Dental Management of Patients Undergoing Antithrombotic Therapy.

For more than half a century, oral anticoagulant and antiplatelet therapy has been used to decrease the risk of thromboembolism, prolonging the lives of countless patients. Patients taking antithrombotic agents may be at risk of excessive hemorrhage. Dentists commonly see such patients, and this can pose a challenge, as adequate hemostasis is crucial for the success of invasive dental treatment. Many dentists refer these patients, as they lack understanding or fear uncontrollable bleeding during and after surgery. In this clinical review, we discuss the mechanisms of hemostasis, drugs that can interfere with these pathways and how to safely and effectively manage patients who are taking antithrombotic agents. We include which procedures are considered safe, which are riskier in terms of bleeding, what laboratory tests must be reviewed before treatment, drug interactions with commonly prescribed dental drugs, as well as agents that can aid in hemostasis. Although antithrombotics cause an increase in bleeding, there is general consensus that treatment regimens should not be altered before routine dental procedures when the risk of bleeding is moderate to low. Procedures that require drug alterations include extractions of more than 3 teeth, crown lengthening, open-flap surgery, surgical extractions and periodontal surgery.

Adverse drug reactions in dentistry.

An adverse drug reaction (ADR) is an undesirable effect of a drug. ADRs are possible with any medication that is prescribed or administered in the dental office. While most pharmacological agents in use today have favourable drug profiles and are relatively safe, the prudent clinician must be aware of the potential ADRs that can occur and be prepared to manage any complications. Here we review the most commonly used agents in dentistry, namely local anaesthetics, sedatives, analgesics and antibiotics, and their ADRs and management.

A Cluster Randomized-Controlled Trial of the Impact of the Tools of the Mind Curriculum on Self-Regulation in Canadian Preschoolers.

Early self-regulation predicts school readiness, academic success, and quality of life in adulthood. Its development in the preschool years is rapid and also malleable. Thus, preschool curricula that promote the development of self-regulation may help set children on a more positive developmental trajectory. We conducted a cluster-randomized controlled trial of the Tools of the Mind preschool curriculum, a program that targets self-regulation through imaginative play and self-regulatory language (Tools; clinical trials identifier NCT02462733). Previous research with Tools is limited, with mixed evidence of its effectiveness. Moreover, it is unclear whether it would benefit all preschoolers or primarily those with poorly developed cognitive capacities (e.g., language, executive function, attention). The study goals were to ascertain whether the Tools program leads to greater gains in self-regulation compared to Playing to Learn (YMCA PTL), another play based program that does not target self-regulation specifically, and whether the effects were moderated by children's initial language and hyperactivity/inattention. Two hundred and sixty 3- to 4-year-olds attending 20 largely urban daycares were randomly assigned, at the site level, to receive either Tools or YMCA PTL (the business-as-usual curriculum) for 15 months. We assessed self-regulation at pre-, mid and post intervention, using two executive function tasks, and two questionnaires regarding behavior at home and at school, to capture development in cognitive as well as socio-emotional aspects of self-regulation. Fidelity data showed that only the teachers at the Tools sites implemented Tools, and did so with reasonable success. We found that children who received Tools made greater gains on a behavioral measure of executive function than their YMCA PTL peers, but the difference was significant only for those children whose parents rated them high in hyperactivity/inattention initially. The effect of Tools did not vary with children's initial language skills. We suggest that, as both programs promote quality play and that the two groups fared similarly well overall, Tools and YMCA PTL may be effective curricula choices for a diverse preschool classroom. However, Tools may be advantageous in classrooms with children experiencing greater challenges with self-regulation, at no apparent cost to those less challenged in this regard.