ABSTRACT
OBJECTIVE: Patients with thromboembolic problems, prosthetic valves, or coagulation issues are commonly prescribed anticoagulants and antiplatelets. Anticoagulant and antiplatelet medication might constitute a challenge for dentists and dental hygienists since possible prolonged bleeding might interfere with dental procedures. The aim of the present study was to examine the bleeding durations associated with various anticoagulants and antiplatelets during professional dental hygiene sessions, utilizing a modified Ivy test adapted for the oral context. MATERIALS AND METHODS: Ninety-three consecutive patients undergoing professional oral hygiene were recruited. Debridement during oral hygiene was performed using ultrasonic mechanical instrumentation, and bleeding sites were assessed and treated with gentle pressure using sterile gauzes. The time for bleeding cessation was recorded. Patients were categorized into six groups based on their drug intake, Control: no anticoagulants or antiplatelets DTI: direct thrombin inhibitors (dabigatran) AntiXa: directa factor Xa inhibitors (endoxaban, apixaban, rivaroxaban) VKA: vitamin K antagonists (warfarin, acenocoumarol) SAPT: single anti-platelet therapy (acetylsalicylic acid or clopidogrel) DAPT: dual anti-platelet therapy (acetylsalicylic acid and clopidogrel). Bleeding time was measured in seconds and mean values were assessed among the different groups. Differences between groups were investigated with Kruskal-Wallis test followed by Dunn's post-hoc correction for multiple comparisons or two-way ANOVA followed by Dunnett post-hoc; RESULTS: Control patients presented the lowest bleeding time 50 s, followed by AntiXa (98), SAPT (105), DTI (120), DAPT (190) and VKA (203). A statistically significant difference was present among control and DTI (p = 0.004), VKA (p < 0.001), DAPT (p < 0.001). CONCLUSIONS: Based on the present outcomes, an increased risk of prolonged bleeding emerged in patients taking VKA and DAPT. CLINICAL SIGNIFICANCE: bleeding did not interfere with the oral hygiene session The optimal period for dental treatment of these patients should be 2-3 h before the next dose, without the need to temporarily suspend the medication.
Subject(s)
Anticoagulants , Platelet Aggregation Inhibitors , Humans , Anticoagulants/therapeutic use , Female , Male , Platelet Aggregation Inhibitors/therapeutic use , Platelet Aggregation Inhibitors/adverse effects , Middle Aged , Bleeding Time , Oral Hemorrhage/prevention & control , Oral Hemorrhage/etiology , Aged , Adult , Oral Hygiene , Dabigatran/therapeutic use , Dabigatran/adverse effects , Factor Xa Inhibitors/therapeutic use , Warfarin/therapeutic use , Warfarin/adverse effects , Clopidogrel/therapeutic use , Clopidogrel/adverse effects , Pyrazoles/therapeutic use , Aspirin/adverse effects , Aspirin/therapeutic use , Rivaroxaban/therapeutic use , Rivaroxaban/adverse effectsABSTRACT
BACKGROUND: Mandibular arteriovenous malformation (AVM) is rare. Our work aims to introduce the ethanol embolization of a patient suffering from acute oral hemorrhage induced by mandibular AVM. METHODS: A 35-year-old woman without coagulopathy underwent tooth extraction, and the acute oral bleeding occurred intraoperatively. Imaging examinations indicated the enhancement of vascular mass with bone destruction inside the mandible. Angiography finally confirmed the high blood flow nature and the diagnosis of AVM. RESULTS: During the interventional procedure, the coils were first applied into the dilated outflowing vein to slow down the blood flow rate of mandibular AVM. Absolute ethanol was injected in a multi-bolus modality to destroy the nidus of AVM. Her mandibular lesion had been stable in the 12-month re-examined angiography, no further bleeding occurred during the period. CONCLUSIONS: Ethanol embolotherapy was a less invasive, more precise, and quick-action approach managing AVM of the jaw and related emergency medicine.
Subject(s)
Arteriovenous Malformations , Embolization, Therapeutic , Ethanol , Mandible , Oral Hemorrhage , Tooth Extraction , Humans , Female , Embolization, Therapeutic/methods , Adult , Arteriovenous Malformations/therapy , Arteriovenous Malformations/complications , Ethanol/administration & dosage , Tooth Extraction/adverse effects , Oral Hemorrhage/etiology , Oral Hemorrhage/therapy , Mandible/blood supply , AngiographySubject(s)
Amyloidosis , Blister , Humans , Amyloidosis/diagnosis , Amyloidosis/complications , Blister/etiology , Blister/diagnosis , Immunoglobulin Light Chains , Immunoglobulin Light-chain Amyloidosis/diagnosis , Immunoglobulin Light-chain Amyloidosis/complications , Oral Hemorrhage/etiology , Oral Hemorrhage/diagnosisABSTRACT
This network meta-analysis was done to thoroughly evaluate the available literature on the use of different hemostatic agents for dental extraction in patients under oral antithrombotic therapy, aiming to identify the agent with the best/worst performance in bleeding control. Considering that such patients have a higher risk of bleeding, choosing the right hemostatic is essential. Twenty-three randomized clinical trials articles were included after completing the literature search. Cyanoacrylate tissue adhesive showed a reduction in the odds of postoperative bleeding events compared with conventional methods (i.e., gauze/cotton pressure, sutures), with a tendency toward a statistical significance (OR 0.03, P = 0.051). Tranexamic acid was the only agent that demonstrated a significantly lower risk of developing postoperative bleeding events (OR 0.27, P = 0.007). Interestingly, chitosan dental dressing and collagen plug had the shortest time to reach hemostasis. However, they ranked last among all hemostatic agents, regarding bleeding events, revealing higher odds than conventional measures. Therefore, it is concluded that the use of cyanoacrylate tissue adhesive and tranexamic acid gives favorable results in reducing postoperative bleeding events following dental extractions. Although chitosan dental dressing and collagen exhibited a faster time to reach hemostasis, they led to a higher occurrence of bleeding events.
Subject(s)
Chitosan , Hemostatics , Tissue Adhesives , Tranexamic Acid , Humans , Tranexamic Acid/therapeutic use , Fibrinolytic Agents/adverse effects , Network Meta-Analysis , Oral Hemorrhage/drug therapy , Oral Hemorrhage/etiology , Tooth Extraction/adverse effects , Hemostatics/therapeutic use , Postoperative Hemorrhage/etiology , Collagen , CyanoacrylatesABSTRACT
Angina bullosa hemorrhagica (ABH) is a rare benign condition that affects the oral and oropharyngeal mucosa. It is characterized by a rapid eruption of one or more red or magenta blood-filled bullae, which typically involves the soft palate. ABH is a self-limiting condition that heals spontaneously usually within 2 weeks without scarring. ABH is not related to any dermatologic, hematologic, systemic disorders, or other known causes. The etiopathogeneses of ABH are unknown, though several theories have been proposed. Trauma has been suggested as a potential cause for the development of ABH in susceptible individuals. Two cases are presented of ABH, and the differential diagnoses of oral vesiculobullous conditions is discussed. Cognizance and identification of this benign condition is important to prevent misdiagnosis and eventual unwarranted treatment.
Subject(s)
Mouth Diseases , Oral Hemorrhage , Blister/diagnosis , Diagnosis, Differential , Humans , Mouth Diseases/diagnosis , Oral Hemorrhage/diagnosis , Oral Hemorrhage/etiologyABSTRACT
Arteriovenous malformations (AVMs) are rare congenital disorders of vascular morphogenesis. These lesions are characterised by high vascular flow with risk of severe bleeding from accidental trauma or surgical manipulation. Although infrequent, potentially life-threatening and fatal oral bleeding has been reported during extraction of tooth associated with AVM. This paper presents a case of uncontrolled bleeding in an adult female patient undergoing mandibular anterior tooth extraction. The bleeding was related to undiagnosed soft tissue AVM in gingivobuccal space. Management of the case with review of previously reported similar cases is presented.
Subject(s)
Arteriovenous Malformations , Adult , Arteriovenous Malformations/complications , Arteriovenous Malformations/diagnostic imaging , Arteriovenous Malformations/surgery , Female , Humans , Mandible/diagnostic imaging , Mandible/surgery , Oral Hemorrhage/etiology , Tooth Extraction/adverse effectsSubject(s)
Blister/etiology , Herpes Zoster Vaccine/adverse effects , Oral Hemorrhage/etiology , Purpura, Thrombocytopenic, Idiopathic/etiology , Dexamethasone/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Middle Aged , Purpura/etiology , Purpura, Thrombocytopenic, Idiopathic/blood , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Purpura, Thrombocytopenic, Idiopathic/therapy , Thrombocytopenia/blood , Thrombocytopenia/etiology , Vaccines, Synthetic/adverse effectsSubject(s)
Antifibrinolytic Agents/therapeutic use , Oral Hemorrhage/drug therapy , Oral Hemorrhage/etiology , Stevens-Johnson Syndrome/complications , Tranexamic Acid/therapeutic use , Administration, Topical , Hospitals, University , Humans , Mouth Mucosa/drug effects , Patient Safety , Stevens-Johnson Syndrome/diagnosis , Treatment Outcome , United KingdomABSTRACT
OBJECTIVE: The aim of this study was to compare the incidence of airway haemorrhage between participants who received manual cardiopulmonary resuscitation (CPR) and those who had received mechanical CPR using the LUCAS device. METHODS: A retrospective cohort study was conducted by means of a medical chart review. All non-traumatic cardiac arrest patients that presented to the ED, from May 2014 to February 2018, were recruited. The groups were stratified according to those who had the majority of CPR performed using the LUCAS and those who had the majority of CPR performed manually. The primary outcome was the proportion of participants with airway haemorrhage, defined as blood observed in the endotracheal tube, pharynx, trachea or mouth, and documented in the doctor or nursing notes. Logistic regression analysis was performed to adjust for confounders. RESULTS: 12 of 54 (22%) participants in the majority LUCAS CPR group had airway haemorrhage, compared with 20 of 215 (9%) participants in the majority manual CPR group, a difference of 13% (95% CI 3% to 26%, p=0.02). The unadjusted odds for developing airway haemorrhage in the majority LUCAS CPR group was 2.8 (95% CI 1.3 to 6.1). After adjusting for confounders, the odds for developing airway haemorrhage in the majority LUCAS CPR group was 2.5 (95% CI 1.1 to 5.7). CONCLUSIONS: The LUCAS mechanical CPR device is associated with a higher incidence of airway haemorrhage compared with manual CPR. Limitations in the study design mean this conclusion is not robust.
Subject(s)
Airway Obstruction/etiology , Cardiopulmonary Resuscitation/instrumentation , Oral Hemorrhage/etiology , Out-of-Hospital Cardiac Arrest/therapy , Airway Obstruction/mortality , Airway Obstruction/physiopathology , Australia , Cardiopulmonary Resuscitation/adverse effects , Cardiopulmonary Resuscitation/methods , Emergency Medical Services , Equipment Design , Female , Humans , Incidence , Male , Middle Aged , Oral Hemorrhage/mortality , Oral Hemorrhage/physiopathology , Out-of-Hospital Cardiac Arrest/mortality , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
A 35-year-old woman developed acute swallowing problems caused by a big oral blood blister after eating nuts. The blister ruptured 32 hours later and healed without scarring. 'Angina bullosa haemorrhagica' was diagnosed after ruling out bleeding disorders.
Subject(s)
Blister/etiology , Gastrointestinal Hemorrhage/etiology , Mouth Diseases/diagnosis , Mouth Diseases/etiology , Oral Hemorrhage/etiology , Adult , Blister/diagnosis , Edema/etiology , Face , Female , Gastrointestinal Hemorrhage/diagnosis , Humans , Mouth Mucosa/pathologySubject(s)
Blister , Chest Pain , Endoscopy, Digestive System/methods , Epidermolysis Bullosa/diagnosis , Esophagus , Lichen Planus, Oral/diagnosis , Pemphigoid, Benign Mucous Membrane/diagnosis , Blister/complications , Blister/diagnosis , Blister/physiopathology , Chest Pain/diagnosis , Chest Pain/etiology , Diagnosis, Differential , Esophagus/diagnostic imaging , Esophagus/pathology , Female , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Humans , Middle Aged , Mouth Mucosa/pathology , Oral Hemorrhage/diagnosis , Oral Hemorrhage/etiologyABSTRACT
INTRODUCTION: Optimal delivery of dental care for adults with congenital bleeding disorders (CBD) requires close collaboration between hemophilia treaters and dentists. AIM: To explore U.K. hemophilia treaters' knowledge of dental procedures and associated hemostatic management in adults with CBD. METHOD: Staff (N = 180) from N = 60 hemophilia facilities in the United Kingdom were invited to participate in a questionnaire-based study using a web-based tool. The questionnaire assessed participants' knowledge, adherence and appropriateness of application of U.K. guidance on hemostatic management of common dental procedures. RESULTS: The response rate was 23% of treaters (n = 41) from 62% (n = 32) hemophilia facilities. Individual participants (87%; n = 34) reported they adhered to guidelines, though knowledge of guidance was poor with only 36% (n = 15) applying guidance appropriately in 3 common dental scenarios. There was a tendency for participants to assign the use of systemic hemostatic measures independent of the agreed bleeding risk associated with the proposed dental procedure. CONCLUSION AND RECOMMENDATIONS: While hemophilia treaters were aware of current guidelines, their knowledge of the guidelines and ability to risk assess dental procedures was poor. There was a tendency to overprescribe systemic hemostatic measures for dental procedures. Education initiatives to aid decision making are needed.
Subject(s)
Dental Care for Chronically Ill/adverse effects , Health Knowledge, Attitudes, Practice , Hemophilia A/complications , Oral Hemorrhage/etiology , Oral Hemorrhage/prevention & control , Physicians , Adult , Cross-Sectional Studies , Female , Guideline Adherence , Hemostasis , Humans , Male , Risk Assessment , Risk Factors , Surveys and Questionnaires , United KingdomABSTRACT
The aim of this study was to perform a critical review of published data on the epidemiological, aetiological, clinical, histological, biological, and therapeutic characteristics of patients with angina bullosa haemorrhagica (ABH). A literature search was conducted in the PubMed, Science Direct, Web of Science, and Cochrane Library databases. All publications fulfilling the selection criteria were included in the eligibility assessment according to the PRISMA statement. The full texts of 54 retrieved articles were screened. Forty articles published between 1985 and 2016 describing 225 cases of ABH were finally selected. The mean age of the patients was 55.4 years; the male to female ratio was 0.7. The predominant localization was the palate (66%). A third of patients had no medical history. When specified, a triggering event or promoting factor was frequently found (82%). Biological tests were normal. A biopsy was performed on 35% of the patients. Treatment was symptomatic with a favourable outcome. Recurrences were frequent (62%). In conclusion, ABH is poorly documented and only by studies of low-level evidence. This review did not allow any aetiopathogenic association to be made with a general pathology or treatment. On the basis of this systematic review of the literature, diagnostic criteria aiming to improve the care of patients presenting with ABH are proposed.
Subject(s)
Blister , Oral Hemorrhage , Biopsy , Blister/diagnosis , Blister/epidemiology , Blister/etiology , Blister/therapy , Diagnosis, Differential , Humans , Oral Hemorrhage/diagnosis , Oral Hemorrhage/epidemiology , Oral Hemorrhage/etiology , Oral Hemorrhage/therapy , Recurrence , Risk FactorsABSTRACT
Tracheostomy is a common procedure for long-term airway management. Although the overall complication rate is greater than 50%, the incidence of serious complications is low. These serious complications can, however, lead to significant morbidity and mortality and it is incumbent on the emergency provider to be prepared to deal with such tracheostomy-related emergencies. The greatest life threats to the tracheostomy patient are decannulation, obstruction, and hemorrhage. Other important but lower-acuity complications include tracheoesophageal fistula formation, tracheal stenosis, infection, and tracheocutaneous fistula formation.
Subject(s)
Emergencies , Tracheostomy , Humans , Oral Hemorrhage/etiology , Oral Hemorrhage/therapy , Tracheostomy/adverse effects , Tracheostomy/methodsABSTRACT
Dental emergencies present frequently to the emergency department and urgent care centers. Trauma to the teeth includes fractures, luxations, and avulsions, which can be reduced in most cases. Avulsed primary teeth should never be replaced. Mouthguards should be worn in most youth sports to prevent many dental injuries. Dental caries can progress to worsening infection and should be diagnosed and promptly referred. More severe infections may require antibiotics, imaging, or incision and drainage. Dental blocks can assist with analgesia and patient comfort during other procedures.