ABSTRACT
Introduction: Antiplatelet drugs are used for the secondary prevention of cardiac and cerebrovascular diseases. Clopidogrel and Aspirin are the most commonly prescribed drugs for these patients. Physicians and dentists have to weigh bleeding risks versus thrombotic risks in interrupting antiplatelet regimen. The balance of these risks for an individual patient is the primary consideration in management of dental patients who are taking antiplatelet drugs and require dental implants. The study was undertaken to assess the risk of bleeding in patients on single and dual antiplatelets undergoing dental implants. Materials and method: 65 patients were assessed for bleeding after placement of dental implants. They were divided into 2 groups: group I included 48 patients on single antiplatelets (Aspirin) and group II included 17 patients on dual antiplatelets (Aspirin and Clopidogrel) based upon the timing of coronary intervention. Bleeding was evaluated intra-operatively and post-operatively. Results: Significant difference in bleeding was noted between group I and group II based on the Visual Analog Scale (VAS) for bleeding severity after implant placement both intra-operatively (P = 0.000) and post-operatively (P = 0.004) within 24 h. However, post-operative complication after 24 h was non-significant (P = 0.277). Conclusion: Dental implants can be safely placed in patients on single antiplatelet drugs without discontinuing them. In patients on dual antiplatelets, risk of bleeding is mild to moderate if the drugs are continued. Consultation with treating cardiologist is a must before any kind of dental invasive surgery in patients on antiplatelets.
ABSTRACT
PURPOSE: Marked variations are noticed in the practices about anti-platelet therapy during dental surgery due to fear of thrombotic events versus bleeding. The main aim of this survey was to study the prevalent practices and perceptions amongst dentists, physicians and cardiologists for stopping anti-platelet agents (APA) in patients undergoing dental extractions. MATERIALS AND METHODS: A questionnaire consisting of 5 questions was distributed to 800 doctors. Questions were related to their perception about increased bleeding complications versus thrombotic risks in cardiac patient on anti-platelet agents undergoing dental surgery. The data was analyzed using Chi-square test and Z-test. RESULTS: Total number of responders was 428 from a total of 800 doctors. It consisted of two groups, group I (325) included physicians and group II (103) included dentists. 82.5 % of dentists believed that bleeding increased if APA are continued whereas 42.77 % of physicians felt the opposite (p = 0.0000035). When asked about stopping APA in patients of stable angina and stroke, both groups had similar answers (63.1 vs. 60.92 %). For patients with medicated stents 70.76 % of physicians were not in favor of stopping APA but 49.51 % dentists believed that it should be stopped (p = 0.0001). However, regarding their attitude towards stopping APA in patients with bare metal stents or post CABG, most of the doctors felt that it should be stopped (48.61 vs. 42.71 %). Discrepancy regarding the number of days for which APA should be withdrawn was found among both the groups. CONCLUSION: Marked variation was found amongst participants in this survey despite international guidelines on APA being used during dental surgery. There is a need for national guidelines to be laid on this issue and dissemination of knowledge among the practicing doctors.
ABSTRACT
Adolescent rampant caries is a new and growing challenge in Conservative Dentistry. It has the same etiology and pattern as that of nursing bottle syndrome. Herein, a case is presented in which the main cause of rampant caries is the patient's habit of keeping cariogenic food in her mouth and going to sleep. Educating this etiology and introduction of preventive strategies not only assists in meeting the special oral needs of the adolescent population, but also helps to establish lifelong healthful habits.
ABSTRACT
A 3-year-old male child presented to the casualty with history of unprovoked dog bite over the right lateral wall of nose. He was managed conservatively with antirabies prophylaxis and dressings. He presented after 3 months with a healed wound and the right upper central incisor projecting into the nostril. The Orthopantomogram showed a rotated temporary incisor with the roots of the permanent incisor placed normally. The tooth was extracted intranasally. Among the mutilating dog bite injuries referred to a plastic surgeon, this injury though thought provoking was also comical.
