Direct Oral Anticoagulants and Bleeding Management Following Tooth Extractions-A Prospective Cohort Study.

The aim of the present study was to assess the occurrence of intra-, peri-, and post-operative bleeding following tooth extractions in patients treated with direct oral anticoagulants (DOACs). Consecutive patients requiring at least one dental extraction were enrolled. The DOAC regimen was either maintained or suspended. Patients were classified in subgroups depending on the number of teeth extracted per procedure (≤3 or >3), the need for flap elevation, and the performance of osteotomy. Bleeding was recorded intra-operatively; peri-operatively at 20, 40, 60, and 80 min after the procedure; and daily in the first seven days following tooth extractions. Forty-nine patients treated with DOACs (17 with rivaroxaban, 16 with apixaban, 8 with edoxaban, and 8 with dabigatran) were enrolled. Of them, 33 refrained from DOAC administration pre-operatively. The performances of >3 teeth extractions, flap elevation, and osteotomy were significantly associated with higher bleeding rates (p < 0.05). In patients treated with rivaroxaban and apixaban, bleeding episodes were more frequent. Although DOAC treatment may increase the rates of intra-operative, peri-operative, and post-operative bleeding, the recorded episodes were mild and manageable. DOAC suspension may reduce peri-operative bleeding, while no effect could be observed for post-operative bleeding.

Clinical and histological efficacy of a new implant surface in achieving early and stable osseointegration: An in vivo study.

An advantage of treated implant surfaces is their increased degree of hydrophilicity and wettability compared with untreated, machined, smooth surfaces that are hydrophobic. The present preclinical in vivo study aimed to compare the two implant surface types, namely SLActive (Straumann, Basel, Switzerland) and nanohydroxyapatite (Hiossen, Englewood Cliffs, NJ, USA), in achieving early osseointegration. The authors hypothesised that the nanohydroxyapatite surface is comparable to SLActive for early bone-implant contact. Six male mixed foxhounds underwent mandibular premolar and first molar extraction, and the sockets healed for 42 days. The mandibles were randomised to receive implants with either SLActive (control group) or nanohydroxyapatite surfaces (test group). A total of 36 implants were placed in 6 animals, and they were sacrificed at 2 weeks (2 animals), 4 weeks (2 animals) and 6 weeks (2 animals) after implant surgery. When radiographic analysis was performed, the difference in bone level between the two groups was statistically significant at 4 weeks (P = 0.024) and 6 weeks (P = 0.008), indicating that the crestal bone level was better maintained for the test group versus the control group. The bone-implant contact was also higher for the test group at 2 (P = 0.012) and 4 weeks (P = 0.011), indicating early osseointegration. In conclusion, this study underscored the potential of implants with nanohydroxyapatite surfaces to achieve early osseointegration.

Antimicrobial and Hemostatic Diatom Biosilica Composite Sponge.

The 3D nanopatterned silica shells of diatoms have gained attention as drug delivery vehicles because of their high porosity, extensive surface area, and compatibility with living organisms. Tooth extraction may result in various complications, including impaired blood clotting, desiccation of the root canal, and infection. Therapeutic sponges that possess multiple properties, such as the ability to stop bleeding and kill bacteria, provide numerous advantages for the healing of the area where a tooth has been removed. This study involved the fabrication of a composite material with antibacterial and hemostatic properties for dental extraction sponges. We achieved this by utilizing the porous nature and hemostatic capabilities of diatom biosilica. The antibiotic used was doxycycline. The gelatin-based diatom biosilica composite with antibiotics had the ability to prevent bleeding and release the antibiotic over a longer time compared to gelatin sponge. These properties indicate its potential as a highly promising medical device for facilitating rapid healing following tooth extraction.

Evaluation of the effect of dental anxiety on vital signs in the order of third molar extraction.

BACKGROUND: Dental anxiety is a prevalent concern affecting patients undergoing various dental procedures, particularly surgical interventions. Understanding the impact of patients' anxiety levels on their physiological responses during dental surgeries, such as third molar impaction surgery, is crucial for optimizing patient care and outcomes. Therefore, this study aimed to investigate the effect of patients' anxiety levels on vital signs during third molar teeth impaction surgery. METHODS: A cross-sectional study was conducted, including 45 randomly selected, healthy patients. Demographic information was recorded after obtaining consent from the patients prior to surgical intervention. Preoperative anxiety levels were determined using the Modified Dental Anxiety Scale (MDAS). Pupil measurements were taken from the patients before surgery, at 10 min after the surgery began, and at 10 min after the surgery ended. Systolic (SBP) and diastolic (DBP) blood pressure, pulse rate, temperature, and haemoglobin oxygen saturation (SpO2) values were recorded. RESULTS: The MDAS test results were statistically significantly higher in women compared to men (p < 0.001). Positive correlations were observed between MDAS score and both preoperative pulse rate (r = 0.344, p = 0.021) and SpO2 level during the operation (r = 0.462, p = 0.001). However, no significant correlations were found between MDAS and DBP (p = 0.575), SBP (p = 0.176), fever (p = 0.238), or pupil diameter (p = 0.338). CONCLUSIONS: Third molar impaction surgery induces anxiety in adult patients 20 years and older. Vital sign monitoring provides information about the patient's emotional state, both before and during the procedure. Since anxiety causes changes in vital signs during dental procedures, it is important to follow these findings to have an idea about the general condition of the patients.

Extraction of primary maxillary incisors and children's speech production: A case series.

Dental caries (tooth decay) is a disease with a significant global burden. Management may necessitate the extraction of teeth to restore oral health. The association between dental extractions and children's speech is unclear, with clinical implications for speech-language pathologists and dentists. This case series describes a prospective study reporting the impact of primary maxillary incisor teeth extraction on speech sound accuracy for three children (C1 aged 5;6 (years; months), C2 aged 4;6, C3 aged 3;10). Their speech was assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP) and the Intelligibility in Context Scale (ICS) before (T1) and 1 month after dental treatment (T2). Speech analysis included the percentage of consonants correct (PCC) and error-type analyses. Caregiver and child perception of the child's oral health-related quality of life (OHRQoL) were assessed pre- and post-operatively using a modified Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). At T1, all three children scored >1 standard deviation below the mean on normative data in the DEAP. There was no clinically significant change in PCC for any child (C1 T1: 89.6%, T2: 90.6%, C2 T1: 78.0%, T2: 75.9%, C3 T1: 56.1%, T2: 63.1%). OHRQoL measures were improved for C1 by the carergiver report and remained stable for C2 and C3 and all child reports. Speech sound difficulties were present before dental treatment in all participants and extraction of primary maxillary incisors did not significantly impact speech production. Dental extractions appear to be independent from speech production in this case series of preschool children.

Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults: A report from the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania.

BACKGROUND: A panel convened by the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania conducted systematic reviews and meta-analyses and formulated evidence-based recommendations for the pharmacologic management of acute dental pain after simple and surgical tooth extraction(s) and for the temporary management (ie, definitive dental treatment not immediately available) of toothache associated with pulp and periapical diseases in adolescents, adults, and older adults. TYPES OF STUDIES REVIEWED: The panel conducted 4 systematic reviews to determine the effect of opioid and nonopioid analgesics, local anesthetics, corticosteroids, and topical anesthetics on acute dental pain. The panel used the Grading of Recommendations, Assessment, Development and Evaluation approach to assess the certainty of the evidence and the Grading of Recommendations, Assessment, Development and Evaluation Evidence-to-Decision Framework to formulate recommendations. RESULTS: The panel formulated recommendations and good practice statements using the best available evidence. There is a beneficial net balance favoring the use of nonopioid medications compared with opioid medications. In particular, nonsteroidal anti-inflammatory drugs alone or in combination with acetaminophen likely provide superior pain relief with a more favorable safety profile than opioids. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Nonopioid medications are first-line therapy for managing acute dental pain after tooth extraction(s) and the temporary management of toothache. The use of opioids should be reserved for clinical situations when the first-line therapy is insufficient to reduce pain or there is contraindication of nonsteroidal anti-inflammatory drugs. Clinicians should avoid the routine use of just-in-case prescribing of opioids and should exert extreme caution when prescribing opioids to adolescents and young adults.

Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in children: A report from the American Dental Association Science and Research Institute, the University of Pittsburgh School of Dental Medicine, and the Center for Integrative Global Oral Health at the University of Pennsylvania.

BACKGROUND: A guideline panel convened by the American Dental Association Council on Scientific Affairs, American Dental Association Science and Research Institute, University of Pittsburgh School of Dental Medicine, and Center for Integrative Global Oral Health at the University of Pennsylvania conducted a systematic review and meta-analyses and formulated evidence-based recommendations for the pharmacologic management of acute dental pain after 1 or more simple and surgical tooth extractions and the temporary management of toothache (that is, when definitive dental treatment not immediately available) associated with pulp and furcation or periapical diseases in children (< 12 years). TYPES OF STUDIES REVIEWED: The authors conducted a systematic review to determine the effect of analgesics and corticosteroids in managing acute dental pain. They used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of the evidence and the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework to formulate recommendations. RESULTS: The panel formulated 7 recommendations and 5 good practice statements across conditions. There is a small beneficial net balance favoring the use of nonsteroidal anti-inflammatory drugs alone or in combination with acetaminophen compared with not providing analgesic therapy. There is no available evidence regarding the effect of corticosteroids on acute pain after surgical tooth extractions in children. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Nonopioid medications, specifically nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen alone or in combination with acetaminophen, are recommended for managing acute dental pain after 1 or more tooth extractions (that is, simple and surgical) and the temporary management of toothache in children (conditional recommendation, very low certainty). According to the US Food and Drug Administration, the use of codeine and tramadol in children for managing acute pain is contraindicated.

Ethical Dilemmas for Dental Students in Greece.

Professional dental ethics for students are based on promoting oral health for dental patients and reinforcing an anthropocentric approach to communication and dental services. A total of 133 dental students (males 33.8% N1 = 46, females 66.2% N2 = 87) completed the study questionnaire. Descriptive statistics were applied, and non-parametric Kruskal-Wallis tests were used (p < 0.05). Students refuse services to patients that misbehave (37.6%), have irrational demands (18%), and when clinical cases exceed their capabilities (36.8%). Of the participants, 50.4% want to waive confidentiality when abuse is declared. Ethical role models are educators (33.8%), other qualified dentists (25.6%), and their parents (21.8%). Female gender positively affects integrity (p = 0.046), altruism (p = 0.032), and difficulty in conversations among colleagues (p = 0.036). Students outside the capital are less interested in esthetic issues (p = 0.007), in giving more than one treatment plan (p = 0.006), and in being confronted with inadequate treatments from other colleagues (p = 0.005). Family income positively affects clinical skills (p = 0.003), trust issues (p = 0.008), and moral insight and intuition (p = 0.02). Presentation with clinical scenarios is the preferred educational method (49.6%). Dental students show compassion for poor patients, respect patients' autonomy, and guide patients to choose the best treatment plan before receiving dental ethics seminars. There is a positive relationship between the ethical footprints of students and gender, origin, family income, postgraduate studies, and future professional plans. Factors and ways to incorporate ethics in the dental curriculum could be considered when planning relevant courses.

Effect of tyrosine kinase inhibitor sunitinib on tissue repair at tooth extraction sites.

BACKGROUND: Both zoledronic acid, a potent bisphosphonate, and the antiangiogenic drug sunitinib are included in anticancer protocols and have also been associated with jaw osteonecrosis. Our aim was to compare the effect of these drugs on tissue repair at tooth extraction sites. METHODS: Wistar rats were allocated into four groups: (1) sunitinib; (2) sunitinib/zoledronic acid; (3) zoledronic acid; (4) control group. The animals underwent tooth extractions and maxillae were macro- and microscopically analyzed. RESULTS: On macroscopic evaluation, the zoledronic acid group showed a significantly higher frequency of oral mucosal lesion; lesions in the sunitinib/zoledronic acid group were larger, albeit not significantly so. The sunitinib/zoledronic acid group had significantly less epithelium than the zoledronic acid and control group, but showed no significant difference compared to the sunitinib group. The sunitinib/zoledronic acid and zoledronic acid groups did not differ from each other, but had significantly less connective tissue and more non-vital bone and microbial colonies than sunitinib and control groups, whereas these latter two groups did not significantly differ from each other. Vital bone and inflammatory infiltrate did not significantly differ between groups. CONCLUSION: Sunitinib alone is not associated with non-vital bone, whereas the sunitinib/zoledronic acid combination and zoledronic acid alone are.

Incidence and risk factors for medication-related osteonecrosis after tooth extraction in cancer patients-A systematic review.

OBJECTIVES: Antiresorptive medication has been reported to be associated with medication-related osteonecrosis of the jaw (MRONJ). This systematic review aims at investigating the incidence of and risk factors for MRONJ after tooth extractions in cancer patients treated with high-dose bisphosphonate and denosumab (BP and DS). MATERIAL AND METHODS: The protocol followed the PRISMA statement list and was registered in PROSPERO. Searches were performed for literature published up to April 2021 in the electronic databases PubMed, Embase, Web of Science, and CINAHL and then supplemented by manual research. RESULTS: The search process resulted in 771 identified articles, of which seven studies fitted the population, intervention, comparison, and outcome framework. All were observational studies and four had control groups. A total of 550 patients treated with BP and DS were identified of whom 271 had received tooth extractions after medication onset. Due to significant heterogenicity in the collected data, only a qualitative analysis was performed. The MRONJ incidence after tooth extractions varied between 11% and 50% at the patient level. MRONJ occurred up to 3 years after the tooth extraction. Teeth affected by inflammation before the extraction and additional osteotomy during the surgical procedure were identified as risk factors. CONCLUSIONS: Reliable methods of diagnosing MRONJ and adequate follow-up periods are important factors in obtaining the actual incidence of MRONJ after tooth extractions in patients treated with high-dose BP and DS.

[Bisphosphonate-related osteonecrosis of the jaws]. / Bisfosfonatnye osteonekrozy chelyustei.

The number of patients with metabolic osteopathies and oncological diseases occurring with the formation of bone metastases is constantly growing and requires special attention not only of oncologists, but also maxillofacial surgeons, dental surgeons and periodontists, due to severe complications from the oral cavity, against the background of antiresorptive therapy with bisphosphonates. These drugs are associated with the development of necrotic processes of the jaw bones and surrounding tissues. It is worth noting the fact that the development of complications after taking these drugs leads to a significant increase in the suffering of patients. The importance of an integrated approach to the treatment and prevention of such complications is extremely important, as it reduces the risk of possible complications and improves the quality of life of this group of patients.

Should we stop dual anti-platelet therapy for dental extractions? An umbrella review for this dental dilemma.

OBJECTIVES: Dual Anti-platelet Therapy (DAPT) are prescribed to patients who had or are at risk of cerebrovascular or cardiovascular ischemic events. This umbrella review appraises existing systematic reviews on the risk of bleeding related complications during and after dental extractions for patients on DAPT. STUDY DATA AND SOURCES: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered to the PROSPERO (International prospective register of systematic reviews) database. A systematic electronic literature search was conducted according to the PRISMA guidelines, via PubMed, Ovid, Cochrane and Embase. STUDY SELECTION: Four systematic reviews met the inclusion criteria and were included the analysis. They show DAPT increases the risk of bleeding related complications after dental extractions, but the differences may not be clinically significant as local haemostatic measures were adequate in controlling bleeding. CONCLUSION: Despite the increased risk of bleeding after dental extractions in patients on DAPT, it may not be necessary to interrupt the anti-platelet therapy. Local haemostatic agents may be sufficient in controlling both the primary or secondary bleeding. On the other hand, the complications of discontinuing DAPT may be more severe and fatal.

Immediate implant placement combining socket seal abutment and peri-implant socket filling: A prospective case series.

OBJECTIVES: The aim of this prospective case series was to assess the implant outcomes as well as hard and soft tissue dimensional changes of immediate implant placement in posterior sites using a custom-made sealing socket abutment (SSA) combined to peri-implant socket filling (PISF). MATERIAL AND METHODS: Twenty patients were considered for single extraction and immediate implant in upper or lower posterior regions. The remaining peri-implant sockets were filled with Deproteinized Bovine Bone Mineral. Based on intra-oral scans (IOS), custom-made SSAs were placed the same day. Implant survival rate, peri-implant bone changes, peri-implant health and pink esthetic score (PES) were recorded up to 1 year post-implant placement. Moreover, CBCT and IOS were performed to monitor hard and soft tissue dimensional changes. RESULTS: One implant failed to osseointegrate leading to an implant survival rate of 95% after 1 year. Peri-implant bone changes yielded 0.19 ± 0.31 mm and 84.2% of the implants displayed no or mild bleeding on probing. Horizontal bone remodeling was not significant from baseline to 1 year at any levels. Finally, soft tissue profile was stable in the most cervical area while minor changes occurred during the first 6 months below the gingival margin. The absence of mid-buccal recession (0.07 mm) and good PES were found after 1 year. CONCLUSION: Despite its limitations, this study showed that immediate implants in the posterior region using the SSA + PISF protocol resulted in promising implant outcomes with limited hard and soft tissue dimensional changes while decreasing the overall treatment time.

Deep Learning-Based Prediction of Paresthesia after Third Molar Extraction: A Preliminary Study.

The purpose of this study was to determine whether convolutional neural networks (CNNs) can predict paresthesia of the inferior alveolar nerve using panoramic radiographic images before extraction of the mandibular third molar. The dataset consisted of a total of 300 preoperative panoramic radiographic images of patients who had planned mandibular third molar extraction. A total of 100 images taken of patients who had paresthesia after tooth extraction were classified as Group 1, and 200 images taken of patients without paresthesia were classified as Group 2. The dataset was randomly divided into a training and validation set (n = 150 [50%]), and a test set (n = 150 [50%]). CNNs of SSD300 and ResNet-18 were used for deep learning. The average accuracy, sensitivity, specificity, and area under the curve were 0.827, 0.84, 0.82, and 0.917, respectively. This study revealed that CNNs can assist in the prediction of paresthesia of the inferior alveolar nerve after third molar extraction using panoramic radiographic images.

Effect of different platelet-rich fibrin matrices for ridge preservation in multiple tooth extractions: A split-mouth randomized controlled clinical trial.

AIM: To evaluate dimensional changes in the alveolar ridge and bone structure after tooth extraction when L-PRF or A-PRF+ was used in comparison to unassisted socket healing. MATERIALS AND METHODS: Twenty patients in need of at least three tooth extractions in the aesthetic zone were included. L-PRF, A-PRF+ or control was randomly assigned, leaving one empty socket/edentulous site between conditions. CBCT scans were obtained immediately after tooth extraction and after 3 months of healing. Horizontal and vertical dimensional changes of the ridge and socket fill were calculated. Histological and micro-CT analysis of bone biopsies were used to evaluate post-surgical bone structural healing. RESULTS: Mean horizontal and vertical changes at 1-mm below the crest (buccal and palatal side) were similar for the three sites (p > 0.05). For the socket fill, L-PRF (85.2%) and A-PRF+ (83.8%) showed superior values than the control (67.9%). The histological and radiological analysis reported more newly formed bone for the PRF groups, without any significant differences between both. CONCLUSIONS: PRF matrices failed to reduce the dimensional changes after multiple tooth extractions in the premaxilla. After 3-month healing, both PRF matrices showed radiographically a significant superiority for the socket fill. Histologically, they seemed to accelerate new bone formation.

Patients with head and neck cancer treated with radiotherapy: Their experiences after 6 months of prophylactic tooth extractions and temporary removable dentures.

OBJECTIVES: The impact of dental occlusion on the experiences of head and neck cancer patients and their oral, social and psychological functioning has been sparsely investigated. There is a lack of knowledge regarding the experience of tooth loss and dentures among patients treated for head and neck cancer. The aim of this study was to describe the experiences of head and neck cancer patients of prophylactic tooth extractions and temporary removable dentures, 6 months after radiotherapy treatment. MATERIAL AND METHODS: An individual interview with 25 patients 6 months after radiotherapy was subjected to a qualitative content analysis. RESULTS: Two categories, Impaired oral function and Belief in the future, and seven subcategories described the patients' experiences of temporary removable dentures during the first 6 months after prophylactic tooth extractions. The temporary removable dentures affected the patients' ability to chew, swallow and speak, caused pain, and were experienced as an enemy. Despite that, the patients were hopeful and had a wish for recovery, which gave them the energy to live. CONCLUSION: Prophylactic tooth extractions and temporary removable dentures 6 months after radiotherapy treatment affect head and neck cancer patients' recovery and everyday life. However, they have the will to take on these challenges, pertaining not only to themselves, but also to relatives and health professionals. At the individual level, the patient needs individualized professional support to get through the arduous procedure, from the acute situation until the end of the rehabilitation phase.

Development of osteomyelitis following dental abscesses-influence of therapy and comorbidities.

OBJECTIVES: Bacterial osteomyelitis of the jaw is a severe disease potentially requiring extensive surgical treatment. We have evaluated the incidence rates of bacterial osteomyelitis following dental abscessation associated with primary or secondary tooth extraction. MATERIALS AND METHODS: A retrospective cohort study was designed and included patients with dental abscesses and surgical treatment including the extraction of focus teeth. Patients were either treated with primary removal during acute infection or secondary delayed extraction within an infection-free interval. The primary outcome variable was the occurrence of bacterial osteomyelitis following the abscess. Secondary outcomes were the influence of general disease, antibiotic therapy, and surgical technique. RESULTS: One hundred nine patients were enrolled in the study; 4 patients (3.7%) developed osteomyelitis. Primary tooth extraction was performed on all these patients (p = 0.017). Significant associations of diabetes (p = 0.001), the use of clindamycin (p = 0.025), and transcutaneous incision (p = 0.017) with the incidence of osteomyelitis were detected. CONCLUSIONS: More severe infections may be associated with a higher risk for the development of osteomyelitis following dental abscesses. A history of diabetes and clindamycin therapy might form further predisposing risk factors. Because of the low incidence and the small case number, our data need to be interpreted carefully. CLINICAL RELEVANCE: Osteomyelitis of the jaw is a rare but severe disease that may require extensive therapy and that impairs the quality of life of affected patients. The evaluation of risk factors to enable further reduction of incidence is therefore urgently required.

Non-impacted tooth extractions and antibiotic treatment: A RCT study.

OBJECTIVES: A controlled, single-blind, randomized clinical trial was performed to evaluate usefulness of antibiotics in preventing pain and complications after tooth extractions and benefits of probiotics in reducing gastro-intestinal symptoms associated with antibiotic therapy. MATERIALS AND METHODS: A total of 159 patients were enrolled in this trial. After tooth extractions, patients were allocated to one of the groups: group 1 received postoperatively amoxicillin + clavulanic acid; group 2 received the same antibiotic therapy with an adjunctive probiotic treatment; and group 3 received neither antibiotics nor probiotics. Follow-up visits were planned at 7, 14, and 21 days after tooth extractions (T1, T2, and T3), and parameters assessed were pain, presence of abscess, edema, fever, alveolitis, trismus, pain, difficulty in daily routine activities, and gastro-intestinal symptoms. RESULTS: The number of patients reporting pain at T1 was significantly higher in the control group when compared to group 2 (p = .016), while no difference for pain intensity was observed between groups. No surgical site infection was observed in any of the groups. Intestinal symptoms seemed to be tackled by probiotic administration. CONCLUSIONS: Pain was the most important symptom in the control group. Antibiotics were not necessary after non-impacted tooth extractions, and probiotics can reduce gastro-intestinal symptoms associated with antibiotics.

Antibiotic's effectiveness after erupted tooth extractions: A retrospective study.

OBJECTIVE: The purpose of this retrospective study was to assess the influence of antibiotics on the development of alveolitis after tooth extractions. MATERIALS AND METHODS: The study population consisted of patients who had erupted tooth extractions in 3 centers. The patients' medical records were collected for several parameters. Moreover, use of antibiotics was evaluated. The primary outcome was the development of alveolitis during the postoperative period. The secondary outcome measure was the possible associations between alveolitis and other patients' characteristics. RESULTS: A total of 1579 patient charts were screened. The patients enrolled in the study were 418 (159 males and 259 females). Alveolitis was reported for 12 extraction sites (2.87%). Six were in the group of patients that received antibiotics (2.14% out of 280 patients treated with antibiotics), and six were in the group of patients that did not receive antibiotics (4.35% out of 138 patients not receiving antibiotics). None of patient-level parameters showed any significant association with the development of alveolitis. CONCLUSION: In conclusion, this study showed that the use of antibiotics after erupted tooth extractions is not useful in preventing alveolitis. Larger, prospective, and randomized studies are needed before incorporating these findings into the daily clinical practice.

Tendencia de actividades odontológicas realizadas en atención primaria del Servicio de Salud Valparaíso - San Antonio, chile: 2008 a 2018 / The evolution of dental services carried out in primary health care centers of the valparaíso - san antonio health service in chile: 2008-2018

INTRODUCCIÓN: La actual Política de Salud Bucal chilena indica que la atención odontológica está orientada a la promoción y prevención, reforzando la atención odontológica en Atención Primaria de Salud (APS). Se desconoce cómo esta política se ha materializado en el tiempo, pues, a la fecha, no existen estudios que analicen la tendencia de este tipo de actividades. El objetivo de este estudio fue analizar la tendencia de las actividades odontológicas, realizadas en adultos y adultos mayores, en APS del Servicio de Salud Valparaíso - San Antonio (SSVSA). MATERIAL Y MÉTODOS: Se realizó un estudio ecológico de tipo mixto entre los años 2008-2018, en 8 de las 9 comunas del SSVSA. Se analizó la tendencia del porcentaje de actividades promocionales-preventivas (APP) y de exodoncias utilizando las bases de datos "Resúmenes Estadísticos Mensuales-A09" (REM-A09). RESULTADOS: El 24,53% y 11,36% de las actividades realizadas correspondieron a APP y a exodoncias, respectivamente. El grupo de 20-64 años presentó un mayor porcentaje de APP y un menor porcentaje de exodoncias que el grupo de 65 y más años, en cada una de las comunas. Hubo una tendencia al aumento del porcentaje de APP y a la disminución del porcentaje de exodoncia en la mayoría de las comunas estudiadas. DISCUSIÓN: La tendencia de las actividades odontológicas realizadas en APS ha evolucionado a lo largo de los años, con diferencias entre comunas del SSVSA. Para poder determinar cuáles son los motivos que explican los resultados encontrados, se sugiere realizar otros estudios enfocados a la gestión odontológica local de APS. (AU)

BACKGROUND: The current Chilean Oral Health Policy indicates that dental care is aimed at promotion and prevention, thus reinforcing the presence of dental programs in Primary Health Care (PHC) Centers. It is unknown how this policy has materialized over time, since no studies to date have analyzed the trend of dental services carried out in PHC. The objective of this study was to analyze the evolution of dental services carried out in adults in PHC of the Valpa-raíso - San Antonio Health Service (VSAHS). MATERIALS AND METHODS: A mixed ecological study was carried out between 2008 and 2018, in 8 of the 9 municipalities of the VSAHS. The per-centage trends of promotional-preventive services (PPS) and extractions were analyzed, using the databases "Resúmenes Estadísticos Mensuales-A09" (REM-A09). RESULTS: The percentage of dental services dedicated to PPS and extractions were 24.53% and 11.36%, respectively. The group of adults between 20 and 64 years of age presented a higher percentage of PPS and a lower percentage of extractions than the 65 and over group in each municipality. There was also a trend of the percentage of PPS services increasing over time, while the percentage of extractions decreased in most of the municipalities studied. DISCUSSION: The type of den-tal services carried out in PHC has evolved over time, and differences were found between municipalities of the VSAHS. To explain these results, future studies should focus on the local management of dental services in PHC. (AU)