: PMC6494262 DOI: 10.1002/14651858.cd011930.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Post-extraction bleeding (PEB) is a recognised, frequently encountered complication in dental practice, which is defined as bleeding that continues beyond 8 to 12 hours after dental extraction. The incidence of post-extraction bleeding varies from 0% to 26%. If post-extraction bleeding is not managed, complications can range from soft tissue haematomas to severe blood loss. Local causes of bleeding include soft tissue and bone bleeding. Systemic causes include platelet problems, coagulation disorders or excessive fibrinolysis, and inherited or acquired problems (medication induced). There is a wide array of techniques suggested for the treatment of post-extraction bleeding, which include interventions aimed at both local and systemic causes. This is an update of a review published in June 2016. OBJECTIVES To assess the effects of interventions for treating different types of post-extraction bleeding. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 24 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 24 January 2018), Embase Ovid (1 May 2015 to 24 January 2018) and CINAHL EBSCO (1937 to 24 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We searched the reference lists of relevant systematic reviews. SELECTION CRITERIA We considered randomised controlled trials (RCTs) that evaluated any intervention for treating PEB, with male or female participants of any age, regardless of type of teeth (anterior or posterior, mandibular or maxillary). Trials could compare one type of intervention with another, with placebo, or with no treatment. DATA COLLECTION AND ANALYSIS Three pairs of review authors independently screened search records. We obtained full papers for potentially relevant trials. If data had been extracted, we would have followed the methods described in the Cochrane Handbook for Systematic Reviews of Interventions for the statistical analysis. MAIN RESULTS We did not find any randomised controlled trial suitable for inclusion in this review. AUTHORS' CONCLUSIONS We were unable to identify any reports of randomised controlled trials that evaluated the effects of different interventions for the treatment of post-extraction bleeding. In view of the lack of reliable evidence on this topic, clinicians must use their clinical experience to determine the most appropriate means of treating this condition, depending on patient-related factors. There is a need for well designed and appropriately conducted clinical trials on this topic, which conform to the CONSORT statement (www.consort-statement.org/).
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Affiliation(s)
- Sumanth Kumbargere Nagraj
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE), ManipalDepartment of Oral Medicine and Oral RadiologyJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Eachempati Prashanti
- Faculty of Dentistry, Melaka‐Manipal Medical College, (Manipal Academy of Higher Education)Department of ProsthodonticsJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Himanshi Aggarwal
- King George's Medical UniversityDepartment of ProsthodonticsKGMU CampusLucknowUttar PradeshIndia
| | - Ashok Lingappa
- Bapuji Dental College and HospitalOral Medicine & RadiologyDavangereKarnatakaIndia
| | - Murugan S Muthu
- Faculty of Dental Sciences, Sri Ramachandra UniversityPaediatric Dentistry2C Akme Park, Pedo PlanetPaediatric Dental Centre, OPP S&S POWER LTD,PorurChennaiIndia600116
| | - Salian Kiran Kumar Krishanappa
- Faculty of Dentistry, Melaka Manipal Medical College (Manipal Academy of Higher Education)Department of ProsthodonticsJalan Batu HamparMelakaMalaysia75150
| | - Haszelini Hassan
- International Islamic University MalaysiaDepartment of Oral Maxillofacial Surgery & Oral Diagnosis, Kulliyyah of DentistryKuala LumpurMalaysia
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Bidlingmaier C, Olivieri M, Hütker S, Dietl S, Kurnik K. Perioperative management of hemostasis in children and adolescents. Blood Cells Mol Dis 2017; 67:91-95. [DOI: 10.1016/j.bcmd.2017.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/13/2017] [Accepted: 01/15/2017] [Indexed: 12/14/2022]
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Abstract
Children with hemophilia (A or B) are at risk for bleeding episodes, which rank from mild mucosal/soft tissues bleeding to life-threatening hemorrhages. This report describes the dental/medical management provided to an 8.10-year-old patient suffering from uncontrolled bleeding after a surgical procedure to expose both permanent upper central incisors, in which hemophilia was a pure incidental finding. Additionally, diverse precautions to be considered during the dental clinical treatment of hemophilic children are discussed.
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Bertamino M, Riccardi F, Banov L, Svahn J, Molinari AC. Hemophilia Care in the Pediatric Age. J Clin Med 2017; 6:E54. [PMID: 28534860 PMCID: PMC5447945 DOI: 10.3390/jcm6050054] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 01/19/2023] Open
Abstract
Hemophilia is the most common of the severe bleeding disorders and if not properly managed since early infancy can lead to chronic disease and lifelong disabilities. However, it enjoys the most efficacious and safe treatment among the most prevalent monogenic disorders. Hemophilia should be considered in the neonatal period in the case of unusual bleeding or in the case of positive family history. Later, hemophilia should be suspected mainly in males because of abnormal bruising/bleeding or unusual bleeding following invasive procedures-for example, tonsillectomy or circumcision. Prophylactic treatment that is started early with clotting-factor concentrates has been shown to prevent hemophilic arthropathy and is, therefore, the gold standard of care for hemophilia A and B in most countries with adequate resources. Central venous access catheters and arterovenous fistulas play an important role in the management of hemophilia children requiring repeated and/or urgent administration of coagulation factor concentrates. During childhood and adolescence, personalized treatment strategies that suit the patient and his lifestyle are essential to ensure optimal outcomes. Physical activity is important and can contribute to better coordination, endurance, flexibility and strength. The present article focuses also on questions frequently posed to pediatric hematologists like vaccinations, day-care/school access and dental care.
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Affiliation(s)
- Marta Bertamino
- Thrombosis and Hemostasis Unit, Regional Reference Center for Hemorrhagic Diseases, Giannina Gaslini Children's Hospital, 16147 Genova, Italy.
| | - Francesca Riccardi
- Hematology Unit, Giannina Gaslini Children's Hospital, 16147 Genova, Italy.
| | - Laura Banov
- Thrombosis and Hemostasis Unit, Regional Reference Center for Hemorrhagic Diseases, Giannina Gaslini Children's Hospital, 16147 Genova, Italy.
| | - Johanna Svahn
- Thrombosis and Hemostasis Unit, Regional Reference Center for Hemorrhagic Diseases, Giannina Gaslini Children's Hospital, 16147 Genova, Italy.
| | - Angelo Claudio Molinari
- Thrombosis and Hemostasis Unit, Regional Reference Center for Hemorrhagic Diseases, Giannina Gaslini Children's Hospital, 16147 Genova, Italy.
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Watterson C, Beacher N. Preventing perioperative bleeding in patients with inherited bleeding disorders. Evid Based Dent 2017; 18:28-29. [PMID: 28338025 DOI: 10.1038/sj.ebd.6401226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Data sourcesCochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, a regularly updated database informed by trials identified within electronic databases including MEDLINE. Further defined searches were undertaken in PubMed, Embase, The Cochrane Library, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. Additional hand searching of relevant journals and books of conference proceedings was undertaken.Study selectionRandomised and quasi-randomised controlled trials in people of all ages with haemophilia or VWD undergoing oral or dental procedures using antifibrinolytic agents (tranexamic acid (TXA) or epsilon aminocaproic acid (EACA)) to prevent perioperative bleeding compared to no intervention with or without placebo.Data extraction and synthesisTwo authors independently assessed identified publications for inclusion based on defined selection criteria. The two authors performed data extraction and risk of bias assessments using standardised forms and the Cochrane risk of bias tools. A third author, deemed to have particular subject expertise, verified eligibility of inclusion.ResultsOne randomised, double-blinded placebo controlled trial and one quasi-randomised trial were included. A total of 59 participants with haemophilia undergoing dental extraction were involved. Both trials evidenced a notable reduction in post-operative bleeding following dental extraction when either TXA or EACA were used, in addition to routine preoperative factor replacement, when compared to placebo. The number of post-operative bleeds, amount of blood loss and the need for additional clotting factors were reduced in the groups receiving antifibrinolytic therapy. No eligible trials in people with VWD were identified.ConclusionsLow quality evidence exists to support the use of adjuvant antifibrinolytic therapy to reduce perioperative bleeding in patients with haemophilia undergoing dental extraction. The limited number of trials identified (N=2), minimal sample size (N=28, N=31) and historic nature of the studies, originating from the 1970s, in addition to study heterogeneity and subsequent selection bias results in a low quality evidence grade for recommending adjuvant antifibrinolytic therapy. There is no clear indication to alter current practice utilising antifibrinolytic therapy to manage patients with haemophilia undergoing dental surgery in accordance with internationally accepted guidelines. However, further research with standardised study deigns would be welcomed in order to enhance the evidence base in the management of people with haemophilia and VWD.
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Affiliation(s)
- Colin Watterson
- Special Care Dentistry, Public Dental Service, NHS Lothian, Edinburgh, Scotland
| | - Nicholas Beacher
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland
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Rasaratnam L, Chowdary P, Pollard D, Subel B, Harrington C, Darbar UR. Risk-based management of dental procedures in patients with inherited bleeding disorders: Development of a Dental Bleeding Risk Assessment and Treatment Tool (DeBRATT). Haemophilia 2017; 23:247-254. [DOI: 10.1111/hae.13122] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2016] [Indexed: 01/22/2023]
Affiliation(s)
- L. Rasaratnam
- Department of Restorative Dentistry; Eastman Dental Hospital; London UK
| | - P. Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Royal Free Hospital; London UK
| | - D. Pollard
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Royal Free Hospital; London UK
| | - B. Subel
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Royal Free Hospital; London UK
| | - C. Harrington
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Royal Free Hospital; London UK
| | - U. R. Darbar
- Department of Restorative Dentistry; Eastman Dental Hospital; London UK
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Sudheesh KM, Bharani KSNS, Kiran HY, Hanagavadi S. "Antihemophilic factor is not the only answer for all factor VIII deficiencies." Case report of odontogenic infection in a patient with hemophilia A, complicated by factor VIII inhibitors, and managed by transfusion of antihemophilic factor and factor VIII inhibitor bypass activity. Indian J Dent 2016; 7:149-152. [PMID: 27795652 PMCID: PMC5015568 DOI: 10.4103/0975-962x.186700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dental extraction in hemophiliacs with acquired inhibitors is always a risky procedure, which often presents a lot of problems associated with bleeding. A known case of hemophilia A complicated with factor VIII inhibitors and having odontogenic infection was successfully managed by transfusion of factor VIII inhibitor bypass activity (FEIBA) and antihemophilic factor. Past medical history was significant for multiple factor VIII transfusions. Bethesda assay done to identify inhibitors revealed low titer factor VIII inhibitors. Extraction of the involved tooth was done after transfusion of FEIBA with low-dose protocols. Minimal bleeding was noted after extraction which was controlled by local measures. FEIBA was proven to be highly effective, and no side effects of the product were observed.
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Affiliation(s)
- K M Sudheesh
- Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, Karnataka, India
| | - K S N Siva Bharani
- Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, Karnataka, India
| | - H Y Kiran
- Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, Karnataka, India
| | - Suresh Hanagavadi
- Department of Pathology, J J M Medical College, Davangere, Karnataka, India
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Abstract
Several systemic diseases (and relative medications) have been reported to impair or in some cases complicate dental implant surgery. In broader terms, when dealing with patients suffering from systemic diseases, the monitoring of the medical condition and of the related post-operative complications is of great importance in order to avoid risks which could jeopardise the health of the patient. In this review, the available evidence on implant survival/success, as well as relevant surgical recommendations in patients affected by systemic diseases, are evaluated and when possible, practical suggestions for the clinician are provided.
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Sumanth KN, Prashanti E, Aggarwal H, Kumar P, Lingappa A, Muthu MS, Kiran Kumar Krishanappa S. Interventions for treating post-extraction bleeding. Cochrane Database Syst Rev 2016:CD011930. [PMID: 27285450 DOI: 10.1002/14651858.cd011930.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Post-extraction bleeding (PEB) is a recognised, frequently encountered complication in dental practice, which is defined as bleeding that continues beyond 8 to 12 hours after dental extraction. The incidence of post-extraction bleeding varies from 0% to 26%. If post-extraction bleeding is not managed, complications can range from soft tissue haematomas to severe blood loss. Local causes of bleeding include soft tissue and bone bleeding. Systemic causes include platelet problems, coagulation disorders or excessive fibrinolysis, and inherited or acquired problems (medication induced). There is a wide array of techniques suggested for the treatment of post-extraction bleeding, which include interventions aimed at both local and systemic causes. OBJECTIVES To assess the effects of interventions for treating different types of post-extraction bleeding. SEARCH METHODS We searched the following electronic databases: The Cochrane Oral Health Group Trials Register (to 22 March 2016); The Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, Issue 2); MEDLINE via OVID (1946 to 22 March 2016); CINAHL via EBSCO (1937 to 22 March 2016). Due to the ongoing Cochrane project to search EMBASE and add retrieved clinical trials to CENTRAL, we searched only the last 11 months of EMBASE via OVID (1 May 2015 to 22 March 2016). We placed no further restrictions on the language or date of publication. We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov), and the WHO Clinical Trials Registry Platform for ongoing trials (http://apps.who.int/trialsearch/default.aspx). We also checked the reference lists of excluded trials. SELECTION CRITERIA We considered randomised controlled trials (RCTs) that evaluated any intervention for treating PEB, with male or female participants of any age, regardless of type of teeth (anterior or posterior, mandibular or maxillary). Trials could compare one type of intervention with another, with placebo, or with no treatment. DATA COLLECTION AND ANALYSIS Three pairs of review authors independently screened search records. We obtained full papers for potentially relevant trials. If data had been extracted, we would have followed the methods described in the Cochrane Handbook for Systematic Reviews of Interventions for the statistical analysis. MAIN RESULTS We did not find any randomised controlled trial suitable for inclusion in this review. AUTHORS' CONCLUSIONS We were unable to identify any reports of randomised controlled trials that evaluated the effects of different interventions for the treatment of post-extraction bleeding. In view of the lack of reliable evidence on this topic, clinicians must use their clinical experience to determine the most appropriate means of treating this condition, depending on patient-related factors. There is a need for well designed and appropriately conducted clinical trials on this topic, which conform to the CONSORT statement (www.consort-statement.org/).
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Affiliation(s)
- Kumbargere N Sumanth
- Department of Oral Medicine & Oral Radiology, Faculty of Dentistry, Melaka-Manipal Medical College, Jalan Batu Hampar, Bukit Baru, Melaka, Malaysia, 75150
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Sumanth KN, Prashanti E, Aggarwal H, Kumar P, Kiran Kumar Krishanappa S. Interventions for managing post-extraction bleeding. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Spivakovsky S, Keenan AV, Congiusta M, Spivakovsky Y. Congenital bleeding disorders and dental surgery. Evid Based Dent 2015; 16:90-91. [PMID: 26492808 DOI: 10.1038/sj.ebd.6401121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Batty P, Honke A, Bowles L, Hart DP, Pasi KJ, Uprichard J, Austin SK. Ongoing risk of thrombosis with factor XI concentrate: 5 years experience in two centres. Haemophilia 2015; 21:490-5. [DOI: 10.1111/hae.12682] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P. Batty
- St George's University Hospitals NHS Foundation Trust; London UK
- Barts and The London School of Medicine & Dentistry; The Royal London Hospital; QMUL; London UK
| | - A. Honke
- Barts and The London School of Medicine & Dentistry; The Royal London Hospital; QMUL; London UK
| | - L. Bowles
- The Royal London Hospital; Barts Health NHS Trust; London UK
| | - D. P. Hart
- Barts and The London School of Medicine & Dentistry; The Royal London Hospital; QMUL; London UK
| | - K. J. Pasi
- Barts and The London School of Medicine & Dentistry; The Royal London Hospital; QMUL; London UK
| | - J. Uprichard
- St George's University Hospitals NHS Foundation Trust; London UK
| | - S. K. Austin
- St George's University Hospitals NHS Foundation Trust; London UK
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Pre- and postoperative management techniques. Before and after. Part 1: medical morbidities. Br Dent J 2015; 218:273-8. [PMID: 25766163 DOI: 10.1038/sj.bdj.2015.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2015] [Indexed: 11/08/2022]
Abstract
This article provides readers with an overview of available evidence in relation to providing care to patients in different medical circumstances within oral surgery. There is evidence available to support discussions with patients taking particular medications (such as bisphosphonates, anticoagulants and corticosteroids) and also to try to prevent certain complications (such as 'dry socket'). In order to reduce the risks of potential morbidities, either perioperatively or postoperatively, operators must use high-quality, reliable and informed protocols, management techniques, advice and interventions to provide patients with the best care. These are used both preoperatively and postoperatively and patients should be consented appropriately, in a manner tailored to their own individual circumstances, but also using available evidence to explain the benefits and harms of any given procedure. In this short series we will outline and discuss common pre- and postoperative management techniques, protocols and instructions, and the evidence available to support these.
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Givol N, Hirschhorn A, Lubetsky A, Bashari D, Kenet G. Oral surgery‐associated postoperative bleeding in haemophilia patients – a tertiary centre's two decade experience. Haemophilia 2014; 21:234-240. [DOI: 10.1111/hae.12573] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- N. Givol
- Unit of Oral and Maxillofacial Surgery Soroka University Medical Center Beer ShevaIsrael
| | - A. Hirschhorn
- Department of Oral and Maxillofacial SurgerySheba Medical Center Ramat Gan Israel
- Sackler Medical School Tel Aviv UniversityRamat GanIsrael
| | - A. Lubetsky
- Sackler Medical School Tel Aviv UniversityRamat GanIsrael
- National Hemophilia Center Sheba Medical Center Ramat Gan Israel
| | - D. Bashari
- Sackler Medical School Tel Aviv UniversityRamat GanIsrael
- National Hemophilia Center Sheba Medical Center Ramat Gan Israel
| | - G. Kenet
- Sackler Medical School Tel Aviv UniversityRamat GanIsrael
- National Hemophilia Center Sheba Medical Center Ramat Gan Israel
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