Postextraction bleeding in a patient taking antithrombotics: report of a case.

Antithrombotic medications, including antiplatelets and anticoagulants, are used by millions of patients to prevent stroke or heart attack. When these patients present for dental surgery, a decision must be made whether to continue the antithrombotic medication and risk a bleeding problem or to interrupt the medication and risk an embolic complication such as a stroke or heart attack. In patients taking antithrombotic medications, a small risk of postoperative bleeding after dental extractions must be weighed against a small risk of stroke or heart attack when these medications are interrupted. This case report discusses an episode of minor postextraction bleeding in a patient taking combination anticoagulant and antiplatelet therapy. Antithrombotic therapy generally should not be interrupted for dental procedures, as the prognosis of potential postextraction bleeding that could result from antithrombotic continuation is almost always better than the prognosis of a potential stroke or heart attack that could follow antithrombotic interruption.

Self-efficacy as a predictor of self-reported physical, cognitive, and social functioning in multiple sclerosis.

OBJECTIVE: The objective of this study was to investigate whether self-efficacy is associated with physical, cognitive, and social functioning in individuals with multiple sclerosis (MS) when controlling for disease-related characteristics and depressive symptomatology. METHOD: Study subjects were 81 individuals between the ages of 29 and 67 with a diagnosis of clinically definite MS. Hierarchical regression analysis was used to examine the relationships between self-efficacy and self-reported physical, cognitive, and social functioning. RESULTS: Self-efficacy is a significant predictor of self-reported physical, cognitive, and social functioning in MS after controlling for variance due to disease-related factors and depressive symptomatology. CONCLUSIONS: Self-efficacy plays a significant role in individual adjustment to MS across multiple areas of functional outcome beyond that which is accounted for by disease-related variables and symptoms of depression.

Size doesn't matter: needle gauge and injection pain.

Many dentists prefer using smaller gauge (27- or 30-gauge) needles for anesthesia injection, believing that needles with a smaller diameter result in less injection pain than wider diameter needles. For this study, three dentists in a general practice administered 930 injections to 810 adult patients using 25- and 27-gauge needles for mandibular inferior alveolar block injections and 25-, 27-, and 30-gauge needles for maxillary buccal infiltration or palatal injections. Patients, who were blinded as to the needle gauge, were asked afterward to rate the injection pain on an 11-point scale (0-10). There was no statistically significant difference in perceived injection pain based on needle gauge when analyzed for injection location (mandibular, maxillary posterior, maxillary anterior, and palatal), injection side, patient gender, treating dentist, or overall. These results indicate that when it comes to injection pain and needle gauge, size does not matter.

Injection pain of prilocaine plain, mepivacaine plain, articaine with epinephrine, and lidocaine with epinephrine.

In a double-blind study design, 1,391 consecutive patients in a general dental practice received one of four different local anesthetics (articaine with epinephrine, lidocaine with epinephrine, mepivacaine plain, or prilocaine plain) via a maxillary buccal infiltration, palatal infiltration, or inferior alveolar block injection. The anesthetics were administered under clinical conditions by one of two dentists. Immediately after receiving the injection, patients rated the pain from each injection on a ten-point scale. The pain response was analyzed according to the dentist administering the injection, the location of injection, the patient's gender, and the type of anesthetic administered. Injection of prilocaine plain produced significantly lower pain scores than lidocaine with epinephrine, mepivacaine plain, or articaine with epinephrine.

Prevalence of cusp fractures in teeth restored with amalgam and with resin-based composite.

BACKGROUND: Complete cusp fracture in restored teeth is a common problem observed in general dental practice. Many dentists believe that teeth restored with amalgam are more likely to be associated with cusp fractures than are those restored with resin-based composite. METHODS. The authors noted the condition of 10,869 posterior teeth with amalgam or resin-based composite restorations with at least one cusp present, unrestored or missing in 1,902 consecutively seen adult patients in a private general dental practice. For each patient, the authors recorded age, type of restorations, number of surfaces of each restoration, and presence or absence of a complete cusp fracture and of caries. RESULTS: There was a lower percentage of cusp fractures in younger subjects than in older subjects and in teeth with a single restored surface than in those with more than one restored surface. There was no significant difference in the prevalence of cusp fracture rates in amalgam-restored teeth versus composite-restored teeth in subjects aged 18 through 54 years. In subjects aged 55 through 96 years, there was a marginally significantly greater cusp fracture rate in composite-restored teeth than in those restored with amalgam. Overall, there was no significant difference in the prevalence of cusp fracture in teeth restored with amalgam (1.88 percent) versus composite-restored teeth (2.29 percent). CONCLUSIONS: The prevalence of cusp fractures in amalgam-restored teeth and resin-based composite-restored teeth is not significantly different. Teeth with more than one surface restored with either resin-based composite or amalgam and teeth in older subjects were more likely to suffer a cusp fracture. CLINICAL IMPLICATIONS: Teeth restored with amalgam and with resin-based composite exhibited equally low cusp fracture prevalence. When choosing between amalgam and resin-based composite in consideration of the likelihood of a future cusp fracture, either restorative material is acceptable.

Taking charge of epilepsy: the development of a structured psychoeducational group intervention for adolescents with epilepsy and their parents.

Children and adolescents with epilepsy frequently experience poor psychosocial outcomes due to numerous factors such as perceived stigma, behavior problems, academic difficulties, and depression. Health psychology research has documented the effectiveness of psychoeducational interventions aimed at improving psychosocial outcomes for individuals with a variety of health conditions. With increasing numbers of adolescents living with epilepsy, interest in improving the quality of life for this particular population has grown. There remains, however, a paucity of research concerning psychosocial interventions for adolescents with epilepsy. The present study outlines the development and initial implementation of a 6-week structured psychoeducational group intervention for adolescents with epilepsy and their parents. Preintervention, the QOLIE-AD-48, Childhood Depression Inventory, and Revised Children's Manifest Anxiety Scale were administered. Educational topics included medical aspects of epilepsy, healthy lifestyle behaviors, family and peer relationships, understanding self-image and self-esteem, and stress management techniques. Participants were introduced to a variety of cognitive-behavioral strategies, and were encouraged to share their own experiences with epilepsy. Feedback from adolescent and parent participants indicated that the intervention was relevant to their needs, helped them better understand their epilepsy, and allowed an opportunity for positive peer support. Also, postintervention outcome measurement indicated an overall positive trend for quality of life improvement in the adolescents.

Injection pain of bupivacaine with epinephrine vs. prilocaine plain.

BACKGROUND: Prilocaine plain has been described in the literature as causing less pain on injection than bupivacaine with epinephrine, possibly because of the higher pH of the prilocaine anesthetic solution. METHODS: In a double-blind study design, 681 consecutive patients in a general dental practice received maxillary buccal infiltration, posterior palatal infiltration or inferior alveolar block injections, administered under clinical conditions by one of two dentists. Immediately after injection, patients rated the pain from each injection on a six-point scale. The pain response was analyzed according to treating dentist, location of injection, patient's sex and anesthetic administered. RESULTS: The reported pain on injection of bupivacaine with epinephrine was significantly greater than that of prilocaine plain. Patients reported no significant difference in pain at different injection locations, except that palatal injections caused significantly more reported pain than did anterior maxillary infiltration, posterior maxillary infiltration or inferior alveolar block injections. CONCLUSIONS: Under clinical conditions, the injection of bupivacaine with epinephrine causes significantly more perceived pain than does the injection of prilocaine plain. Clinical Implications. Bupivacaine with epinephrine and prilocaine plain have certain advantages and disadvantages that should be considered before choosing an anesthetic for a dental procedure. A disadvantage of bupivacaine with epinephrine is that it produces more perceived pain than does prilocaine plain.