Major haemorrhage from oral arteriovenous malformation during pregnancy: a case report.

This case report describes the presentation of a pregnant woman at 39 weeks gestation to The Royal Prince Alfred Hospital emergency department (Sydney, NSW) with major haemorrhage from an oral arteriovenous malformation (AVM) and foetal distress. The lesion had grown rapidly during her pregnancy and she had presented to multiple hospitals and dental practitioners who had failed to diagnose her condition and recognize the potential for major complications for the patient and her baby. Bleeding was controlled with manual pressure while she underwent an emergency Caesarean section followed by emergency angiography and partial embolization of the lesion. The bleeding did not recur, and the lesion continued to regress post-partum. This paper illustrates the diagnostic dilemma of recognizing an AVM and also the potentially disastrous consequences that could occur if a dentist was to embark on extractions or other surgical treatment in the vicinity of such a lesion without realizing its significance.

Hemorrhagic complications and dental management of patients with anticoagulant therapy: case report

Introduction: There are different protocols for the management of anticoagulated patients that can be used when performing oral surgical procedures. Objective: To report the previous eva-luation and management of a hemorrhagic complication in the maxillofacial region in a patient undergoing oral anticoagulant therapy and the recommendations described in the literature for these patients. Clinical Case: Sixty-eight year old male patient, hospitalized in the cardiology unit due to heart failure, pending surgery for valve replacement. Treating physician requests evaluation for dental infection foci by a maxillofacial surgeon. Prior to medical examination and corresponding blood tests, four carious teeth are extracted, controlling hemostasis with local measures. During the night of the same day, the patient is referred again to the dental unit be-cause of an alveolorrhagia, being treated and controlled with new local measures; new standard blood tests are performed. Forty-eight hours later the patient presents an increase of volume in the right mandibular region compatible with hematoma and ecchymosis. It is decided to perform treatment, removing sutures, collagen and draining through the alveolus. Subsequently, new local measures are performed and the anticoagulant is suspended for 24 hrs. Conclusion: There are different care protocols for patients undergoing anticoagulant treatment in the literature, so each patient should be studied in advance to define what is the best therapeutic procedure to prevent complications.

Asphyxial death related to postextraction hematoma in an elderly man.

We here report an autopsy case of a man in his seventies who died from asphyxia due to compression of the trachea caused by postextraction bleeding after extraction of his left mandibular third molar by a dentist in private practice. On the morning after the tooth extraction, he had complained of dyspnea and became unconscious at home. Although he was brought to the emergency room by ambulance, he died 7 days later without regaining consciousness. Autopsy examination revealed that the lingual side of the alveolar bone was fractured at the extraction socket. Moreover, subcutaneous bleeding that extended from the extraction socket to the thyrohyoid ligament in the cervical region and deviation of the epiglottis due to the bleeding were observed. Histological findings revealed liver cirrhosis; there were no significant findings in other organs. On the basis of these findings, we concluded that alveolar bone fracture occurred during the extraction and that the bleeding spread to the cervical region. Thus, the patient had died from asphyxia resulting from airway obstruction caused by cervical subcutaneous bleeding derived from postextraction bleeding. We emphasize that tooth extraction may cause fatal complications in patients with bleeding tendencies, particularly in the elderly.

Avaliação do risco de hemorragia em pacientes submetidos à cirurgia bucal fazendo uso contínuo de anticoagulante oral, sem alterar o regime terapêutico: um estudo clínico / Assessment of the risk of bleeding in patients undergoing oral surgery in continuous oral anticoagulante therapy without modifying the therapeutic regimen: a clinical study

Certas condições médicas e seus respectivos tratamentos farmacológicos tem influenciado o tratamento odontológico de uma forma geral. A terapia com anticoagulante oral (TAO) tem sido utilizada com sucesso na redução do risco de tromboembolismo. Frequentemente, pacientes que fazem terapia com anticoagulante oral necessitam de procedimentos cirúrgicos odontológicos. O controle pré-operatório destes pacientes que serão submetidos à cirurgia bucal é um problema comum e desafiador. O objetivo deste estudo foi avaliar complicações hemorrágicas associadas à cirurgia bucal em pacientes em TAO sem alterar o regime terapêutico. Os pacientes que foram incluídos neste estudo estavam em tratamento com anticoagulante oral e necessitavam de um procedimento cirúrgico (extrações, alveoloplastias). Um total de 73 intervenções em 25 pacientes foi realizado. A média do INR no pré-operatório foi de 2.59, variando entre 1.20 e 4.61. Apenas 1 paciente (4%) evoluiu, no segundo dia de pós-operatório, com hemorragia leve, que foi resolvida com pressão local. Sendo assim, podemos concluir que os pacientes em TAO, que necessitam de exodontias, não devem interromper ou alterar o regime terapêutico devido ao baixo risco de sangramento e potencial risco de desenvolver um acidente tromboembólico. A incidência de complicações hemorrágicas neste estudo foi de 4%. A exodontia é um procedimento seguro em pacientes sob a TAO com valor de INR dentro da faixa terapêutica preconizada como ideal para a condição clínica de que se está tratando, desde que associada a cuidados locais de hemostasia.

Certain medical conditions and their respective treatments have often influenced dental treatments. Oral anticoagulant therapy (OAT) has been successfully used to reduce the risk of thromboembolism. Patients using oral anticoagulants often require dental surgical procedures. The pre-operative assessment of these patients submitted to oral surgery is a common and challenging problem. The aim of this study was to evaluate the hemorrhagic complications due to oral surgery in patients submitted to OAT without modifying the therapeutic regimen. The patients included in this study were undergoing OAT and required surgical procedures (extractions, alveoloplasties). A total of 73 interventions in 25 patients were made. The average INR during the pre-operative period was 2.59, ranging from 1.20 to 4.61. Only one patient (4%) presented, on the second day, a light hemorrhage, which was managed with local pressure. Therefore, patients in OAT that require dental extractions should not interrupt or alter the therapeutic regimen due to the low risk of bleeding and the potential risk of developing a thromboembolic accident. The incidence of hemorrhagic complications in this study was of 4%. Dental extractions are safe procedures for patients undergoing OAT, with INR values within the therapeutic interval recommended as ideal for the clinical conditions being treated, as long as they are associated to local hemostatic actions.

Hematoma of the floor of the mouth and airway obstruction during mandibular dental implant placement: a case report.

BACKGROUND: Hematoma of the floor of the mouth during mandibular dental implant placement is a rare but potentially life-threatening complication. REPORT: A 53-year-old man developed a hematoma of the floor of the mouth following a dental implant procedure, requiring admission to the hospital. SUMMARY: The floor of the mouth is richly vascularized by a number of branches of the submental and sublingual arteries. During a dental implant procedure in the anterior zone of the mandible, perforation of the lingual cortex may invade the floor of the mouth and therefore damage structures within the sublingual space. The anatomy of the lower portion of the anterior mandibular zone, with the mylohyoid ridge, makes it particularly vulnerable to this kind of injury, particularly in patients with atrophic mandibles. Only a few cases have been reported in the literature to date.

Nonvital tooth bleaching: a review of the literature and clinical procedures.

Tooth discoloration varies in etiology, appearance, localization, severity, and adhesion to tooth structure. It can be defined as being extrinsic or intrinsic on the basis of localization and etiology. In this review of the literature, various causes of tooth discoloration, different bleaching materials, and their applications to endodontically treated teeth have been described. In the walking bleach technique the root filling should be completed first, and a cervical seal must be established. The bleaching agent should be changed every 3-7 days. The thermocatalytic technique involves placement of a bleaching agent in the pulp chamber followed by heat application. At the end of each visit the bleaching agent is left in the tooth so that it can function as a walking bleach until the next visit. External bleaching of endodontically treated teeth with an in-office technique requires a high concentration gel. It might be a supplement to the walking bleach technique, if the results are not satisfactory after 3-4 visits. These treatments require a bonded temporary filling or a bonded resin composite to seal the access cavity. There is a deficiency of evidence-based science in the literature that addresses the prognosis of bleached nonvital teeth. Therefore, it is important to always be aware of the possible complications and risks that are associated with the different bleaching techniques.

Glycogen Storage Disease type Ib: a paediatric case report.

AIM: This paper addresses the need of the dental literature to document cases of Glycogen Storage Disease (GSD) type Ib with focus on the paediatric management of oral and dental problems and the potential complications arising from the increased susceptibility to bacterial infections, cariogenicity, and blood diathesis. METHODS: Previous medical and dental papers on GSD type Ib published from 1980 to 2006 have been searched in the electronic databases PubMed and EMBASE using keywords of the NLM's Thesaurus, with the aim to retrieve important implications of treatment and preventive measures for an evidence-based multidisciplinary medical and dental management of the oral health problems of a 9-year old boy affected by GSD type Ib. CASE REPORT: Oral and dental manifestations observed during a period of two years and relative treatments are reported from our case. Data on pharmacologic, oral hygienic, dietary, and surgical preventive measures for the control of recurrent oral infections, dental caries, gingival inflammation and risk of surgical bleeding are described. In addition, an electronic microscope structural analysis at SEM of the enamel tooth surface was conducted to identify any characteristic difference in the enamel architecture of this GSD type Ib affected patient compared with the normal enamel structure. CONCLUSION: The oral manifestations of our case included uncommon findings such as multiple deep oral ulcers of the tongue, labial and vestibular mucosa, which could be related with a severe impairment of the neutrophil-related immune system of the patient. At SEM, the enamel of the deciduous teeth showed dark spots of hypomineralisation which are the first published data of an enamel-related susceptibility to dental caries. The quality of life of our patient increased thanks to the oral and dental treatments and preventive oral health measures given at clinical appointments. The dentist should be prepared to face the possible complications of surgery in these patients and the hospital setting seems to allow for this clinical safety.

Acquired C1 esterase inhibitor deficiency: An atypical first presentation intra-operatively.

We report a case of airway difficulties encountered as a result of blistering, oedema and bleeding from the oropharyngeal mucosa of an 85-year-old female undergoing an elective excision of a submandibular neck lump. This led to a delay in extubation by several hours. The patient was subsequently found to have an acquired form of C1 esterase inhibitor deficiency considered to be consequent of haematological malignancy.

[Acute airway obstruction in acquired hemophilia A]. / Akute Atemwegsverlegung durch erworbene Hämophilie A.

We report the case of a 67 year old patient suffering from acute airway obstruction caused by hemorrhage localized to the tongue, mouth cavity and hypopharynx, with no evidence of bleeding in his history. The patient presented initially with a globus feeling of the neck, dysphagia and a sore throat. CT scan revealed a swelling of the lingual and sublingual areas and the pharyngeal wall. Next day, there was an immediate life-threatening event caused by progressive bleeding with airway obstruction and an inability to intubate requiring coniotomy. The etiology of the hemorrhage was confirmed by finding a depletion of factor VIII and the presence of auto-antibody directed against this factor. Based on this case report and a review of the literature, we discuss the diagnosis and treatment of acquired hemophilia.

Controle da hemorragia oral e anestesia local em pacientes hemofílicos / Control of oral hemorrhage and local anesthesia in hemophilic patients

Uma grande preocupação dos Cirurgiões-dentistas é a hemorragia durante procedimentos odontológicos que possam envolver sangramento excessivo. Sendo assim, a hemofilia, doença hereditária, preocupa aqueles Cirurgiões que irão submeter seus pacientes a procedimentos odontológicos que envolvam sangramento. O objetivo deste estudo é mostrar a classificação da doença, bem como os tipos de procedimentos odontológicos e condutas para o atendimento destes pacientes. Como a hemofilia está diretamente relacionada com a deficiência de alguns fatores de coagulação, o mecanismo de hemostasia envolvendo estes fatores é descrito neste estudo. A anestesia local nesses pacientes é de fundamental importância. Desta forma, uma avaliação das opções técnicas e suas indicações foi descrita com critério, e também o controle do sangramento através de agentes hemostáticos sistêmicos e locais, que podem ser usados nos atos cirúrgicos

Oral health is impaired in Behçet's disease and is associated with disease severity.

OBJECTIVES: This study aimed to investigate the oral health of Turkish patients with Behçet's disease (BD) and whether it is associated with the disease course. METHODS: One hundred and twenty patients with BD, 35 patients with recurrent aphthous stomatitis (RAS) and 65 healthy Turkish controls (HC) were included in the study. Oral health was investigated by indices applied in a BD out-patient clinic. RESULTS: The mean scores of plaque, sulcus bleeding and gingival indices, probing depth and the number of extracted teeth were observed to be higher in patients with BD and RAS compared to HC (P<0.05). In the linear regression analysis, plaque index score was associated with the presence of oral ulcers and male gender. An elevated plaque index score was observed to be a significant risk factor for increased severity score in patients with BD in the logistic regression analysis (P = 0.034). CONCLUSIONS: Oral health is impaired in BD and associated with disease severity. Improvement of the oral health of BD patients may affect their disease course, leading to a better prognosis.

Encuesta: información a pacientes anticoagulados con acenocumarol relativa a futuras complicaciones odontológicas / Survey: Information administered to anticoagulated patients treated with acenocoumarol regarding future dental treatment complications

Introducción. En España se estima que 400.000 personas reciben tratamiento con anticoagulantes orales (TAO). Se pretende evaluar sus hábitos de higiene oral y la información que reciben sobre las complicaciones derivadas del tratamiento odontológico. Pacientes y método. Seleccionamos 173 pacientes, 87 TAO y 86 portadores de prótesis valvulares cardiacas (PPV-TAO), que respondieron a un cuestionario sobre higiene oral y prevención de complicaciones hemorrágicas y de endocarditis bacteriana. Resultados. El 17,5 por ciento de los TAO y el 26,5 por ciento de los PPV-TAO admitieron no cepillarse los dientes nunca. El 68,1 por ciento de los TAO y el 73,9 por ciento de los PPV-TAO habían sido informados sobre el riesgo de sangrado y de endocarditis bacteriana respectivamente. Conclusión. La mayoría de los pacientes TAO y PPV-TAO reciben información específica previa al tratamiento odontológico sobre potenciales complicaciones y su prevención. Sin embargo, sus hábitos de higiene oral son deficientes, presumiblemente porque existen importantes carencias en educación odontológica (AU)

Haematoma of the floor of the mouth following implant placement.

Placement of implants in the anterior mandibular region is generally regarded as a routine, safe procedure. This case report describes an extensive haematoma in the floor of the mouth, following such a procedure, which rapidly became life-threatening, requiring an emergency tracheostomy to establish a surgical airway. The anatomic, radiographic and surgical aspects to the problem are discussed. Finally, when undertaking such procedures it is advisable to perform them reasonably close to a hospital where such a complication can be effectively and promptly handled by suitably trained persons.

Near-fatal airway obstruction after routine implant placement.

Implants have gained tremendous popularity over the past two decades, and their placement in the interior edentulous mandible has become routine. A case of near-fatal airway obstruction secondary to sublingual bleeding and hematoma is presented. The complication, anatomy of the area, and previous literature are reviewed, as are precautions to implant placement and other surgical procedures near the floor of the mouth. Although placing dental implants is generally a benign procedure, practitioners must be prepared for potential complications and have a rehearsed plan of action for the treatment of emergent situations. The floor of the mouth contains branches of the submental and sublingual and mylohyoid arteries that may lead to life-threatening complications. This caution obviously extends to any dentoalveolar surgical procedures that concerns the floor of the mouth such as tori removal, extractions, and iatrogenic dental injuries.