Aggressive Fibromatosis in the Mandible of a Child: A Rare Case Report.

Aggressive fibromatosis (AF) is an uncommon, benign, collagen-forming soft tissue neoplasm that is characterized by monoclonal myofibroblast cell proliferation and derived from musculoaponeurotic structures. It has a locally invasive pathological behavior and a high potential for recurrence. Fibromatoses with onset in infancy and childhood are characterized with higher cellularity and more aggressive growth. The mainstream management of AF is surgical removal with microscopically lesion-free margins. In advanced cases, radical surgery can lead to function loss and disfigurement. Hence, early diagnosis and management can avoid complications. Although uncommon (two to four cases per million per year are reported), approximately 25 percent of AF incidents occur in children younger than 15 years of age. Pediatric dentists are likely to be the first practitioners to encounter new cases of AF in younger populations and should have knowledge and understanding of this entity. The purpose of this report is to present a rare case of AF affecting the mandible of a young patient.

Discontinuation of Oral Antiplatelet Agents before Dental Extraction - Necessity or Myth?

BACKGROUND: The risk of excessive bleeding often prompts physicians to interrupt the antiplatelet agents as acetylsalicilyc acid and clopidogrel before dental extractions which puts patients at risk of adverse thrombotic events. AIM: To assess the bleeding risk during dental extractions in patients with continued antiplatelet therapy. MATERIALS AND METHODS: The study included 130 patients (64 men and 66 women) aged between 18 and 99 years old. Sixty-eight of the patients received 100 mg acetilsalicilic acid (ASA); these were divided into two groups: 34 patients continued taking ASA and 34 patients stopped it 72 hours before extraction. Sixty-two of the patients were treated with 75 mg clopidogrel; these were also divided into two groups: 31 continued taking clopidogrel and 31 patients stopped it 72 hours before extractions. Extraction was performed under local anaesthesia as no more than 3 teeth per visit were extracted. Local haemostasis with gelatine sponge and/or suturing was used to control bleeding. RESULTS: Mild bleeding was observed most frequently in the first 30 minutes, successfully managed by local haemostasis. Only 1 patient in the control and 1 in the experimental group receiving ASA reported mild bleeding in the first 24 hours, controlled by compression with gauze. No major haemorrhage requiring emergency or more than local haemostasis occurred. No statistically significant difference in bleeding between two groups was found. CONCLUSION: Single and multiple dental extractions in patients receiving acetylsalicylic acid or clopidogrel can be safely performed without discontinuation of the therapy with provided appropriate local haemostasis.