Knowledge on the guideline-recommended use of antiplatelet and anticoagulant therapy during dental extractions: a contemporary survey among Polish dentists.

BACKGROUND: The number of dental patients requiring periodic or lifelong antiplatelet or anticoagulanttherapy is constantly growing. AIMS: We aimed to determine the level of knowledge on antiplatelet and anticoagulant therapy among Polish dentists. METHODS: self­designed online questionnaire was distributed among dentists to evaluate their knowledge on the use of antiplatelet and anticoagulant drugs in clinical dental practice. RESULTS: The study included 352 dentists. Patients requiring vitamin K antagonists were referred for a cardiac consultation by 64.52%, 57.29%, and 58.55% of dentists with <5, 5-15, and >15 years of experience,respectively (P = 0.003). A similar trend was observed for non-vitamin K antagonist oral anticoagulants among nonsurgical dentists. However, an equal percentage of surgical dentists (39.7%) performedextraction with and without consultation, and they were more likely to perform extraction withoutconsultation than nonsurgical dentists (39.7% vs 27.8%; P = 0.01). Most surgical and nonsurgical dentistspreferred to consult a cardiologist about dual antiplatelet therapy before an invasive procedure (56.9%and 73.81%, respectively; P = 0.03). Extractions in patients on aspirin were accepted by 75.81%, 70.83%, and 49.34% of dentists with <5, 5-15, and >15 years of experience, respectively (P = 0.004), and by 79.31%of surgical and 57.14% of nonsurgical dentists (P = 0.003). CONCLUSIONS: Knowledge on antiplatelet and anticoagulant therapy in patients undergoing dental procedures is unsatisfactory among Polish dentists. Both therapies were discontinued before extractionsmore frequently than recommended in the guidelines, while extractions in patients on aspirin were common.

Prevention of infective endocarditis during dental extractions among Polish dentists - a contemporary nationwide survey.

INTRODUCTION: Infective endocarditis (IE) is a potentially life-threatening condition. According to current ESC (European Society of Cardiology) guidelines, the use of antibiotic prophylaxis should only be reserved for specific dental procedures with interruption of consistency of the oral mucosa such as extractions and should be reserved for patients with the highest risk of developing IE. The aim of this study was to assess the knowledge of need for IE prophylaxis in de ned clinical settings among Polish dentists. MATERIAL AND METHODS: A specially self-designed internet questionnaire was created concerning the topic of infective endocarditis prophylaxis in specific clinical scenarios for patients undergoing dental extractions during outpatient visits. The survey was made available to the dentists via internet and was active in March 2018. RESULTS: there were 352 Polish dentists who completed the survey. Antibiotic prophylaxis for IE during dental extractions was used in 93% of cases with prior IE, 89% with artificial heart valve, 69% with biological valve, 28% with pacemaker, 54% with coronary stent, 73% with cyanotic heart defect, 58% with diabetes mellitus, 20% after prior myocardial infarction and 54% with heart valve disease. There was a significant relationship between the time of working as a physician (>15 years) and more outdated or improper IE prophylaxis (p = 0.04). CONCLUSIONS: the management of patients for infective endocarditis prophylaxis undergoing dental extractions is suboptimal. Antibiotic therapy is overused in some clinical scenarios and on the other hand underutilized in those recommended by the current ESC guidelines.