Dental implant considerations in patients with systemic diseases: An updated comprehensive review.

BACKGROUND: Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise. AIM: The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population. METHODS: The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts. RESULTS: In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study. CONCLUSION: In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.

Expanding the phenotype in Pitt-Hopkins syndrome; description of new oral finding and dental management considerations.

BACKGROUND: Pitt-Hopkins syndrome (PTHS) is a rare neurodevelopmental disorder with physical, cognitive, and behavioral characteristics that is caused by heterozygous mutations in the TCF4 gene. Patients with PTHS might present a unique challenge for oral healthcare professionals because of the associated comorbidities. CASE REPORT: Here we describe a new case of PTHS in a 13-year-old girl with particular emphasis on oro-dental findings and oral healthcare management. Observed oro-dental findings in our case included shallow palate, absence of lingual frenum, gingival enlargement, thick lips and relative microdontia. The patient was unable to tolerate dental care under local anesthesia. Therefore, comprehensive dental treatment was performed under general anesthesia after a careful pre-anesthetic cardio-respiratory, neurological, and hematological evaluation. The patient was closely monitored intra-operatively for breathing rhythm, O2 saturation, and signs of respiratory distress. The patient was observed for 24 h post-op for respiratory distress and was discharged then uneventfully. CONCLUSION: Dental treatment under general anesthesia in these patients might be complicated by the abnormal breathing rhythm, and close monitoring and follow up for signs of respiratory distress after general anesthesia is necessary. Recognition of oral and dental findings might help to expand the phenotype and better characterize rare syndromes.

[Haemophilia and dental procedures; a complex combination]. / Hemofilie en tandheelkundige behandelingen; een complexe combinatie.

A 28-year-old patient with severe haemophilia A presented to the emergency department with significant and painful swelling of the left cheek, an extensive haematoma extending from the left ear to the anterior thoracic region, an intraoral haematoma over the soft palate with deviation of the uvula to the right, and complaints of shortness of breath when lying down. Three days prior, his dentist had performed a restoration of the 36 molar under local anaesthesia. Due to pain, the general practitioner had administered an intramuscular injection of a non-steroidal anti-inflammatory drug (NSAID) two days post-procedure. The patient was admitted for treatment with coagulation factors and pain management. Dental procedures and local anaesthesia in patients with a severe coagulation disorder require specific preparatory measures, such as administration of coagulation factors. Collaboration and consultation with a patient's haematologist or haemophilia treatment centre are essential requirements for safe dental care.

Evaluation of oral care protocols practice by dentists in Rio de Janeiro towards HIV/AIDS individuals.

BACKGROUND: The aim of this study was to evaluate the dentists' knowledge and practice regarding HIV positive individuals' oral care in Rio de Janeiro State. METHODS: Dentists from Rio de Janeiro State (n = 242) answered an electronic questionnaire on biosafety procedures, oral manifestations of AIDS, and knowledge of HIV infection. Collected information was stratified by gender, and data were analyzed using Chi-square and t tests. RESULTS: From the 14 oral manifestations investigated, oral candidiasis, necrotizing ulcerative gingivitis, and hairy leucoplakia were more associated with HIV, with no differences between the responses from men and women. Above 85% of the participants would be concerned about becoming infected with HIV after a needle/ sharp object injury and more than 80% of them were willing to be tested for HIV. However, significantly more women (98.8%), compared to men (91.3%), said they knew that HIV/ AIDS patients can contaminate dental care professionals, p = 0.007. There was a significant difference in the answers for the questions: "Are there special dental clinics for treatment of HIV/AIDS patients in Brazil?" (p = 0.044), and "Do the negative HIV tests surely indicate that the persons are free of viruses?" (p = 0.005). Significant differences between men and women were also observed regarding use of disposable mask (p = 0.01), and cap (p < 0.0001). CONCLUSION: Most dentists who participated in the study presented a good knowledge on the care of HIV/ AIDS individuals, including biosafety protocols and in terms of the oral manifestations commonly associated to AIDS.

Bleeding related to dental treatment in patients taking novel oral anticoagulants (NOACs): a retrospective study.

OBJECTIVE: Several novel oral anticoagulants (NOACs) are currently prescribed for patients suffering from atrial fibrillation, pulmonary thromboembolism, and venous thrombosis. However, there is no clinical guideline for dental treatment in patients taking NOACs. This study investigated bleeding events related to various dental treatments. MATERIALS AND METHODS: This retrospective study included 120 patients (153 cases) who were prescribed NOACs and received dental procedures in the Department of Advanced General Dentistry at Yonsei University Dental Hospital from January 2014 to June 2017. The indication for NOACs, initiation of NOACs, duration of discontinuance, creatinine clearance, and type of dental treatment were investigated. Bleeding events were assessed at a follow-up visit to the clinic. RESULTS: Postoperative bleeding occurred in only 9 of the 153 included cases; they comprised 2 cases of scaling, 3 cases of simple extraction, 3 cases of the first stage of implant surgery, and 1 case of resin filling. The creatinine clearance (P = .111) and duration of discontinuance (P = .222) did not differ significantly between the groups with and without bleeding events. CONCLUSIONS: Our data indicate that most dental treatments may be performed in patients taking NOACs without an increased likelihood of bleeding events regardless of the discontinuance duration. Moreover, any postoperative bleeding can be stopped by applying compressive pressure or local hemostatic agents. CLINICAL RELEVANCE: Our study suggests that patients taking NOACs who need dental treatments may have a bleeding tendency based on our retrospective data. Preoperative history taking and treatment modification should therefore be considered before performing dental surgery.

Orofacial pain and its potential oral causes in older people with mild cognitive impairment or dementia.

BACKGROUND: The number of people with dementia and natural dentition is growing. As dementia progresses, the degree of self-care decreases and the risk of oral health problems and orofacial pain increases. OBJECTIVES: To examine and compare the presence of orofacial pain and its potential causes in older people with Mild Cognitive Impairment (MCI) or dementia. METHODS: In this cross-sectional observational study, the presence of orofacial pain and its potential causes was studied in 348 participants with MCI or dementia with all levels of cognitive impairment in two outpatient memory clinics and ten nursing homes. RESULTS: Orofacial pain was reported by 25.7% of the 179 participants who were considered to present a reliable pain self-report (Mini-Mental State Examination score ≥14 points), while it could not be determined in people with more severe cognitive impairment. The oral health examination of the 348 participants indicated that potential painful conditions, such as coronal caries, root caries, tooth root remnants or ulcers were present in 50.3%. There was a significant correlation between the level of cognitive impairment and the number of teeth, r = 0.185, P = 0.003, teeth with coronal caries, r = -0.238, P < 0.001, and the number of tooth root remnants, r = -0.229, P = 0.004, after adjusting for age. CONCLUSIONS: This study indicated that orofacial pain and its potential causes were frequently present in participants with MCI or dementia. Therefore, a regular oral examination by (oral) healthcare providers in people with MCI or dementia remains imperative, even if no pain is reported.

Oral tranexamic acid associated with platelet transfusion to prevent hemorrhage in a patient with Glanzmann thrombasthenia.

Glanzmann thrombasthenia (GT) is a rare genetic disorder that alters platelet function. The clinical manifestations include purpura, epistaxis, gingival bleeding, and menorrhagia. For patients with GT, conventional surgical dental treatment may result in hemorrhagic complications. There are many reported ways to prevent hemorrhage in patients with GT during surgical procedures but no standardized recommendations. In this case study, a woman diagnosed with GT required 2 types of surgery (periodontal surgery and third molar extractions), which were performed on separate days. Preoperative evaluation and planning with a hematology service led to the transfusion of 1 pack of platelet concentrate immediately before each surgery. Additionally, the patient was prescribed oral tranexamic acid, which was started 1 day before each surgery and continued for 3 additional days. A distal wedge procedure was performed for the mandibular right third molar, and later the maxillary and mandibular left third molars were extracted. The use of oral tranexamic acid associated with a single platelet bag was effective in the present case, and no bleeding or thrombotic events were observed after either surgery. Although this coagulopathy is rare, dentists must be aware of its implications, which necessitate specific precautions for oral surgical procedures. Multidisciplinary integration and surgical planning can reduce the risk of complications for the patient.

Dentists' knowledge and behavior toward managing hypertensive patients.

OBJECTIVES: Dental office is an ideal screening place to identify undiagnosed/uncontrolled patients with hypertension. The aim of this study was to assess the knowledge and behavior of dentists toward performing proper management of hypertensive patients in Saudi Arabia. MATERIALS AND METHODS: A close-ended e-questionnaire was created and sent to dentists of all levels (n = 710) in Saudi Arabia. The questionnaire included questions that assessed attitudes and behavior toward using a sphygmomanometer in dental clinics and assessed dentists' knowledge and behavior toward proper management of patients with hypertension. RESULTS: About 62.4% of dentists had a sphygmomanometer in their clinic. Around 79.5% believe that working on patients with high blood pressure (BP) is associated with a risk of complications. However, only 13.3% of them measure the BP of all patients prior to treatment, and 63.3% would do so only if the patient noted a problem. About 54.3% of the respondents prefer using local anesthetics without epinephrine, and they would prefer to refer those patients to dental consultants for treatment. If a patient's BP was 180/100 mmHg, 78.1% of dentists would urgently refer that patient to his or her physician and would not perform a routine elective dental treatment. CONCLUSION: There is a lack of knowledge and behavior toward proper management of patients with hypertension in our dental sociality. Broadening the breath of dentists' responsibilities to include screening and working together with physicians will help improve the community dental and general health of visiting patients and should be the goal of all dentists.

Cost-effectiveness of non-surgical periodontal therapy for patients with type 2 diabetes in the UK.

AIM: Periodontal therapy has been shown to reduce glycated haemoglobin in patients with diabetes, although considerable uncertainty remains regarding the sustainability of such changes. We evaluate the cost-effectiveness of non-surgical periodontal therapy and rigorous maintenance treatment in patients with type 2 diabetes and periodontitis from a provider perspective in the UK. METHOD: Lifetime costs relating to periodontal treatment were modelled for a cohort of patients with type 2 diabetes. The projected lifetime impact of changes in glycated haemoglobin on diabetes treatment costs and quality adjusted life expectancy were estimated from a published simulation model. Costs and outcomes were combined to estimate the Incremental Cost-Effectiveness Ratio for periodontal therapy in patients with type 2 diabetes. RESULTS: The Incremental Cost-Effectiveness Ratio was £28,000 per Quality Adjusted Life-Year for a man aged 58 with glycated haemoglobin of 7%-7.9%. The results were particularly sensitive to assumptions on the impact of periodontal therapy on glycated haemoglobin, the proportion of patients who comply with maintenance therapy and the proportion of compliant patients who respond to treatment. CONCLUSION: Assuming improvements in glycated haemoglobin can be maintained, periodontal therapy may be cost-effective for patients with type 2 diabetes at acceptable cost-per-Quality Adjusted Life-Year thresholds in the UK.

Pragmatic approach to manage new oral anticoagulants in patients undergoing dental extractions: a prospective case-control study.

OBJECTIVES: The aim of this study was to validate a standardized pragmatic approach to manage new oral anticoagulants (NOACs) in patients who undergo dental extractions. MATERIALS AND METHODS: This prospective case-control study in patients undergoing dental extraction included 26 patients (mean age 76 years, 57% male) treated with dabigatran, rivaroxaban, or apixaban and 26 matched controls. Regardless of timing of extraction, drug regimen, or renal function, patients were instructed to skip only the dose on the morning of the procedure. A procedural bleeding score was recorded and early and delayed bleeding was assessed at day 1 and day 7. Bleeding events were compared with a prospectively matched control group not taking any antithrombotic drug. RESULTS: There was no difference in the procedural bleeding score or in early bleeding events (5 in both groups). However, delayed bleeding occurred more frequently in anticoagulated compared to non-anticoagulated patients (7 versus none, p = 0.01). CONCLUSIONS: Skipping the morning dose of NOACs avoids excess bleeding during and early after the procedure. However, anticoagulated patients had an increased risk of delayed bleedings. Further study is needed to determine the optimal post-procedural management. CLINICAL RELEVANCE: This is the first prospective study for the management of patients on NOACs undergoing dental extraction. Our pragmatic approach, omitting only a single morning dose, can guide clinical practice. Both patients and physicians should be aware of the increased delayed bleeding risk.

Dental implants in medically complex patients-a retrospective study.

INTRODUCTION: Dental implant insertion for oral rehabilitation is a worldwide procedure for healthy and medically compromised patients. The impact of systemic disease risks on the outcome of implant therapy is unclear, since there are few if any published randomized controlled trials (RCTs). OBJECTIVE: The objective of this study is to investigate the rate of complications and failures following dental implantation in medically compromised patients in order to elucidate risk factors and prevent them. MATERIAL AND METHODS: A retrospective cohort study was conducted from patient files treated with dental implantation between the years 2008-2014. The study group consisted of medically complex patients while the control group consisted of healthy patients. Preoperative, intraoperative, and post operative clinical details were retrieved from patients' files. The survival rate and the success rate of the dental implants were evaluated clinically and radiographically. RESULTS: A total of 204 patients (1003 dental implants) were included in the research, in the study group, 93 patients with 528 dental implants and in the control group, 111 patients with 475 dental implants. No significant differences were found between the groups regarding implant failures or complications. The failure rate of dental implants among the patients was 11.8 % in the study group and 16.2 % in the control group (P = 0.04). It was found that patients with a higher number of implants (mean 6.8) had failures compared with patients with a lower number of implants (mean 4.2) regardless of their health status (P < 0.01). CONCLUSIONS: We found a similar rate of failure and complications of dental implantation in medically complex patients and in healthy patients. CLINICAL RELEVANCE: Medically complex patients can undergo dental implantation. There are similar rates of complications and failures of dental implants in medically complex patients and in healthy patients.

Oral health and orofacial pain in older people with dementia: a systematic review with focus on dental hard tissues.

OBJECTIVE: The aim of this review was to provide a systematic overview including a quality assessment of studies about oral health and orofacial pain in older people with dementia, compared to older people without dementia. METHODS: A systematic literature search was performed in PubMed, CINAHL, and the Cochrane Library. The following search terms were used: dementia and oral health or stomatognathic disease. The quality assessment of the included articles was performed using the Newcastle-Ottawa Scale (NOS). RESULTS: The search yielded 527 articles, of which 37 were included for the quality assessment and quantitative overview. The median NOS score of the included studies was 5, and the mean was 4.9 (SD 2.2). The heterogeneity between the studies was considered too large to perform a meta-analysis. An equivalent prevalence of orofacial pain, number of teeth present, decayed missing filled teeth index, edentulousness percentage, and denture use was found for both groups. However, the presence of caries and retained roots was higher in older people with dementia than in those without. CONCLUSIONS: Older people with dementia have worse oral health, with more retained roots and coronal and root caries, when compared to older people without dementia. Little research focused on orofacial pain in older people with dementia. CLINICAL RELEVANCE: The current state of oral health in older people with dementia could be improved with oral care education of caretakers and regular professional dental care.

Arab dentists' refusal to treat HIV positive patients: a survey of recently graduated dentists from three Arab dental schools.

OBJECTIVE: To assess intended refusal of recent graduates from three Arab dental schools to treat HIV + patients and factors associated with this intention. MATERIALS AND METHODS: In 2015, convenience samples of recent dental graduates were included from Libya, Egypt and the United Arab Emirates. Participants responded to a questionnaire assessing personal background, knowledge of oral manifestations and fluids transmitting HIV, perceived adequacy of training and self-efficacy to manage blood exposures, attitude to risk of infection, moral beliefs and willingness to treat HIV + patients. Logistic regression assessed factors associated with intended refusal to treat HIV + patients. RESULTS: The overall response rate was 552/710 (77.8%), mean age = 23.7 years with 41.8% males. The mean (SD) scores for knowledge of oral manifestations and fluids transmitting HIV were 5.5 (1.3)/8 and 4.2 (1.7)/7. The mean (SD) scores for attitude to risk of infection and moral beliefs were 2.9 (1.0)/4 and 2 (0.9)/3, respectively. One-third of respondents indicated intention to refuse treating HIV + patients. Knowledge of body fluids transmitting HIV and moral beliefs were associated with lower odds of refusing to treat HIV + patients (OR = 0.86 and 0.38) whereas attitude indicating greater concern for risk of infection was associated with higher odds (OR = 1.54). CONCLUSIONS: One third of dentists from three Arab dental schools indicated they would refuse to treat HIV + patients. Adequate knowledge and moral beliefs reflecting professional ethics were associated with lower odds of refusal counterbalancing the association with attitude indicating increased concern for risk of infection with implications for dentist education and training.

Comparison of clinical and radiographic status around immediately loaded versus conventional loaded implants placed in patients with type 2 diabetes: 12- and 24-month follow-up results.

There are no studies that have compared the clinical and radiographic status around immediately loaded (IL) and conventional loaded (CL) implants placed in patients with type 2 diabetes mellitus (T2DM). The aim was to compare the clinical and radiographic status around IL and CL implants placed in T2DM patients. One hundred and eight diabetic patients [55 with IL implants (Group 1) and 53 with CL implants (Group 2)] were included in this cross-sectional study. All implants were placed in healed sites in the maxillary and mandibular premolar and molar regions and supported single restorations. All patients underwent full mouth mechanical debridement biannually. Haemoglobin A1c (HbA1c) levels, clinical [bleeding on probing (BOP) and probing depth (PD) ≥ 4 mm] and radiographic [crestal bone loss (CBL)] peri-implant parameters were measured for both groups at 12- and 24-month follow-up. Group comparisons were performed using the Mann-Whitney U-test (P < 0·05). The mean age and duration of T2DM in groups 1 and 2 were 50·6 ± 2·2 and 51·8 ± 1·7 years, and 9·2 ± 2·4 and 8·5 ± 0·4 years, respectively. At 12- and 24-month follow-up, the mean HbA1c levels in groups 1 and 2 were 5·4% (4·8-5·5%) and 5·1% (4·7-5·4%) and 5·1% (4·7-5·2%) and 4·9% (4·5-5·2%), respectively. At 12- and 24-month follow-up, there was no statistically significant difference in peri-implant BOP, PD and CBL in both groups. It was concluded that clinical and radiographic status is comparable around IL and CL implants placed in patients with T2DM. The contribution of careful case selection, oral hygiene maintenance and glycaemic control is emphasised.

Dental management of patients with inherited bleeding disorders: a multidisciplinary approach.

Bleeding disorders can be inherited or acquired and demonstrate different levels of severity. Dentists may be called on to treat patients who have bleeding disorders such as hemophilia A and von Willebrand disease (vWD). Dental extraction in any patient with clotting factor defects can result in a delayed bleeding episode. Local hemostatic measures provide effective results in a majority of cases but are insufficient in patients with severe hemophilia A and vWD. Therefore, consultation with the patient's hematologist is required to ensure preoperative prophylactic coverage. Dental care providers have to be aware of any signs of bleeding disorders and refer patients for further medical investigations. This article aims to provide dental care providers with the knowledge to manage patients with inherited bleeding disorders, especially hemophilia A and vWD.

Cardiovascular considerations for the dental practitioner. 1. Review of cardiac anatomy and preoperative evaluation.

Cardiovascular disease is the most prevalent chronic medical condition in patients treated in a dental setting. Therefore, dental practitioners must have a sound understanding of cardiovascular anatomy and physiology. Dentists also should be equipped to perform an effective preoperative cardiovascular examination and determine when medical consultation is necessary in higher risk patients. This article provides an overview of cardiovascular anatomy and physiology and discusses evaluation of cardiac risk factors with the aim of enabling dentists to effectively assess patients for potential cardiovascular events, thereby avoiding cardiovascular emergencies in the dental setting.

Oral Radiographic Evidence of Secondary Hyperparathyroidism in an End-Stage Renal Failure Patient: A Case Report.

BACKGROUND: The authors report a case of a 42-year-old woman with End Stage Renal Disease (ESRD) undergoing dialysis therapy with the relative loss of tooth root lamina dura and several mandibular radiolucencies. Secondary hyperparathyroidism related to End Stage Renal Disease may result in the loss of bone density and radiolucent lesions, which has been previously described as Brown tumor. Findings significant for hyperparathyroidism may befound on routine dental imaging. RESULTS: The patient was evaluated, and treatment was initiated for her dental conditions. She is at present still on the kidney transplant waiting list. CONCLUSION: Patients with End Stage Renal Disease and hyperparathyroidism require communication and cooperation between dentists and physicians. PRACTICAL IMPLICATIONS: It is important for dentists to consider Brown tumor as a possible diagnosis of radiolucent jaw lesions.

[Out-patient dental care in patients with arterial hypertension]. / Osobennosti okazaniia ambulatornoi stomatologicheskoi pomoshchi patsientam s arterial'noi gipertenziei.

The aim of the study was to improve dental treatment quality in patients with arterial hypertension. The study included 256 patients with arterial hypertension (153 females, 103 males) aged 35 to 60 years. Anesthesia efficacy was assessed by visual analog scale after treatment. Oral adverse effects caused by regular intake of antihypertensive drugs and interrelation with articaine and mepivacaine were described. The study proved high efficacy of 4% articaine 1:200 000. The efficacy of 3% mepivacaine with no vasoconstriction agents was 86.4±2.3% but may be enhanced to 93.3±2.3% by preventive non-steroid anti-inflammatory agents taken 25-30 minutes before treatment in maximal daily dosage.

Ethics, research and HIV: lessons learned- a workshop report.

Assessing risk for transmission of a blood-borne pathogen requires the use of the hazard and risk model. Infection control is a system that uses a number of individual processes to eliminate or reduce the probability of a hazard occurring. Strategies employed to reduce risk should be rehearsed, used routinely, audited, reviewed, and the results shared. Continuing dental education has improved dental healthcare worker willingness to treat people living with HIV/AIDS (PLWHA) and has decreased negative attitudes and staff fears. Providing care for PLWHA during undergraduate dental school or dental hygiene programme is also associated with a greater willingness to treat. Whether by identifying suspect oral lesions or offering rapid screening tests in the dental setting for HIV, the dental team can play an important role in linkage to confirmatory diagnosis and care with the goal of reducing to zero the number of undiagnosed cases.