World Workshop on Oral Medicine VII: Platelet count and platelet transfusion for invasive dental procedures in thrombocytopenic patients: A systematic review.

OBJECTIVES: To evaluate the evidence for a 50,000/µl platelet count threshold for platelet transfusion for invasive dental procedures in thrombocytopenic patients. SUBJECTS AND METHODS: We searched in MEDLINE/PubMed, EMBASE, the Cochrane Library (Wiley) and Scopus from 1960 through April 2018 for studies on patients with quantitative platelet disorders not related to medical co-morbidities or medications and undergoing invasive dental procedures. Two reviewers conducted assessments independently. RESULTS: We found a total of 176 non-duplicate articles, of which 9 cohort studies met our inclusion criteria. The incidence of postoperative bleeding in thrombocytopenic patients was low (4.9%), and we found no difference in bleeding incidence between patients who had platelet transfusion and those who did not. There was no difference in the mean platelet count for patients with and without bleeding. Different modalities are now available to prevent and control bleeding, which may reduce the need for platelet transfusion. CONCLUSIONS: There is no evidence to support the long-standing dogma of a need for a platelet count ≥ 50,000/µl for safe invasive dental procedures. Platelet transfusion effectiveness for haemostasis support could not be determined based on available data. Local measures and antifibrinolytics are the mainstay for the prevention and management of bleeding.

World workshop on oral medicine VII: Direct anticoagulant agents management for invasive oral procedures: A systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to evaluate the current literature regarding the importance of discontinuing or not discontinuing direct oral anticoagulants (DOACs) before invasive oral procedures, and to establish the frequency and type of postoperative bleeding events in patients. MATERIAL AND METHODS: We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up until November 5, 2018. Selection of the studies, extraction of data, qualitative, and bias assessment was performed independently by two authors. RESULTS: Twenty-one studies were included. No randomized controlled studies were identified. Six studies reported a direct comparison between patients taking DOACs and those who discontinued DOACs. The meta-analysis of these studies resulted in an OR of 0.92 (95% CI = 0.37-2.27, I2  = 9%) for postoperative bleeding events for patients taking DOACs. We found that 59/497 (11.8%) postoperative bleeding events occurred in patients who continued DOACs, while 27/200 (13.5%) events were reported for patients who discontinued treatment. All postoperative bleeding events were controlled with local measures. CONCLUSION: Results from the included studies did not discern any important differences in postoperative bleeding events in patients who continued versus patients who discontinued DOACs. Furthermore, no thromboembolic events were recorded. However, the low quality of the studies must be considered.

World Workshop on Oral Medicine VII: Non-opioid pain management of head and neck chemo/radiation-induced mucositis: A systematic review.

OBJECTIVE: To evaluate the current evidence regarding the effectiveness of non-opioid interventions for the therapeutic management of pain in head and neck cancer patients with oral mucositis resulting from radiotherapy only or chemoradiotherapy. MATERIALS AND METHODS: A literature search was conducted which included randomised controlled trials that assessed patient-related outcome of pain in patients with oral mucositis associated with radiation therapy only or chemoradiotherapy. Literature searches were conducted in MEDLINE via Pubmed, Embase, Scopus and CINAHL. RESULTS: The electronic searches identified 846 articles. Screening revealed that six articles met all eligibility inclusion criteria. Interventions showing statistically significant benefits to reduce oral mucositis associated pain compared to placebo included doxepin (p < 0.001, 95% CI -6.7 to -2.1), amitriptyline (p = 0.04), diclofenac (p < 0.01) and benzydamine (p = 0.014). CONCLUSIONS: Non-opioid interventions, including topical doxepin, amitriptyline, diclofenac and benzydamine, were found to provide relief of pain due to mucositis, and when effective may allow for reduction in the use of opioids in pain management.

Leprosy and its dental management guidelines.

OBJECTIVES: Leprosy is a chronic, non-fatal disease caused by Mycobacterium leprae. It can cause cutaneous lesions, peripheral nerve lesions and orofacial manifestations, including destruction of the alveolar premaxillary process associated with loss of the maxillary incisors. The aims of this study were to assess orofacial manifestations of disease in patients attending the Bombay Leprosy Project clinics and develop clinical guidelines for dentists. MATERIALS AND METHODS: A cross-sectional questionnaire based study was administered to 43 diagnosed leprosy patients. This included questions on perceived oral health status and oral hygiene habits. An extra-oral and intra-oral examination was also performed. RESULTS: Eighty-four per cent of patients were male with a mean age of 35.9 years. Forty-nine per cent had extra-oral cutaneous lesions. Twenty-eight per cent had intra-oral lesions including hyperpigmented patches. Twenty-one per cent had cranial nerve involvement and the trigeminal nerve was most commonly affected. CONCLUSIONS: From this data a clinical dental pathway protocol for managing patients with leprosy was developed. It highlights dental issues when managing leprosy patients. Nerve involvement may mean patients are unable to give an accurate account of their symptoms. Special tests should include cranial nerve examination and swabs of intra-oral ulcers. Low rates of infectivity means that normal infection control measures can be taken when treating these patients.