Hemostasis control in dental extractions in patients receiving oral anticoagulant therapy: an approach with calcium sulfate.

The aim of this study was to evaluate the use of calcium sulfate (CaS) as a hemostatic agent after tooth extraction in patients with anticoagulant drug therapy. A total of 30 patients undergoing anticoagulant therapy (22 women and 8 men) with a mean age of 54.6 years (SD = 9.2 years), needing dental extractions, were selected for this study. They were divided into 2 groups, control (group 1) and test (group 2), in a randomized way. In group 1 patients, the postextraction socket was managed with obliterative suture only. Group 2 patients were treated with CaS placed into the postextraction sockets. All the patients did not interrupt the anticoagulant therapy during the dental treatment. The healing pattern was found to be approximately similar in all treatment groups, showing significant improvement at each consecutive visit. However, a statistically significant difference in the adequate hemostasis was evident between groups 1 and 2 (P = 0.0056). The use of CaS helped to control the bleeding from inside the socket, producing instantly a very good hemostasis. Further studies are necessary to confirm the simplicity, possibilities, and limits of the proposed procedure.

Use of local anesthesia during dental rehabilitation with general anesthesia: a survey of dentist anesthesiologists.

The purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: "stabilization of vital signs/decreased depth of general anesthesia" (92.9%, 26/28) and "improved patient recovery" (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia.

Blue-violet light-emitting diode irradiation in combination with hemostatic gelatin sponge (Spongel) application ameliorates immediate socket bleeding in patients taking warfarin.

OBJECTIVE: The control of bleeding after tooth extraction is a major concern in patients taking warfarin. Light-emitting diode (LED) irradiation with hemostatic gelatin sponge application was investigated. STUDY DESIGN: Patients who took warfarin and required tooth extraction were divided randomly into 3 groups. The first group was irradiated with blue-violet LED after tooth extraction. The second group was treated with a hemostatic gelatin sponge and LED irradiation. The third group was treated with only hemostatic gelatin sponges. Hemostasis was evaluated at 30 seconds after treatment. RESULTS: Less than 30% of the patients achieved hemostasis within 30 seconds in the hemostatic sponge group; approximately 50% of the patients in the simple LED irradiation group achieved hemostasis within 30 seconds; and 86.7% of the patients in the LED and hemostatic sponge combined group achieved hemostasis within 30 seconds, indicating that combined treatment with LED and hemostatic sponges provided a significantly higher hemostasis than in the hemostatic sponge group (P < .01). CONCLUSIONS: Blue-violet LED irradiation combined with hemostatic gelatin sponge treatment yielded hemostasis of the extraction socket within 30 seconds without suture in most cases.

Inherited platelet disorders and oral health.

Platelets play a key role in thrombosis and hemostasis. Accumulation of platelets at the site of vascular injury is the first step in the formation of hemostatic plugs, which play a pivotal role in preventing blood loss after injury. Platelet adhesion at sites of injury results in spreading, secretion, recruitment of additional platelets, and formation of platelet aggregates. Inherited platelet disorders are rare causes of bleeding syndromes, ranging from mild bruising to severe hemorrhage. The defects can reflect deficiency or dysfunction of platelet surface glycoproteins, granule contents, cytoskeletal proteins, platelet pro-coagulant function, and signaling pathways. For instance, Bernard-Soulier syndrome and Glanzmann thrombasthenia are attributed to deficiencies of glycoprotein Ib/IX/V and GPIIb/IIIa, respectively, and are rare but severe platelet disorders. Inherited defects that impair platelet secretion and/or signal transduction are among the most common forms of mild platelet disorders and include gray platelet syndrome, Hermansky-Pudlak syndrome, and Chediak-Higashi syndrome. When necessary, desmopressin, antifibrinolytic agents, and transfusion of platelets remain the most common treatment of inherited platelet disorders. Alternative therapies such as recombinant activated factor VII are also available for a limited number of situations. In this review, we will discuss the management of patients with inherited platelet disorders in various clinical situations related to dental cares, including surgical intervention.

Effect of hypnosis on induction of local anaesthesia, pain perception, control of haemorrhage and anxiety during extraction of third molars: a case-control study.

INTRODUCTION: Systemic conditions are considered limiting factors for surgical procedures under local anaesthesia in the oral cavity. All the pharmacological methods to control pain in patients have some disadvantages, such as side effects and extra costs for rehabilitation. Therefore, in such cases alternative treatment modalities are considered, such as hypnosis in dentistry. The aim of the present study was to evaluate the effect of hypnosis on haemorrhage, pain and anxiety during the extraction of third molars. MATERIALS AND METHODS: In this case-control study, 24 female and male volunteers were included. The subjects had been referred to the Department of Oral and Maxillofacial Surgery, Kerman University of Medical Sciences, for extraction of third molars. Demographic data for all the subjects were recorded. Patients with chronic medical conditions were excluded. The patients were used as their own controls, with the third molars on one side being removed under hypnosis and on the opposite side under local anaesthetic. Hypnosis was induced by one of the two methods, either fixing the gaze on one point or Chiasson's technique; both these methods are appropriate for patients in the dental chair. The Spielberger State-Trait Anxiety Inventory was used to determine patient anxiety levels before hypnosis and anaesthesia. Pain was scored using VAS (visual analogue scale). After surgery the patient was asked to bite on a sterile gauze pad over the surgical site for 30 min when haemorrhage from the area was evaluated. If there was no haemorrhage the patient was discharged. If haemorrhage persisted, the gauze pad was left in place for another 30 min and the area was re-evaluated. Any active oozing from the area after 30 min was considered haemorrhage. Haemorrhage, anxiety and pain were compared between the two groups. Data was analyzed using the t-test, McNemar's test and Wilcoxon's signed rank test using SPSS 18 statistical software. RESULTS: Twenty-four patients were evaluated; there were 14 males (58.3%) and 10 females (41.7%). The mean age of the subjects was 24.1 ± 2.7 years (age range = 18-30 years). A total of 48 third molars were extracted. In each patient, one-third molar was extracted under hypnosis and the other under local anaesthesia. All the patients were in the ASA 1 category (normal) with no significant medical history. Of the subjects who underwent hypnosis, only two subjects (8.3%) reported pain after induction of hypnosis. In the local anaesthetic group, 8 subjects (33.3%) reported pain. There was a significant difference between the two groups. The results of the study showed that patients in the hypnosis group had less pain during the first few hours post-operatively. Anxiety scores in the two groups were very close to each other and no statistically significant differences were observed in general and when each person was compared with himself or herself. Pain intensity in the two groups at 5- and 12-h post-operatively exhibited significant differences. In the hypnosis group, 10 patients (41.7%) took analgesic medication; in the local anaesthesia group, 22 patients (91.7%) took the analgesic medication (P = 0.0001). In other words, patients reported less pain when they were under hypnosis. CONCLUSION: The results of the study showed that hypnosis can effectively reduce anxiety, haemorrhage and pain. More studies are necessary to collect data on the effect of hypnosis on oral and maxillofacial surgeries.

Blue-violet light emitting diode (LED) irradiation immediately controls socket bleeding following tooth extraction: clinical and electron microscopic observations.

OBJECTIVE: Bleeding control is a major concern during dental surgery. A novel photocoagulation method using an irradiating blue-violet light emitting diode (LED) was investigated. BACKGROUND: Some dental light-curving units can emit blue-violet wavelengths around 380-515 nm with two peaks (410 nm and 470 nm). These wavelengths can cover the maximum absorption spectra of hemoglobin (430 nm). MATERIALS AND METHODS: Blue-violet LED 380-515 nm, 750 mW/cm(2), 10 sec (7.5 J/cm(2)) was used. Irradiation was performed for 10 sec or an additional 10 sec for 10 cases of tooth extraction at a distance of 1 cm from the socket. Bleeding was stopped by conventional roll pressure in another five cases as a control. Bleeding time for both procedures was measured. A Mann-Whitney U test was used for statistical analysis. In vitro transmission electron microscope (TEM) studies were performed to clarify the mechanism of hemostasis by blue-violet LED irradiation. RESULTS: Irradiation with the blue-violet LED yielded immediate hemostasis of the socket. Five cases showed coagulation within the first 10 sec, and another five cases required an additional 10 sec to fully control the bleeding. In contrast, the conventional method required 2-5 min (median 180 sec) to obtain hemostasis. The difference between the time required to stop the bleeding in the two methods was found to be statistically significant (p = 0.0014). A week later, the LED-irradiated sockets were healed uneventfully with epithelial covering. TEM showed the formation of a thin amorphous layer and an adjacent agglutination of platelets and other cellular elements under the layer at the interface of the irradiated blood. CONCLUSION: Blue-violet LED irradiation of bleeding sockets caused immediate clot formation and hemostasis. This procedure was safe and reliable and showed no adverse effects.

Application of calcium sulfate in surgical-orthodontic treatment of impacted teeth: a new procedure to control hemostasis.

PURPOSE: Calcium sulfate (CaS) is a simple, biocompatible material with a very long, safe clinical history in several different fields of medicine. CaS is a rapidly resorbing material that leaves behind a calcium phosphate lattice, which promotes bone regeneration and hemostasis. The aim of this study was to perform a clinical evaluation of a possible hemostatic effect of calcium sulfate hemihydrate (CaSO(4)), commonly known as plaster of Paris, in the surgical and orthodontic treatment of impacted teeth. MATERIALS AND METHODS: Forty-three patients with 66 impacted cuspids and premolars were enrolled in this study. The gap between teeth and bone was filled with several layers of CaS cement. Each layer was put in place and was compressed with a dry gauze. The outer layer was then hardened with a potassium sulfate solution. After hardening, the CaS excess was removed, and a bracket was applied to the surface of the tooth. RESULTS: In no case was a separation of the bracket by the surface of the tooth observed. CONCLUSIONS: These results seem to confirm the usefulness of the hemostatic effect of CaS in this procedure.

Use of Ankaferd Blood Stopper as a hemostatic agent: a clinical experience.

AIM: To determine the efficacy of the topical application of Ankaferd Blood Stopper (ABS) on hemorrhagic diathesis following dental procedures under different conditions. BACKGROUND: Some patients have a tendency to bleed excessively after dental surgery for a variety of reasons, making oral surgical procedures more risky for these patients. Since hemorrhage can cause major morbidity and mortality, the identification of a novel, effective hemostatic agent could improve the management of excessive bleeding that occurs during dental procedures. CASE DESCRIPTIONS: Four patients (3 females, 1 male) aged 28-45 with bleeding tendencies due to different presurgical conditions such as von Willebrand Disease, chronic liver failure, and mitral valve replacement presented for tooth extraction. Hematological consultations were obtained prior to surgical intervention and their international normalized (INR) ratio values were adjusted to less than 1.5; none received clotting factor replacement. All the extractions were performed under local anesthesia with and without epinephrine. In the presence of postsurgical bleeding, the efficacy of the ampule form of topical ABS was observed. Sex, age, anamnesis, von Willebrand Factor, activated partial thromboplastin time, factor VIII, and platelet counts of patients were recorded prior to the extractions. CONCLUSIONS: ABS was found to be effective within 10 to 20 minutes in controlling bleeding in most of the patients after dental surgery. These observations suggest the use of ABS may be a beneficial hemostatic agent for use in patients with hemorrhagic diathesis following tooth extraction. Additional research is needed to clarify the role of this unique medicinal product in the surgical treatment of dental patients with bleeding tendency. CLINICAL SIGNIFICANCE: ABS has demonstrated potential for being an effective hemostatic agent for the treatment of excessive bleeding following dental surgery in four patients with hemorrhagic diathesis.

[The silicone palatal plaque: an effective bandage after harvesting autogenous hard palate mucosa]. / La plaque palatine en silicone, un pansement efficace après prélèvement d'une greffe muco-palatine.

INTRODUCTION: Autogenous hard palate mucosa is recognized in eyelid surgery for reconstruction of the posterior lamella. Complications such as pain or donor site hemorrhage are due to surgical technique and can reduce the indications for this graft. METHOD: We describe the autogenous hard palate mucosa graft technique and the production of a silicone plaque for the palate. RESULTS: For the three patients studied, the autogenous hard palate mucosal graft was effective in reconstructing the lower eyelid posterior lamella with good functional and aesthetic results. The silicone palatal plaque controlled palatal hemorrhage and pain and accelerated palatal mucosa healing. CONCLUSION: The silicone palatal plaque is an advantageous adjuvant for autogenous hard palate mucosa.

Current concepts of the management of dental extractions for patients taking warfarin.

BACKGROUND: Controversy has surrounded the correct management of patients therapeutically anticoagulated with warfarin who require dental extractions. The risk of bleeding must be weighed up against the risk of thromboembolism when deciding whether to interfere with a patient's warfarin regimen. An improved understanding of the importance of fibrinolytic mechanisms in the oral cavity has resulted in the development of various local measures to enable these patients to be treated on an outpatient basis. METHODS: A review of the literature was undertaken. This was supplemented by the authors' clinical trials and extensive clinical experience with anticoagulated patients. RESULTS: Various protocols for treating patients taking warfarin have been reviewed and summarized and an overview of the haemostatic and fibrinolytic systems is presented. A protocol for management of warfarinized patients requiring dental extractions in the outpatient setting is proposed. CONCLUSIONS: Patients therapeutically anticoagulated with warfarin can be treated on an ambulatory basis, without interruption of their warfarin regimen provided appropriate local measures are used.

Dental management considerations for the patient with an acquired coagulopathy. Part 2: Coagulopathies from drugs.

Dental patients often give a medical history that suggests the possibility of a coagulopathy from drugs, with a corresponding risk for prolonged bleeding during and following an invasive procedure. Identification of patients who may be prone to oral bleeding requires specific medical history information and the proper use of laboratory tests. Some NSAIDs are reported to cause prolonged oral bleeding, but scientific evidence is lacking. Likewise, the risk of oral bleeding from anticoagulants such as warfarin is often over stated, and unnecessary adjustment of NSAID or warfarin dosage puts patients at risk for significant morbidity and mortality. Some commonly employed laboratory tests such as the prothrombin time provide helpful information when used in the appropriate setting, but others, such as the bleeding time test, provide little or no predictive value in the determination of patients at risk for oral bleeding. Dental management of patients with potential coagulopathies from medications requires an understanding of basic principles of coagulation. The vast majority of these patients can be managed in the community setting without risk and without alteration of anticoagulant drug regimes.

[Dental extraction in patients with bleeding disorders. Proposal of a protocol based on the type of anesthesia used]. / Extractions dentaires chez les patients porteurs d'un trouble de l'hémostase. Proposition d'un protocole basé sur le type d'anesthésie nécessaire.

INTRODUCTION: The authors propose a protocol to avoid bleeding complications in patients with bleeding disorders. MATERIAL AND METHOD: When a general anesthesia or trunk nerve infiltration is indicated, clotting factor concentrates are to be used in patients with severe bleeding disorders. Desmopressin is to be used in patients with mild bleeding disorders but who are good responders and in patients with thrombopathy. An antifibrinolytic treatment and a fibrin glue are also used. Ninety-six patients underwent 107 extractions with this protocol. RESULTS: Only two patients had bleeding complications requiring an additional treatment. DISCUSSION: In case of bleeding disorders, the treatment depends on disease severity and type of anesthesia. A general treatment (clotting factor concentrates or desmopressin) is indicated with general anesthesia and with local anesthesia in severe bleeding disorders, but not absolutely necessary with local anesthesia in mild bleeding disorders. However, desmopressin can used in all good responders.

Comparison of 2 hemostatic agents for the prevention of postextraction hemorrhage in patients on anticoagulants.

OBJECTIVE: The objective of this study was to compare the use of a resorbable oxycellulose dressing with a fibrin adhesive for the prevention of postextraction hemorrhage in patients taking anticoagulants. STUDY DESIGN: A control group of 26 patients with a preoperative international normalized ratio (INR) in the range of 2.0 to 4.2 had extractions performed with the use of local anesthesia and the socket(s) dressed with a resorbable oxycellulose dressing and sutured with a resorbable suture. The study group with a comparable INR range of 2.1 to 4.1 was treated in a similar manner, except the sockets were dressed with a fibrin adhesive. RESULTS: No discernible difference in the postoperative outcome with regard to hemorrhage was noted. Postoperative pain was reported more frequently in the group that used a resorbable oxycellulose dressing. Only 1 patient had significant postoperative bleeding. CONCLUSIONS: This study shows that in patients receiving warfarin whose INR is within the therapeutic range, the fibrin adhesive is as effective as the resorbable oxycellulose dressing in preventing postextraction hemorrhage.

Tratamiento preventivo de las hemorragias con remedios homeopaticos en Odontologia / Preventive treatment of hemorrhages with homeopathic medicaments in Odontology

Se describen el Phosphorus, la Lachesisy el preoperatorio Millefolium, como los remedios homeopaticos mas indicados en el odontologico y quirurgico de pacientespropensos a presentar hemorragias, aun cuando las pruebas de coagulacion sanguinea esten dentro de limites normales. Tambien se recalca sobre la notable importancia de la medicina homeopatica en prevencion de las enfermedades en general. (AU)

A randomised trial of calcium alginate swabs to control blood loss in 3-5-year-old children.

OBJECTIVE: To compare the effectiveness of calcium alginate swabs and traditional cotton swabs in the control of blood loss after extraction of deciduous teeth from healthy children, aged 3-5 years, under general anaesthetic. DESIGN: Prospective, randomised clinical trial. SETTING: General anaesthetic suite in a dental teaching hospital. SUBJECTS: 101 patients were recruited to the study, comprising 50 randomised to be treated with cotton swabs and 51 with alginate swabs. INTERVENTIONS: Teeth were extracted under general anaesthesia and blood collected for measurement in order to compare blood loss using the two systems. MAIN OUTCOME MEASURES: The number of teeth extracted ranged from 1-14. The total blood loss ranged from 0.53-78.13 ml with a median of 12.9 ml. CONCLUSION: Calcium alginate swabs were not found to produce any clinical or statistical advantage over traditional cotton swabs in this surgical setting.

The effect of an antiseptic mouthrinse on implant maintenance: plaque and peri-implant gingival tissues.

The purpose of this controlled double-blind, parallel, randomized clinical study was to determine the effect of antiseptic mouthrinse on parameters important to dental implant maintenance. Plaque, peri-implant gingivitis, gingival bleeding, probing depth, and attachment level were assessed over a 3-month test period. Twenty healthy adult patients each of whom had at least two dental implants, a modified gingival index > 1.5, and a modified Quigley-Hein plaque index score > 1.7 were enrolled into the study. After a thorough oral prophylaxis, patients were randomly assigned to either the antiseptic mouthrinse or a 5% hydroalcohol placebo mouthrinse group and instructed to rinse twice daily for 30 seconds with 20 ml of their assigned mouthrinse as an adjunct to their usual oral hygiene procedures. The baseline examination included plaque index, gingival index, bleeding index, probing depth measurement, and attachment level measurements. The plaque and gingival indices were rescored at 1, 2, and 3 months. Probing depths, attachment levels, and bleeding index were determined again at 3 months only. At the end of 3 months, the antiseptic mouthrinse group had statistically significant reductions in plaque index, gingival index, and bleeding index compared to the placebo group. There were no significant differences between groups in probing depth or attachment level. The results of this clinical study indicate that twice daily use of an antiseptic mouthrinse may provide benefits in the maintenance of dental implants.

[Hemostasis in patients at high hemorrhagic risk]. / Emostasi in pazienti ad alto rischio emorragico.

Surgical treatment in patients with heavy coagulation disorders needs measures that minimize immediate and post-surgical hemorrhagic risk. Besides the subjects afflicted with constitutional coagulation pathologies such as haemophilia A, B, C, AB, Von Willebrand disease, platelet disorders and others, too many are the patients that need pharmacological therapy to impede the creation of intra-vascular coagula. Today, surgical treatment of these patients is possible with the use of human fibrin glue (Tissucol) that permits excellent surgical and post-surgical hemostasis without therapy suspension, independently of coagulation disorder. The purpose of this study is a clinical evaluation of a surgical procedure based on the use of human fibrin glue in association or not with suture, hemostatic sponge and lyophilized dura mater in patients with coagulation disorders. In a group of 309 patients in oral anticoagulant therapy have been done a total of 822 operations such as root fragments extraction with mucoperiosteal flap elevation, teeth or roots simple extractions, third molar extractions, cyst removal, apicoectomies. Only patients with PA over 20% have been treated. All the operations have been leaded with minimal trauma; after the extractions, alveolar margins have been regularized to improve flaps adaptation. Hemostatic sponge or dura mater have been used like basis for the flaps and the fibrin glue, that was injected in the residual cavity after surgical suture. In a few cases, for example with little extraction wounds, only fibrin flue without suture or sponge has been used. In all cases and after all operations, the presence or absence of bleeding has been evaluated after 2 hours, 24 hours, 7 days after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)