Constructions of the scale of difficulty in the extraction of impacted mandibular third molars by using Delphi method / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the relevant indicators affecting difficulty in the extraction of impacted mandibular third molars and score difficulty of different operation and risk indicators, so as to build an intuitive and accurate scale to help operators make more accurate analysis and prediction of difficulty before the operation.@*METHODS@#Based on literature and the clinical review, the difficulty indicators of tooth extraction were summarized. Firstly, 10 doctors from Peking University School and Hospital of Stomatology who had been engaged in alveolar surgery for a long time established an expert nominal group, and then rated whether the summarized indicators needed to be retained in the form of face-to-face questionnaires. A level 1 and 2 item frame for evaluating difficulty in the tooth extraction was formed after discussion; Then Delphi method was used to send a questionnaire to 30 experts by e-mail. After two rounds of scoring and modification, the scale of difficulty in the extraction of impacted mandibular third molars was formed.@*RESULTS@#The recycling rate of two rounds of questionnaires was 100.0%, which showed that the experts were very enthusiastic about the study; The authority coefficients (Cr) of the two rounds of Delphi expert consultation were both 0.92, which showed that the results were representative and authoritative. After two rounds of grading and revision, the variable coefficient (CV) decreased and the Kendall's concordance coefficient (W) increased, which were statistically significant: In the first round, the CV was 0.24 and W was 0.56 (P < 0.001), and in the second, the CV was 0.19 and W was 0.72 (P < 0.001), which indicated that there was a good convergence among the expert opinions. Finally, a scale of difficulty in the tooth extraction containing 12 items at level A and 37 items at level B was formed, including operation difficulty indicators, risk difficulty indicators and common difficulty indicators.@*CONCLUSION@#Based on comprehensive literature retrieval, the study has put forward the concept that difficulty in the extraction of impacted mandibular third molars is composed of operation difficulty and risk difficulty. Using Delphi method, the long-term clinical experience and professional knowledge of experts are transformed into quantitative indicators as a scoring scale. The scale has certain representativeness and authority.

Clinical evaluation of influence of aspirin on post-operative bleeding after tooth extraction in the elderly / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of continuation of aspirin before tooth extraction in the elderly.</p><p><b>METHODS</b>The patients enrolled in this study were the elderly requiring a single non-impacted tooth extraction. 300 elderly outpatients used lidocaine local infiltration anesthesia, 200 patients without using aspirin before tooth extraction served as control group I, 100 patients with prolong use of aspirin before tooth extraction as observation group I. 300 elderly outpatients used compound articaine local infiltration anesthesia, 200 patients without using aspirin before tooth extraction served as control group II, 100 patients with prolong use of aspirin before tooth extraction as observation group II.Bleedings at 5, 10, 30 min, 24 h after tooth extraction were observed and the relationship between postoperative bleeding and intake of aspirin was analyzed.</p><p><b>RESULTS</b>There was no significant difference at 5, 10, 30 min, 24 h in postoperative bleeding after extraction between control group I and observation group. The incidence of bleeding of observation group II after tooth extraction at 5 min was higher than that of control group II and there was no significant difference at 10, 30 min, 24 h between the two groups.</p><p><b>CONCLUSIONS</b>Continuation of aspirin have no influence on postoperative bleeding. Therefore we suggest that there was no indication to discontinue aspirin for the elderly before a single non-impacted tooth extraction.</p>

Clinical observation of influence of warfarin on post-operative bleeding after tooth extraction in the elderly / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of continuing warfarin when international normalized ratio (INR) was less than 2.5 before tooth extraction in the elderly.</p><p><b>METHODS</b>One hundred elderly outpatients with prolong use of warfarin and maintaining INR < 2.5 before tooth extraction served as observation group, 200 elderly outpatients without taking anticoagulant and antiplatelet medicine served as control group. All the patients underwent a single non-impacted tooth extraction. Postoperative bleeding at different time was observed.</p><p><b>RESULTS</b>There was significant difference in postoperative bleeding at 5, 10, 30 min, 24 h after extraction and there was no significant difference at 48 h between control group and observation group (P < 0.05) and no bleeding was found in either group at 48 h (incidence of bleeding were 0%).</p><p><b>CONCLUSIONS</b>It was feasible to continue warfarin for the elderly maintaining INR < 2.5 undergoing a single non-impacted tooth extraction by monitoring postoperative bleeding and hemostatic treatment measures.</p>