A study to assess management of patients on warfarin by general dental practitioners (GDPs) in the West Midlands.

UNLABELLED: Current management protocols for anticoagulated patients undergoing dental procedures are influenced by evidence-based guidelines. These guidelines state that the risk of significant bleeding is low in patients who have a stable INR within a therapeutic range, (2-4). The risks of interruption of anticoagulant therapy is greater than the risk of bleeding. This paper discusses the current practice of general dental practitioners (GDPs) in the West Midlands when treating patients taking warfarin and compares these findings with standard guidelines. A questionnaire was sent to 638 GDPs in West Midlands in 2010, 492 (77%) were returned. This study was carried out three years after a similar study carried out in South West Wales and after the guidance updated by the BNF and NMWIC. Thirty-three (7%) of the respondents did not treat patients on warfarin. The majority of respondents (86%) considered that a dental extraction in a patient on warfarin is a procedure associated with a high risk of bleeding. Surgical implant placement (75%), subgingival debridement (49%) and inferior dental block (40%) administration were also considered by GDPs to be associated with a high risk of bleeding.The majority (88%) of the respondents check the INR of anticoagulated patients before carrying out treatment. Of these, 244 (52%) would do so within 24 hours and 78 (17%) of them within 72 hours. Only 117 (25%) considered 4.0 as the safe upper limit for the INR for performing high-risk procedures. CLINICAL RELEVANCE: The findings of this study demonstrate that there is general awareness about how to manage patients on warfarin but uncertainties still exist among general dental practitioners. Further education and training would improve the care of patients on warfarin in a primary care setting.

Wildlife in climate refugia: Mammalian diversity, occupancy, and tiger distribution in the Western Himalayas, Nepal.

Anthropogenic land-use change continues to be predicated as a major driver of terrestrial biodiversity loss for the rest of this century. It has been determined that the effect of climate change on wildlife population will accelerate the rate and process of decline of global vertebrate populations. We investigated wildlife composition, occupancy, and activity pattern along the larger climate resilient forests that serve as microrefugia for a wide range of species under the escalating climate change. We used camera trap survey covering 250 km2 of climate microrefugia in Dadeldhura hills in far western region of Nepal. We used 62 trapping locations accumulating 1800 trap nights taking 98,916 photographs in 62 days-survey period during the summer season of 2020. We photographed 23 mammalian species with estimated species richness of 30 species (95% CI: 25-34) based on multi-species occupancy model. We estimated overall species occupancy ψ(SE(ψ)) to be 0.87 (0.09) in climatic microrefugia. While human activity predominated throughout the day, the majority of animals was found to exhibit nocturnal temporal patterns. Tiger and hyaena, two of the top predators, were newly discovered in the western Himalayan range of Nepal, with their discovery at the 34 highest elevations of 2511 meters and 2000m, respectively. In Nepal, high-altitude tiger range is characterized by tiger distribution above a 2000 m cutoff representing habitats in the physiographic zone of high mountains and above. Our findings establish a baseline and show that the climatic microrefugia that have been identified have high levels of species richness and occupancy, which characterize the Dadeldhura hill forest ranges as biologically varied and ecologically significant habitat. These areas identified as climatic microrefugia habitats should be the focus of conservation efforts, particularly efforts to reduce human disturbance and adapt to climate change.

Management of a patient suffering with Cherubism with dental implants.

Cherubism is a rare non-neoplastic, fibro-osseous hereditary disorder characterized by bilateral expansion of the maxilla and mandible producing a characteristic facial appearance. It can affect the facial and dental growth of the individual and often results in gross aesthetic and functional deficiencies. The teeth may also be displaced or submerged and these problems can often compromise successful restorative rehabilitation. This paper describes the restorative management of an adult patient with Cherubism involving a fixed implant retained mandibular restoration. The care utilized 3D planning software and implant insertion guides to facilitate an early loading protocol and the use of optimum bone quality/volume areas.

A prosthetic management technique for osteopetrosis affecting the maxilla.

Bony anatomical anomalies can complicate the construction and successful wearing of removable prostheses. Osteopetrosis is a group of diseases that affect the growth and continuous remodelling of bone which in turn can result in gross irregular alveolar bone morphology. This paper describes the management of a patient with this problem and emphasises the challenges in constructing a successful complete maxillary removable prosthesis. The utilisation of a flexible base plate material as an alternative to traditional materials will be highlighted. Irregular bony morphology is a recognised potential obstacle to the successful construction of removable prostheses. In most cases the problem can be overcome but in extreme and less common circumstances, management of these features can be more problematic. This paper describes a technique used to manage extreme alveolar irregularity which may perhaps be applied to those problems more commonly encountered in every day clinical practice but are less extreme then those described in this paper.

A retrospective study to assess patient satisfaction with implant-stabilized prostheses.

UNLABELLED: This study measured the levels of patient satisfaction in those who received treatment with implant-retained overdentures, and compared their status before and after therapy. Satisfaction questionnaires were mailed to patients who had previously worn a removable prosthesis. Questions addressed eating, aesthetics and comfort before and after the treatment. Eighty-six (79.8%) subjects had problems regarding looseness of their denture prior to treatment. Patients were generally satisfied with their implant-retained overdentures in terms of function, comfort, appearance and speech. The results suggest that unstable, problematic complete dentures can be managed by providing patients with implant-retained overdentures. CLINICAL RELEVANCE: From the patients' perspective, implant-supported overdentures offer overall satisfaction and improvement.