Oral and dental management of people with myelodysplastic syndromes and acute myeloid leukemia: A systematic search and evidence-based clinical guidance.

AIMS: To systematically search all studies that discussed dental procedures in patients diagnosed with myelodysplastic syndromes (MDS) and/or acute myeloid leukemia (AML) and to provide an evidence-based clinical guidance on oral and dental management of people with MDS and/or AML. METHODS: The systematic search followed the Preferred Reporting Item for Systematic Review and Meta-analyses Protocols (PRISMA-P) guideline. Two databases systems were used (MEDLINE and EMBASE). PROSPERO was searched for ongoing or recently completed systematic reviews. The International Clinical Trials Registry Platform Search was searched for ongoing or recently completed trials. Level of evidence was evaluated based on the Oxford Level of Evidence. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to summarize the evidence. RESULTS: Only 18 articles were selected and included in data synthesis and analysis. The level of evidence and recommendation ranged from 1 to 5 and A to D, respectively. CONCLUSIONS: All the included studies in the data synthesis (n = 18) showed no specific guidelines were followed; however, all reflected the importance of liaison with the patient's hematoncologist at all stages of MDS and/or AML therapy. RECOMMENDATIONS: Oral and dental assessment is crucial prior to MDS therapy to help reduce anticipated complications. Dental treatment prior to hematopoietic stem cell transplantation and/or active stage of MDS therapy is tricky and always required liaison with the hematoncologist. MDS can progress to AML; hence, dental care providers are in a good position to spot any changes and refer early to the hematoncologist for further assessment.

U.K. hemophilia treaters' knowledge of risk assessment for prolonged bleeding associated with dental procedures.

INTRODUCTION: Optimal delivery of dental care for adults with congenital bleeding disorders (CBD) requires close collaboration between hemophilia treaters and dentists. AIM: To explore U.K. hemophilia treaters' knowledge of dental procedures and associated hemostatic management in adults with CBD. METHOD: Staff (N = 180) from N = 60 hemophilia facilities in the United Kingdom were invited to participate in a questionnaire-based study using a web-based tool. The questionnaire assessed participants' knowledge, adherence and appropriateness of application of U.K. guidance on hemostatic management of common dental procedures. RESULTS: The response rate was 23% of treaters (n = 41) from 62% (n = 32) hemophilia facilities. Individual participants (87%; n = 34) reported they adhered to guidelines, though knowledge of guidance was poor with only 36% (n = 15) applying guidance appropriately in 3 common dental scenarios. There was a tendency for participants to assign the use of systemic hemostatic measures independent of the agreed bleeding risk associated with the proposed dental procedure. CONCLUSION AND RECOMMENDATIONS: While hemophilia treaters were aware of current guidelines, their knowledge of the guidelines and ability to risk assess dental procedures was poor. There was a tendency to overprescribe systemic hemostatic measures for dental procedures. Education initiatives to aid decision making are needed.

Advanced conscious sedation training--the pilot course, training and impact on a hospital service.

UNLABELLED: Advanced conscious sedation techniques for dental procedures include continuous propofol infusion and combinations of midazolam and fentanyl. A course based on the Independent Expert Group on Training & Standards for Sedation in Dentistry (IEGTSSD) training syllabus was set up in 2012 to provide training in these techniques. Training involved: self-directed study modules; attendance at didactic teaching day; presentation by candidates of knowledge; medical emergency simulated training; written examination; supervised cases; and submission of case logbook. A dedicated clinic was set up by dentists to provide training for supervised cases. RESULTS: nine dentists are now trained in advanced sedation techniques and over 250 patients have been successfully treated using continuous propofol infusion. CONCLUSION: the advanced sedation training course based on the EGTSSD curriculum was a successful way to train dentists experienced in standard sedation techniques to be confident and knowledgeable to deliver advanced sedation in a dental setting. Patients mostly preferred propofol to midazolam, however, as amnesia is not guaranteed; propofol may be more appropriate for mild to moderately anxious patients.

Special Care Dentistry: Part 2. dental management of patients with drug-related acquired bleeding disorders.

UNLABELLED: The first of this series of three articles discussed the dental management of patients with inherited bleeding disorders. This paper will discuss and outline the dental management of patients with acquired bleeding disorders that can result from drug therapy. These may be associated with vascular defects, platelet defects or coagulation defects. In an age when people are living longer, and medical interventions are continually becoming more advanced, clinicians will need to be aware of systemic disorders and treatments that may cause complications in the dental setting. According to National Statistics, the UK population is projected to increase by 0.7% by 2016. This trend is shared with other European countries which also have ageing populations. The proportion of people aged over 65 is predicted to increase from 16% in 2006 to 22% in 2031. CLINICAL RELEVANCE: Being able to recognize which drugs may cause bleeding problems at an early stage will lead to good patient management, particularly in planning and delivering treatment following invasive procedures such as dental extractions. Whilst most patients can be successfully treated in general dental practice, the clinician may need to make a decision on whether or not to refer a patient to specialist services for all dental treatment, or to share care between primary care and specialist services for selected procedures.

Special care dentistry: part 3. Dental management of patients with medical conditions causing acquired bleeding disorders.

UNLABELLED: The second paper in this three part series discussed the dental management of patients with drug-related acquired bleeding disorders. This paper will discuss and outline the dental management of patients with acquired bleeding disorders that can result from medical conditions. Again, these may be associated with vascular defects, platelet defects or coagulation defects. In an age when people are living longer, and medical interventions are continually becoming more advanced, clinicians will need to be aware of systemic disorders and treatments that may cause complications in the dental setting. CLINICAL RELEVANCE: Being able to recognize which medical conditions, including their management, may cause bleeding problems at an early stage will lead to good patient management, particularly in planning and delivering treatment involving any invasive dental procedures that can cause bleeding. Whilst most patients can be successfully treated in general dental practice, the clinician may need to make a decision on whether or not to refer a patient to specialist services for all dental treatment, or to share care between primary care and specialist services.