Complications and treatment errors in periodontal therapy in medically compromised patients.

Patients who are medically compromised may be at an increased risk of complications and treatment errors following periodontal therapy. A review of the evidence on the topic is presented, in relation to the type of complication reported, of periodontal treatment, and of patients' medical status. Further, a framework for risk assessment and appropriate treatment modifications is introduced, with the aim of facilitating the management of patients with existing comorbidities and reducing the incidence of treatment complications.

World Workshop on Oral Medicine VII: Non-opioid pain management of head and neck chemo/radiation-induced mucositis: A systematic review.

OBJECTIVE: To evaluate the current evidence regarding the effectiveness of non-opioid interventions for the therapeutic management of pain in head and neck cancer patients with oral mucositis resulting from radiotherapy only or chemoradiotherapy. MATERIALS AND METHODS: A literature search was conducted which included randomised controlled trials that assessed patient-related outcome of pain in patients with oral mucositis associated with radiation therapy only or chemoradiotherapy. Literature searches were conducted in MEDLINE via Pubmed, Embase, Scopus and CINAHL. RESULTS: The electronic searches identified 846 articles. Screening revealed that six articles met all eligibility inclusion criteria. Interventions showing statistically significant benefits to reduce oral mucositis associated pain compared to placebo included doxepin (p < 0.001, 95% CI -6.7 to -2.1), amitriptyline (p = 0.04), diclofenac (p < 0.01) and benzydamine (p = 0.014). CONCLUSIONS: Non-opioid interventions, including topical doxepin, amitriptyline, diclofenac and benzydamine, were found to provide relief of pain due to mucositis, and when effective may allow for reduction in the use of opioids in pain management.

World workshop on oral medicine VII: Direct anticoagulant agents management for invasive oral procedures: A systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to evaluate the current literature regarding the importance of discontinuing or not discontinuing direct oral anticoagulants (DOACs) before invasive oral procedures, and to establish the frequency and type of postoperative bleeding events in patients. MATERIAL AND METHODS: We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up until November 5, 2018. Selection of the studies, extraction of data, qualitative, and bias assessment was performed independently by two authors. RESULTS: Twenty-one studies were included. No randomized controlled studies were identified. Six studies reported a direct comparison between patients taking DOACs and those who discontinued DOACs. The meta-analysis of these studies resulted in an OR of 0.92 (95% CI = 0.37-2.27, I2  = 9%) for postoperative bleeding events for patients taking DOACs. We found that 59/497 (11.8%) postoperative bleeding events occurred in patients who continued DOACs, while 27/200 (13.5%) events were reported for patients who discontinued treatment. All postoperative bleeding events were controlled with local measures. CONCLUSION: Results from the included studies did not discern any important differences in postoperative bleeding events in patients who continued versus patients who discontinued DOACs. Furthermore, no thromboembolic events were recorded. However, the low quality of the studies must be considered.

Recent Advances in Bioimage Analysis Methods for Detecting Skeletal Deformities in Biomedical and Aquaculture Fish Species.

Detecting skeletal or bone-related deformities in model and aquaculture fish is vital for numerous biomedical studies. In biomedical research, model fish with bone-related disorders are potential indicators of various chemically induced toxins in their environment or poor dietary conditions. In aquaculture, skeletal deformities are affecting fish health, and economic losses are incurred by fish farmers. This survey paper focuses on showcasing the cutting-edge image analysis tools and techniques based on artificial intelligence that are currently applied in the analysis of bone-related deformities in aquaculture and model fish. These methods and tools play a significant role in improving research by automating various aspects of the analysis. This paper also sheds light on some of the hurdles faced when dealing with high-content bioimages and explores potential solutions to overcome these challenges.

The impact of hospitalization on oral health: a systematic review.

BACKGROUND: Poor oral health of hospitalized patients is associated with an increased risk of hospital-acquired infections and reduced life quality. OBJECTIVES: To systematically review the evidence on oral health changes during hospitalization. DATA SOURCES: Cochrane library, Medline, OldMedline, Embase and CINAHL without language restrictions. STUDY ELIGIBILITY CRITERIA: Observational longitudinal studies. DATA APPRAISAL AND SYNTHESIS METHODS: Two independent reviewers screened studies for inclusion, assessed the risk of bias and extracted data. Risk of bias was assessed using the Newcastle-Ottawa assessment scale. A narrative synthesis was conducted. RESULTS: Five before and after studies were included. The data suggest a deterioration in oral health following hospitalization with an increase in dental plaque accumulation and gingival inflammation and a deterioration in mucosal health. LIMITATIONS: While before and after studies are at a general risk of bias, other specific study characteristics were judged to have a low risk of bias. However, methodological issues such as unvalidated outcome measures and the lack of assessor training limit the strength of the evidence. CONCLUSION: Hospitalization is associated with a deterioration in oral health, particularly in intubated patients.

Jaw involvement in Gaucher disease: a not-so-uncommon feature of a rare disease.

Gaucher disease is an inborn error of metabolism resulting from the deficiency of the enzyme glucocerebrosidase and consequent accumulation of glucocerebroside within the lysosomes of macrophages. The clinical presentation is very diverse, depending on the age of onset and the severity of the disease, and results from the progressive infiltration of lipid-laden cells in various organs. Common manifestations of Gaucher disease include enlarged liver and/or spleen (hepatosplenomegaly), bone marrow disease (pancytopenia) and bone abnormalities, which are extremely variable and can affect multiple skeletal sites. While bone involvement of long bones and vertebrae is a well-recognised feature of Gaucher disease, jawbone involvement is less commonly noted. Here, we describe a case of a 63-year-old patient with type 1 Gaucher disease with a history of long-term use of bisphosphonates and who had presented with dental pain, with subsequent investigations confirming the radiological features of jaw involvement in Gaucher disease, including periodontal disease.

Multiple myeloma and pulmonary aspergillosis: dental treatment prior to chemotherapy and management of post extraction complications.

This case study discusses the dental management of a patient with a history of multiple myeloma and pulmonary aspergillosis, whom was referred to a hospital-based dental service for urgent dental review. The patient had received a dental assessment in primary care prior to commencement of chemotherapy and had four teeth extracted without complications. However, following the commencement of chemotherapy, he presented with a significant infection associated with two of his wisdom teeth resulting in extraction. Despite atraumatic extraction, the upper right wisdom tooth socket developed an oroantral fistula. A multidisciplinary team approach was required to enable effective patient management in this complex patient regarding myeloma, aspergillosis and the medications used including bisphosphonates and chemotherapy. It highlights the higher risk of oral complications that can arise in myelosuppressed patients and emphasises the need to identify potential sources of dental infection prior to the commencement of chemotherapy.

Dental management of a patient with head and neck cancer: a case report.

Head and neck cancer is the eighth most common cancer in the UK. Management may include surgery, chemotherapy, radiotherapy or a combination of these. A multidisciplinary approach is required, with the dental team forming an integral part of the patient pathway. Prior to commencement of cancer therapy, patients should have a dental assessment and urgent treatment should be provided as necessary. This article presents the case of a 49-year-old male with previous T4N0M0 squamous cell carcinoma of the pharynx. Surgery, chemotherapy and radiotherapy had been provided four years prior to presentation. The patient had significant post-operative complications of cancer therapy which were significantly affecting his quality of life. The patient underwent dental treatment, including preventive care, periodontal therapy and restorative care, with the multidisciplinary dental team. This case illustrates that oral assessment and urgent dental treatment should start prior to cancer treatment. Post-operative regular dental follow-ups should be instigated for monitoring and maintenance.

Cold agglutinin disease and its implications for dental treatment.

Cold agglutinin disease (CAD) is a rare variant of autoimmune hemolytic anemia, characterized by the destruction of red blood cells by autoantibodies following exposure to cold temperatures. This case is of a 75-year-old male who presented to a dedicated hematology dental clinic. The dental management over a 3-year period is described, whereby the patient had extraction and periodontal disease management with considerations for medical, social and dental risk assessments and treatment modifications. The principles are applicable to patients with other hematological disorders.

Dentistry for those requiring special care.

Individuals with special needs, namely those whose dental care is complicated by a physical, mental or social disability, often have a higher level of unmet dental need and poorer oral hygiene than the general population, and offer unique challenges to the dental practitioner. This paper outlines the dental management of the three most common groups of individuals with special needs.