Developing Bioactive Hydrogels with Peptides for Dental Application.

Dental caries is an avoidable and complex condition impacting billions of individuals worldwide, posing a specific concern among younger generations, despite the progress of oral hygiene products. This deterioration occurs due to the acid demineralization of tooth enamel, leading to the loss of minerals from the enamel subsurface. The remineralisation of early enamel carious lesions could prevent the cavitation of teeth. The enamel protein amelogenin constitutes 90% of the total enamel matrix protein and plays a key role in the bio mineralisation process. The aim of this study is to investigate the self-assembly microstructure and reticulation behaviour of a newly developed bioactive hydrogel with leucine-rich amelogenin peptide (LRAP) intended for enamel remineralisation. SEM, AFM, UV-VIS, and FTIR analyses emphasize the ability of peptides to promote cell adhesion and the treatment of early carious lesions. In conclusion, short-chain peptides can be used in hydrogels for individual or professional use.

Biomaterials Functionalized with Inflammasome Inhibitors-Premises and Perspectives.

This review aimed at searching literature for data regarding the inflammasomes' involvement in the pathogenesis of oral diseases (mainly periodontitis) and general pathologies, including approaches to control inflammasome-related pathogenic mechanisms. The inflammasomes are part of the innate immune response that activates inflammatory caspases by canonical and noncanonical pathways, to control the activity of Gasdermin D. Once an inflammasome is activated, pro-inflammatory cytokines, such as interleukins, are released. Thus, inflammasomes are involved in inflammatory, autoimmune and autoinflammatory diseases. The review also investigated novel therapies based on the use of phytochemicals and pharmaceutical substances for inhibiting inflammasome activity. Pharmaceutical substances can control the inflammasomes by three mechanisms: inhibiting the intracellular signaling pathways (Allopurinol and SS-31), blocking inflammasome components (VX-765, Emricasan and VX-740), and inhibiting cytokines mediated by the inflammasomes (Canakinumab, Anakinra and Rilonacept). Moreover, phytochemicals inhibit the inflammasomes by neutralizing reactive oxygen species. Biomaterials functionalized by the adsorption of therapeutic agents onto different nanomaterials could represent future research directions to facilitate multimodal and sequential treatment in oral pathologies.

Salivary Biomarkers of Anti-Epileptic Drugs: A Narrative Review.

Saliva is a biofluid that reflects general health and that can be collected in order to evaluate and determine various pathologies and treatments. Biomarker analysis through saliva sampling is an emerging method of accurately screening and diagnosing diseases. Anti-epileptic drugs (AEDs) are prescribed generally in seizure treatment. The dose-response relationship of AEDs is influenced by numerous factors and varies from patient to patient, hence the need for the careful supervision of drug intake. The therapeutic drug monitoring (TDM) of AEDs was traditionally performed through repeated blood withdrawals. Saliva sampling in order to determine and monitor AEDs is a novel, fast, low-cost and non-invasive approach. This narrative review focuses on the characteristics of various AEDs and the possibility of determining active plasma concentrations from saliva samples. Additionally, this study aims to highlight the significant correlations between AED blood, urine and oral fluid levels and the applicability of saliva TDM for AEDs. The study also focuses on emphasizing the applicability of saliva sampling for epileptic patients.

In Vitro and In Vivo Characterisation of a Mucoadhesive Buccal Film Loaded with Doxycycline Hyclate for Topical Application in Periodontitis.

Mucoadhesive films loaded with doxycycline hyclate (Doxy Hyc), consisting of mixtures of hydroxypropylmethyl cellulose (HPMC) E3, K4 and polyacrylic acid (Carbopol 940), were prepared by casting method, aiming to design a formulation intended for application in the oral cavity. The obtained film formulations exhibited a Doxy Hyc content between 7.52 ± 0.42 and 7.83 ± 0.41%, which had adequate mechanical properties for application in the oral cavity and pH values in the tolerance range. The x-ray diffraction studies highlighted the amorphisation of Doxy Hyc in the preparation process and the antibiotic particles present on the surface of the films, identified in the TEM images, which ensured a burst release effect in the first 15 min of the in vitro dissolution studies, after which Doxy Hyc was released by diffusion, the data presenting a good correlation with the Peppas model, n < 0.5. The formulation F1, consisting of HPMC K4 combined with C940 in a ratio of 5:3, the most performing in vitro, was tested in vivo in experimentally-induced periodontitis and demonstrated its effectiveness in improving the clinical parameters and reducing the salivary levels of matrix metalloproteinase-8 (MMP-8). The prepared Doxy Hyc loaded mucoadhesive buccal film could be used as an adjuvant for the local treatment of periodontitis, ensuring prolonged release of the antibiotic after topical application.

Immunomodulatory Effect of Novel Electrospun Nanofibers Loaded with Doxycycline as an Adjuvant Treatment in Periodontitis.

The immunomodulatory effect of a novel biomaterial obtained through electrospinning, based on polylactic acid (PLA) and nano-hydroxyapatite (nano-HAP), loaded with doxycycline (doxy) was evaluated in an animal model. The treatment capabilities as a local non-surgical treatment of periodontitis was investigated on the lower incisors of Wistar rats, after the induction of localized periodontitis using the ligature technique. Following the induction of the disease, the non-surgical treatment of scaling and root planing was applied, in conjunction with the application of the new material. The results of the treatment were evaluated clinically, using the tooth mobility and gingival index scores, as well as histologically. The salivary concentrations of matrix metalloproteinase 8 (MMP-8) and plasmatic concentrations of interleukin 1 (IL-1), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) were also monitored. Two weeks after the ligature application, the periodontal disease was successfully induced in rats. The application of the novel biomaterial obtained through electrospinning was proven to be more effective in improving the clinical parameters, while decreasing the salivary MMP-8 and plasmatic IL-1 and TNF-α concentrations, compared to the simple scaling and root planing. Thus, the novel electrospun biomaterial could be a strong candidate as an adjuvant to the non-surgical periodontal therapy.

Occlusal Splint Therapy Combined with Cranio-Temporomandibular Kinesiotherapy in Patients with Temporomandibular Disorders-A CBCT Study.

Occlusal splints are used as a non-invasive treatment for patients diagnosed with temporomandibular disorders (TMD). Another non-invasive treatment option for TMD patients is kinesiotherapy, which may be used alone or in conjunction with occlusal splint therapy. The aim of this study was to evaluate the changes in the intra-articular spaces of the temporomandibular joint (TMJ) after occlusal splint therapy combined with cranio-temporomandibular kinesiotherapy in TMD patients. Twenty-four patients (N = 24) diagnosed with TMD according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were included. Cone beam computed tomography (CBCT) images were taken before and after treatment. The anterior, superior, posterior, and medial joint spaces were measured on the CBCT images, and the condylar ratio was calculated using Pullinger and Hollender's formula. Additionally, the thickness of the glenoid fossa (GFT), condylar medio-lateral widths (MLW), and condylar height (HCo) were measured. The condylar ratio was significantly higher after treatment (p = 0.049). The changes in dimensions of the anterior, superior, posterior and medial joint spaces were not statistically significant after treatment. No statistically significant differences were found in the dimensions of the GFT, MLW, and HCo post treatment. The condylar position did not shift anteriorly in a statistically significant way after occlusal splint therapy combined with cranio-temporomandibular kinesiotherapy in TMD patients.

In Vitro Antimicrobial Effect of Novel Electrospun Polylactic Acid/Hydroxyapatite Nanofibres Loaded with Doxycycline.

The present study aimed to assess the in vitro antimicrobial effects of a novel biomaterial containing polylactic acid (PLA), nano-hydroxyapatite (nano-HAP) and Doxycycline (Doxy) obtained by electrospinning and designed for the non-surgical periodontal treatment. The antimicrobial activity of two samples (test sample, PLA-HAP-Doxy7: 5% PLA, nano-HAP, 7% Doxy and control sample, PLA-HAP: 5% PLA, nano-HAP) against two periodontal pathogens­Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis­was assessed using the Kirby−Bauer Disk Diffusion Susceptibility Test and compared with the effect of four antibiotics used as adjuvants in periodontal therapy: Amoxicillin, Ampicillin, Doxy and Metronidazole. The test sample (embedded with Doxy) showed higher inhibitory effects than commonly used antibiotics used in the treatment of periodontitis, while the control sample showed no inhibitory effects. Moreover, significant differences were observed between the inhibition zones of the two samples (p < 0.05). The Doxy-loaded PLA nanofibres had an antimicrobial effect against the periodontal pathogens. Based on these results, the novel biomaterial could be a promising candidate as adjuvant for the non-surgical local treatment in periodontitis.

Study on the Surface of Cobalt-Chromium Dental Alloys and Their Behavior in Oral Cavity as Cast Materials.

This study presents the correct processing of Co-Cr alloys as a method of preserving the properties of the materials as-cast, and therefore they can be safely placed in contact with the oral cavity tissues as resistance frameworks. The basic materials analyzed in this study were five commercial Co-Cr dental alloys with different components obtained in three processing steps. The analysis of the electrochemical behavior at the surface of the Co-Cr alloys was performed by electrochemical measurements: impedance spectroscopy (EIS), open circuit electrical potential (OCP), and linear polarization (LP). In terms of validation, all five alloys had a tendency to generate a stable oxide layer at the surface. After the measurements and the graphical representation, the alloy that had a higher percentage of tungsten (W) and iron (Fe) in composition showed a higher tendency of anodizing. After the application of the heat treatment, the disappearance of the hexagonal phase was observed, with the appearance of new phases of type (A,B)2O3 corresponding to some oxide compounds, such as Fe2O3, Cr2O3, (Cr,Fe)2O3, and CoMnO3. In conclusion, the processing of Co-Cr alloys by melting and casting in refractory molds remains a viable method that can support innovation, in the context of technology advance in recent years towards digitalization of the manufacturing process, i.e., the construction of prosthetic frameworks conducted by additive methods using Co-Cr powder alloy.

Preparation and Characterization of Doxycycline-Loaded Electrospun PLA/HAP Nanofibers as a Drug Delivery System.

The present study aimed to prepare nanofibers by electrospinning in the system polylactic acid-hydroxyapatite-doxycycline (PLA-HAP-Doxy) to be used as a drug delivery vehicle. Two different routes were employed for the preparation of Doxy-containing nanofibers: Immobilization on the electrospun mat's surface and encapsulation in the fiber structure. The nanofibers obtained by Doxy encapsulation were characterized using Fourier transform infrared (FTIR) spectroscopy, thermogravimetric (TG) and differential thermal analyses (DTA) and scanning electron microscopy (SEM). The adsorption properties of pure PLA and PLA-HAP nanofibers were investigated for solutions with different Doxy concentrations (3, 7 and 12 wt%). Moreover, the desorption properties of the active substance were tested in two different fluids, simulated body fluid (SBF) and phosphate buffer solution (PBS), to evidence the drug release properties. In vitro drug release studies were performed and different drug release kinetics were assessed to confirm the use of these nanofiber materials as efficient drug delivery vehicles. The obtained results indicate that the PLA-HAP-Doxy is a promising system for biomedical applications, the samples with 3 and 7 wt% of Doxy-loaded PLA-HAP nanofibers prepared by physical adsorption are the most acceptable membranes to provide prolonged release in PBS/SBF rather than an immediate release of Doxy.

High-Frequency Ultrasound Assessment of Skin and Oral Mucosa in Metabolic Syndrome Patients-A Cross-Sectional Study.

BACKGROUND: Exogenous factors (such as sun exposure, smoking habits, and diet) and endogenous (inflammatory status, general diseases) have a direct influence on skin and soft tissue characteristics. The study's objective was to assess the impact of metabolic syndrome (MS) on characteristics of skin layers in sun-exposed and non-exposed maxillofacial tissues evaluated by high-frequency ultrasound (HFU), as a potential diagnosis and monitoring tool for the aging process. MATERIAL AND METHODS: The present study included 102 subjects (24 with MS; 78 without MS). Anthropometric parameters and disease history were recorded, and blood samples were harvested in order to assess biochemical parameters of MS. Sun-exposed skin (zygomatic region) and non-exposed oral mucosa of the lower lip were assessed using HFU (DUB® cutis, Taberna Pro Medicum) with a 22 MHz probe. RESULTS: Patients with cardiac disease had significantly lower values for epidermis density (p = 0.002). Gender was independently linked to the aged dermis depth (p < 0.001), aged dermis no. of px (pixels) (p < 0.001), dermis depth (p < 0.001), dermis no. of px (p < 0.001), and subcutaneous tissue density (p < 0.001). Patients with MS had thinner epidermis (p = 0.008) and thinner aged dermis (p = 0.037) when compared to non-MS subjects. CONCLUSION: Patients with MS had thinner epidermis and a lower epidermis number of pixels in sun-exposed skin. Women had lower epidermis density and thicker dermis in sun-exposed skin. Our study showed that HFU, as a non-invasive investigation approach, is useful to diagnose and monitor the aging process in skin and oral mucosa, correlated with skin phenotype pathological conditions.

The Role of Mesenchymal Stem Cells in the Treatment of a Chronic Rhinosinusitis-An In Vivo Mouse Model.

Objectives/Hypothesis: It is acknowledged that the treatment of chronic rhinosinusitis (CRS) represents an important challenge for rhinology and for social and economic life. At present, one of the most common treatments for CRS is represented by local corticosteroids followed by endoscopic sinus surgery (ESS). Starting from the example of the mesenchymal stem cell's (MSC) capacity to migrate and to modulate a real response in the nasal mucosa of an allergic rhinitis mouse model, we try to obtain a response in a CRS mouse model, using MSC derived by adipose tissue. The aim of this study is to demonstrate that the MSC can be used in CRS treatment and could change its priorities. Methods: Seventy female mice (6 MSC donor mice) were randomized in two stages of study, 32 Aspergillus fumigatus (Af) exposure mice (20 for histological comparison to 1st control mice and 12 for MSC administration, to CRS/MCS model) and 32 control mice (20 for histological comparison to CRS model and 12 for MSC administration and histological control to MSC model); in the first stage, the Aspergillus fumigatus (Af) CRS mouse model was targeted, in this section were included 64 (n = 32) mice (treated and control group). In order to assess the inflammation level (histological analysis), the animals were euthanized; in the second stage MSCs (1 × 106/animal) were administered intravenously to a total of 24 (n = 24) mice (12 mice from the exposed group and 12 mice from the second control group). Results: After 12 weeks of Af intranasal instillation, the inflammation parameters evaluated indicated a severe diffuse chronic inflammation, associated with diffuse severe hyperplasia and mature diffuse squamous metaplasia. The MSCs' injection via the ophthalmic vein induced important histopathological changes in the CRS experimental group, starting with the presence of MSCs in all samples and continuing with the important degenerative character of inflammation. Conclusions: MSC administration demonstrated a real improvement of CRS evolution on the CRS mouse model.

Impact of COVID-19 Pandemic on Healthcare Professionals and Oral Care Operational Services: A Systemic Review.

The unprecedented climate of the COVID-19 pandemic has some restrictions on oral care operational services, which heavily impacted the delivery of aerosol generating procedures (AGPs). This led the health authorities to set up guidelines and policies that should be followed to minimize the virus spread and ensure safe and effective dental care delivery. This systemic review aimed to evaluate the current guidelines and strategies in providing safe dental services and ensuring efficacy of the current universal personal preventive and protective measures, as well the impact that this outbreak might have on practicing the dental profession in full scope. The review focus questions were as follows: are the current guidelines and measures in literature mitigated enough to ensure safe and effective oral care delivery to patients during the COVID-19 pandemic? Is it possible to highlight the essential and fundamental cross-infection control measures and policies? Twenty articles were chosen out of 180,248 after the inclusion and exclusion criteria were applied in the period between January 1st and August 1st 2020. Our results highlighted effective safety measures that can be implanted in protecting healthcare professionals and patients and ensuring optimal dental care delivery in a safe and healthy environment, taking into consideration the risk assessment and management of AGPs. In conclusion, informative updated standardized policies and protocols are required when more knowledge on the virus behavior keeps evolving. Moreover, there is a need for evidence-based protective measures to be modified on a regular basis to be followed, until a safe vaccine is produced.

Casting over Metal Method Used in Manufacturing Hybrid Cobalt-Chromium Dental Prosthetic Frameworks Assembles.

Cobalt-chromium (Co-Cr) alloys are the most widely used materials for removable and fixed dental prosthetic frameworks. The fitting accuracy between these components in dental prosthetic frameworks assembles (DPFAs) is largely influenced by the manufacturing method. This study presents a novel manufacturing method that combined two common techniques for obtaining one single framework: casting of Co-Cr inserts on top of parts previously manufactured by selective laser melting (SLM) of Co-Cr powder (CoM). Horizontal (n = 4) and vertical (n = 3) surfaces were microscopically analyzed (n = 770 count sum). The results revealed a high precision of the process and high fitting accuracy between the hybrid frameworks. The average distance measured between the frameworks in joined position was 41.08 ± 7.56 µm. In conclusion, the manufacturing of Co-Cr alloys DPFA using the CoM method reduced the deformation of hybrid frameworks and improved the joining accuracy between them.

Oral appliance therapy in obstructive sleep apnea and snoring - systematic review and new directions of development.

Objective: Oral appliance therapy is a non-invasive treatment that offers a wide variety of oral devices for the treatment of obstructive sleep apnea (OSA). The present review focuses on the effectiveness of mandibular advancement devices for the treatment of OSA.Methods: A systematic review based on the PRISMA checklist was carried out. A detailed electronic database search was conducted using "Obstructive sleep apnea" AND "Oral appliance" AND "Dentistry" as keywords.Results: The initial search in the electronic databases resulted in a total of 262 papers. After the title and abstract analysis and full-text review, the number of eligible papers was reduced to 15.Conclusion: The mandibular advancement device is an effective treatment, improving the Apnea Hypopnea Index and the symptoms of patients with OSA in 92% of the subjects from all the investigated studies. The future may include the integration of a biosensor for the diagnosis and follow-up.Abbreviations: OSA: Obstructive sleep apnea; MADs: Mandibular advancement devices; CPAP: Continuous positive airway pressure; OAT: Oral appliance therapy; MRD: Mandibular repositioning devices; MAS: Mandibular advancement splints; MAA: Mandibular advancement appliances; OA: Oral appliances; AASM: American Academy of Sleep Medicine; AHI: Apnea-hypopnea index; EEG: Sleep-related breathing disorder SRBD; Electroencephalogram; EOG: Electrooculogram; ECG: Electrocardiogram; QOL: Quality of life; TMJ: Temporomandibular joint.

Cannabidiol and Vitamin D3 Impact on Osteogenic Differentiation of Human Dental Mesenchymal Stem Cells.

Background and objective: The aim of the present study was to establish a new differentiation protocol using cannabidiol (CBD) and vitamin D3 (Vit. D3) for a better and faster osteogenic differentiation of dental tissue derived mesenchymal stem cells (MSCs). Materials and methods: MSCs were harvested from dental follicle (DFSCs), dental pulp (DPSCs), and apical papilla (APSCs) of an impacted third molar of a 17-year old patient. The stem cells were isolated and characterized using flow cytometry; reverse transcription polymerase chain reaction (RT-PCR); and osteogenic, chondrogenic, and adipogenic differentiation. The effects of CBD and Vit. D3 on osteogenic differentiation of dental-derived stem cell were evaluated in terms of viability/metabolic activity by alamar test, expression of collagen1A, osteopontin (OP), osteocalcin (OC), and osteonectin genes and by quantification of calcium deposits by alizarin red assay. Results: Stem cell characterization revealed more typical stemness characteristics for DFSCs and DPSCs and atypical morphology and markers expression for APSCs, a phenotype that was confirmed by differences in multipotential ability. The RT-PCR quantification of bone matrix proteins expression revealed a different behavior for each cell type, APSCs having the best response for CBD. DPSCs showed the best osteogenic potential when treated with Vit. D3. Cultivation of DFSC in standard stem cell conditions induced the highest expression of osteogenic genes, suggesting the spontaneous differentiation capacity of these cells. Regarding mineralization, alizarin red assay indicated that DFSCs and APSCs were the most responsive to low doses of CBD and Vit. D3. DPSCs had the lowest mineralization levels, with a slightly better response to Vit. D3. Conclusions: This study provides evidence that DFSCs, DPSCs, and APSCs respond differently to osteoinduction stimuli and that CBD and Vit. D3 can enhance osteogenic differentiation of these types of cells under certain conditions and doses.

Influence of Filler Loading on the Mechanical Properties of Flowable Resin Composites.

The aim of this study was to evaluate the correlation between the percent of inorganic filler by weight (wt. %) and by volume (vol. %) of 11 flowable resin composites (FRCs) and their mechanical properties. To establish the correlation, the quantity of inorganic filler was determined by combustion and shape/size analyzed by SEM images. The compressive strength (CS), flexural strength (FS), and flexural modulus (FM) were determined. The CS values were between 182.87-310.38 MPa, the FS values ranged between 59.59 and 96.95 MPa, and the FM values were between 2.34 and 6.23 GPa. The percentage of inorganic filler registered values situated between 52.25 and 69.64 wt. % and 35.35 and 53.50 vol. %. There was a very good correlation between CS, FS, and FM vs. the inorganic filler by wt. % and vol. %. (R2 = 0.8899-0.9483). The highest regression was obtained for the FM values vs. vol. %. SEM images of the tested FRCs showed hybrid inorganic filler for Filtek Supreme XT (A3) and StarFlow (A2) and a homogeneous type of inorganic filler for the other investigated materials. All of the FS values were above 50 MPa, the ISO 4049/2019 limit for FRCs.

Assessment of mismatch repair deficiency, CDX2, beta-catenin and E-cadherin expression in colon cancer: molecular characteristics and impact on prognosis and survival - an immunohistochemical study.

Microsatellite instability (MSI) or the deficiency of mismatch repair (MMR) proteins is one of the molecular pathways of colorectal tumorigenesis and may have important clinical implications in predicting the treatment response. We evaluated the relationship between clinicopathological features and MMR proteins [mutL homologue 1 (MLH1), mutS homologue 2 (MSH2), mutS homologue 6 (MSH6), postmeiotic segregation increased 2 (PMS2)], adhesion molecules (E-cadherin, beta-catenin) and caudal-type homeobox 2 (CDX2) in 31 patients with colon adenocarcinoma, using immunohistochemistry. We also aimed to assess the prognostic value of the studied proteins. MLH1 loss was correlated to PMS2 loss (p=0.006) and MSH2 loss (p=0.023); MSH2 loss was significantly associated to MSH6 loss (p=0.011). Tumors with MSH6 loss, together with tumors with PMS2 loss, covered all the patients with MSI status. We found a significant correlation between MSI tumors and mucinous histological type (p=0.03), but no significant associations with other clinicopathological features or with survival rate. There was a significant correlation between E-cadherin expression and differentiation degree (p=0.018) and between beta-catenin expression and lymph node invasion (p=0.046). No significant association between CDX2 loss and any clinical or pathological features was found (p>0.05). No significant differences were identified in overall survival according to E-cadherin, beta-catenin or CDX2 expression (p>0.05). In our study, PMS2 loss was significantly correlated with CDX2 loss (p=0.03). In conclusion, the molecular analysis of biological markers for colon cancer may be important for patient stratification, in order to select the optimal treatment algorithm. Our results suggest that probably the double panel (MSH6 and PMS2) is enough to detect the MSI status, instead of using the quadruple panel.

An Intra-Oral Optical Sensor for the Real-Time Identification and Assessment of Wine Intake.

Saliva has gained considerable attention as a diagnostics alternative to blood analyses. A wide spectrum of salivary compounds is correlated to blood concentrations of biomarkers, providing informative and discriminative data regarding the state of health. Intra-oral detection and assessment of food and beverage intake can be correlated and provides valuable information to forecast the formation and modification of salivary biomarkers. In this context, the present work proposes a novel intra-oral optical fiber sensor, developed around an optical coupler topology, and exemplified on the detection and assessment of wine intake, which is accounted for example for the formation of Nε-carboxymethyllysine Advanced Glycation End-products. A laboratory proof of concept validates the proposed solution on four white and four red wine samples. The novel optical sensor geometry shows good spectral properties, accounting for selectivity with respect to grape-based soft drinks. This enables intra-oral detection and objective quality assessment of wine. Moreover, its implementation exploits the advantages of fiber-optics sensing and facilitates integration into a mouthguard, holding considerable potential for real-time biomedical applications to investigate Advanced Glycation End-products in the saliva and their connection with consumption of wine, for the evaluation of risk factors in diet-related diseases.

State of the art regarding anticoagulant and thrombolytic therapy in dental procedures.

Patients with anticoagulant therapy have a high thromboembolic risk. Due to the rich oro-maxillofacial vasculature and the fact that some dental procedures may cause a bleeding, the physician should be able to correlate this risk with the hemorrhagic risk. Dental procedures are a trigger for psychic stress. One of the most important changes in acute stress is in cardiovascular system. In healthy patients, these changes are reversible and have no significant consequences, but in patients with cardiovascular diseases, the response to the catecholamine stress can cause organic lesions resulting in an acute myocardial infarction or stroke. This review explores in a concise manner the biochemical changes concerning anticoagulation and thrombolytic treatment in dental procedures.