Dental management of patients taking antiplatelet medications.

Antiplatelet medications are drugs that decrease platelet aggregation and inhibit thrombus (clot) formation. They are widely used in primary and secondary prevention of thrombotic cerebrovascular or cardiovascular disease. The most common antiplatelet medications are the cyclo-oxygenase inhibitors (aspirin) and the adenosine disphosphate (ADP) receptor inhibitors clopidogrel (Plavix) and ticlopidine (Ticlid). The dental management of patients taking these drugs is reviewed here.

Dental management of patients taking antiplatelet medications.

Antiplatelet medications are drugs which decrease platelet aggregation and inhibit thrombus (clot) formation. They are widely used in primary and secondary prevention of thrombotic cerebrovascular or cardiovascular disease. The most common antiplatelet medications are the cyclooxygenase inhibitors (aspirin) and the adenosine disphosphate (ADP) receptor inhibitors clopidogrel (Plavix) and ticlopidine (Ticlid). The dental management of patients taking these drugs is reviewed here.

Bondsteel fixed partial denture: a provisional indirect technique for in-the-field dental emergencies.

This article presents a modified resin-bonded fixed partial denture technique of replacing a single missing anterior tooth under limitation of material and time. This technique involved a small section of an oral surgery arch bar that was bent and fitted passively into the grooves that were prepared in the lingual of the abutment teeth. A polycarbonate crown was fitted passively on the arch bar by a thin layer of Vaseline. The polycarbonate crown was then filled with acrylic resin to bond the polycarbonate crown and the arch bar together. The result provides an esthetic appearance and a 4-month clinical success without complication. Thus, this technique is a short-term solution for clinics that have limited resources for a definitive treatment.

Clonidine as a preoperative sedative.

The purpose of this study was to -examine the use of oral clonidine as a preoperative sedative prior to parenteral moderate sedation. Initially, four patients were given 0.2 mg oral clonidine but reduced to 0.1 mg clonidine due to -significant drops in blood pressure. Oral clonidine doses of 0.1 mg were then given to 19 patients preoperatively. In all these patients, blood pressure measurements decreased, but there were no significant differences in amounts of sedative agents needed in the clonidine group and the control group (N = 80). The conclusions reached suggest that clonidine has an advantage over other preoperative sedation agents in anxious patients exhibiting hypertension and tachycardia. However, the preop ideal dose required to reduce the amount of sedative drugs used as well as provide anxiolysis remains unknown. In further studies, different doses should be explored to determine what dosage of clonidine may offer hemodynamic protection as well as decrease sedative drugs needed.

Disparities in risk of and survival from oropharyngeal squamous cell carcinoma.

BACKGROUND: Oropharyngeal cancer has a low 5-year survival rate in the United States, indicating that much remains to be learned about risk and survival factors. The purpose of this research was to identify factors that contribute to risk of and survival from this disease in a region associated with high tobacco use. METHODS: A retrospective chart review of 221 subjects with diagnosis of head and neck cancer at a regional University Medical Center during a 10-year period (1986 to 1995) was performed to identify relationships between risk and survival factors of oropharyngeal squamous cell carcinoma (OSCC). Data from 92 records met the inclusion criteria and were analyzed with the chi(2) test of association, the Fisher exact test, and the log-rank test for comparison of survival distributions. The software used was SAS for Windows, release 8.2. RESULTS: Most study subjects were white men between the ages of 50 and 75 years who chronically used tobacco and alcohol. The overall median survival period of the group was 18.1 months. The percentage of subjects surviving to 3 years was 35.6%. Disparities were identified in risk and survival by sex, race, age, dwelling, anatomic site, and exposure to carcinogenic substances. In particular, the disease more adversely affected minorities and those who chronically used tobacco or alcohol. CONCLUSIONS: Our results show that, in the examined regional population, a high prevalence of tobacco use correlated with alcohol use and a lower rate of survival from OSCC than the national rate. Also, risk of and survival from OSCC are affected by demographic, geographic, and behavioral factors. This information is useful for the design and implementation of more effective preventive and intervention strategies.

Antithrombotic agents: implications in dentistry.

Thrombosis and the complicating emboli that can result are important causes of illness and death. Thrombosis is of greater overall clinical importance in terms of morbidity and mortality than all of the hemorrhagic disorders combined. Agents such as heparin, low-molecular weight heparin, warfarin, aspirin, ticlopidine, clopidogrel, and tirofiban are used to prevent venous or arterial thrombosis. Patients taking these antithrombotic agents may be at risk for excessive bleeding after invasive dental procedures. The current antithrombotic agents used in medicine are reviewed, and the dental management of patients taking these agents is discussed.

Dental management considerations for a patient taking dabigatran etexilate: a case report.

Dabigatran is a direct thrombin inhibitor approved to help prevent thrombotic events in patients with atrial fibrillation. As a rather new drug approval, information on management of bleeding during dental surgery in patients taking dabigatran is sparse. In this case report, a 67-year old male with a positive history for atrial fibrillation, coronary artery disease, intermittent angina, hypertension, type 2 diabetes and normal renal function was taking dabigatran 150 mg, 2 times daily. He underwent 8 surgical extractions, alveoloplasty and tuberosity reduction. Per guidelines prescribed by van Ryn et al., the patient's dabigatran was held the night before surgery and resumed the day after. Adverse outcomes were not observed during the procedure or in the 7-month postoperative period. This case suggests that due to its short half-life, dabigatran can be temporarily discontinued 24 h prior to elective oral surgery with consent of the physician and restarted the following day resulting in minimal complications.

Oral health status of older adults in Kentucky: results from the Kentucky Elder Oral Health Survey.

The purpose of the Kentucky Elder Oral Health Survey (KEOHS) was to assess the oral health status of Kentuckians 65 and older. The KEOHS consisted of a self-administered questionnaire and a clinical examination. Recruitment occurred from May 2002 through March 2005 of persons aged 65 and older (n = 1,386) whose functional ability was classified by residential setting. Independent elders living in their own homes were designated as "well-elders," those who lived in skilled nursing facilities and who were functionally dependent were designated as "nursing home elders," and those older adults who were considered frail were designated as "homebound elders." Significant associations were found between the functional ability of the elders and demographic characteristics. While elders who were homebound reported the highest rate of barriers to care, dental insurance, affordability, and transportation were consistently reported as barriers for all groups of elders. This study has established the baseline oral health status of older adults in Kentucky and the data show differences that exist for various community living situations.

Poor oral hygiene in long-term care.

The poor oral care given to vulnerable patients in long-term care settings can have serious consequences, including increased risk of stroke, heart disease, and pneumonia. Nurses can take action by making sure supplies are in place, promoting oral care to all direct care staff and administrators, and making evidence-based recommendations during resident care conferences.

Managing older patients who have neurologic disease: Alzheimer disease and cerebrovascular accident.

Neurologic diseases represent some of the most common disabling and costly conditions in older age. Alzheimer disease and cerebrovascular accidents (strokes) are two of the most common neurologic conditions, and represent the leading causes of nursing home placement. Dental professionals will be caring for older patients who have age-associated neurologic diseases, including Alzheimer disease and stroke because of the increased longevity of the United States population coupled with improved survivorship of these conditions as a result of advanced medical diagnosis and treatment. Understanding the clinical manifestations of these two common, but distinctly different, neurologic conditions will enable dental professionals to provide safe and rational dental care.

Common oral conditions in older persons.

Older persons are at risk of chronic diseases of the mouth, including dental infections (e.g., caries, periodontitis), tooth loss, benign mucosal lesions, and oral cancer. Other common oral conditions in this population are xerostomia (dry mouth) and oral candidiasis, which may lead to acute pseudomembranous candidiasis (thrush), erythematous lesions (denture stomatitis), or angular cheilitis. Xerostomia caused by underlying disease or medication use may be treated with over-the-counter saliva substitutes. Primary care physicians can help older patients maintain good oral health by assessing risk, recognizing normal versus abnormal changes of aging, performing a focused oral examination, and referring patients to a dentist, if needed. Patients with chronic, disabling medical conditions (e.g., arthritis, neurologic impairment) may benefit from oral health aids, such as electric toothbrushes, manual toothbrushes with wide-handle grips, and floss-holding devices.