Factors influencing postoperative bleeding after dental extraction in older adult patients receiving anticoagulation therapy.

OBJECTIVES: To investigate factors influencing postoperative bleeding occurrence after dental extraction in older patients receiving anticoagulation therapy. MATERIALS AND METHODS: This retrospective study included patients aged ≥ 65 years receiving one of the following anticoagulants: apixaban, edoxaban, rivaroxaban, and warfarin. Patients who underwent one to multiple tooth extractions in the geriatric dentistry clinic at Tokyo Medical and Dental University Hospital between August 1, 2016, and November 30, 2020, were included. The outcome variable was postoperative bleeding occurrence. Logistic regression analysis was performed with the following ten factors as explanatory variables: age, sex, maximum systolic blood pressure during the extraction, type of local anesthesia, vertical incision, osteotomy, usage of surgical splints, the mesiodistal width of the extracted tooth on a radiograph, use of antiplatelet agents, and history of diabetes requiring medication. RESULTS: Among 395 participants (mean age, 82.3 ± 6.5 years) included in this study, 75 patients experienced postoperative bleeding after tooth extraction. Logistic regression analysis revealed that the odds ratios for the vertical incision (18.400, p < 0.001), osteotomy (3.630, p = 0.00558), usage of surgical splints (1.860, p = 0.0395), and the mesiodistal width of the extracted tooth on a radiograph (1.060, p = 0.0261) were statistically significant. CONCLUSIONS: For dental extraction in older patients receiving anticoagulants, postoperative bleeding is more likely to occur in patients with vertical incision, osteotomy, and posterior or multiple tooth extractions. CLINICAL RELEVANCE: Dentists should consider suturing and adjunctive hemostatic procedures for patients undergoing vertical incision, osteotomy, and multiple tooth extractions while receiving anticoagulation therapy to minimize the risk of postoperative bleeding.

Postoperative bleeding after dental extraction among elderly patients under anticoagulant therapy.

OBJECTIVES: This study aimed to assess and compare postoperative bleeding occurrence after dental extraction in medically compromised elderly patients under anticoagulant therapy. MATERIALS AND METHODS: This retrospective study included medically compromised elderly patients aged ≥ 65 years who were taking apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin and had undergone single or multiple dental extractions. The primary outcome measure was postoperative bleeding occurrence, which was defined as oozing or marked hemorrhage from 24 h to 7 days after dental extraction. Postoperative bleeding occurrence was calculated for each anticoagulant and compared using Fisher's exact test, followed by multiple comparisons. RESULTS: Two hundred thirty-two patients met the inclusion criteria. The highest postoperative bleeding occurrence was recorded for rivaroxaban (12/37: 32.4%), followed by apixaban (8/44: 18.2%), warfarin (17/98: 17.3%), and edoxaban (2/35: 5.7%). Patients taking dabigatran did not present postoperative bleeding (0/18: 0%). Fisher's exact test, followed by multiple comparison tests, revealed a significant among-anticoagulant difference (p = 0.0095). Postoperative bleeding was significantly higher in patients taking rivaroxaban than in those taking edoxaban or dabigatran (p = 0.03088). CONCLUSIONS: Within the limitations of this retrospective study design, these findings suggest that different anticoagulants may affect postoperative bleeding occurrence after dental extraction among medically compromised elderly patients. CLINICAL RELEVANCE: Clinicians should carefully consider postoperative bleeding after dental extraction in patients taking anticoagulant therapy, especially rivaroxaban.

Comparison of cardiovascular response between patients on warfarin and hypertensive patients not on warfarin during dental extraction.

OBJECTIVE: To evaluate cardiovascular response in patients on warfarin and hypertensive patients not on warfarin during dental extraction. MATERIALS AND METHODS: This retrospective study included 53 patients who had undergone dental extraction while on warfarin (mean age 78.8 ± 6.3 years, 26 men) and 66 with hypertension who had undergone dental extraction but were not on warfarin (mean age 77.4 ± 6.8 years, 22 men). Vital signs were monitored in both groups during extraction. RESULTS: The highest systolic blood pressure (SBP) values (mean 150.1 ± 21.1 mmHg) were observed in patients on warfarin before (9.0%) and after (10.3%) administration of local anesthesia (LA), during extraction (39.7%), and during (33.3%) and after (7.7%) suturing (n = 78; p < 0.01), and in hypertensive patients not receiving warfarin (160.6 ± 24.8 mmHg) before (19.2%) and after (27.3%) administration of LA, during extraction (29.3%), and during (18.2%) and after (6.1%) suturing (n = 99; p < 0.01). The highest SBP was linearly correlated with SBP before administration of LA in patients on warfarin (highest SBP = 0.9415 × SBP before LA + 23.243, R2 = 0.75481) and in hypertensive patients not on warfarin (highest SBP = 1.0027 × SBP before LA + 15.789, R2 = 0.60341). CONCLUSIONS: The highest SBP was not distributed evenly between patients on warfarin and hypertensive patients not on warfarin during dental extraction and was strongly associated with SBP before LA regardless of anticoagulant status. CLINICAL RELEVANCE: Thorough management of SBP is required in patients on warfarin to avoid thromboembolism and major hemorrhagic complications. Knowing the SBP value before dental treatment would help predict the risk of cardiovascular complications.

An intervention study to test Locker's conceptual framework of oral health in edentulous elders.

OBJECTIVE: To test a previously described conceptual framework of oral health in edentulous elders using an intervention study that included complete denture replacement. Confirmatory factor analysis (CFA) was also conducted to substantiate construct validity. BACKGROUND DATA: To date, the model proposed by Locker has been tested on edentulous elders using structural equation model (SEM) analysis. However, cross-sectional designs and the Short-Form Oral Health Impact Profile (OHIP-14) cannot adequately express cause-effect relationships and distribution in edentulous patients. Accordingly, the authors investigated Locker's model using an interventional design that included complete denture replacement using the OHIP for edentulous subjects (OHIP-EDENT). METHODS: A total of 265 edentulous participants who visited the Dental Hospital of Tokyo Medical and Dental University (Tokyo, Japan) for new complete dentures were recruited. Locker's model was investigated, and CFA was performed using the change in subscale scores in the Japanese version of the OHIP-EDENT before and after complete denture replacement. RESULTS: CFA demonstrated an excellent model fit after adding several covariates. The Locker model also met the criteria of fit in all indices after 1 nonsignificant path was omitted. All path coefficients were significant. CONCLUSION: The findings of the present interventional study demonstrated an empirical fit to Locker's model in edentulous elders using SEM analysis, which included complete denture replacement. It is anticipated that clarification of causal mechanisms of oral health-related quality of life will lead to improvement of overall quality of life, thus maintaining or improving the activities of normal daily life for edentulous elders.

A structural equation model to test a conceptual framework of oral health in Japanese edentulous patients with an item weighting method using factor score weights: a cross-sectional study.

BACKGROUND: To investigate Locker's multidimensional model of oral health in Japanese edentulous patients with an item weighting method using factor score weights, which is more accurate than the sum scoring method. A previous study tested Locker's model in edentulous elders in the UK, using empirical evidence from the Short-Form Oral Health Impact Profile (OHIP-14). Investigating the model using the OHIP for edentulous subjects (OHIP-EDENT), which contains 19 items suitable for these patients, may complement that study. Testing Locker's model in Japanese patients may support generalization of the model. METHODS: A total of 394 patients who were edentulous in both arches and visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures were recruited. This cross-sectional study had a non-probabilistic sampling design and included the following: data collection; application of the new item weighting method that involves hierarchical confirmatory factor analysis (CFA) to derive factor score weights for each item, using the bootstrap method, to check the significance of the factor score weights; and empirical testing of Locker's conceptual model of oral health in Japanese edentulous patients, using structural equation modelling analysis with the bootstrap method for precise estimations and model generation. RESULTS: Factor score weights derived from CFA were significant. After item weighting, the initial model was analyzed and found to have an inconsistent direct path (functional limitation to disability). This path was eliminated from the model and the modified model was re-run. All effects were significant. The model showed acceptable fit on indices including the model chi-squared, standardized root-mean-square residual, root mean-square error of approximation, goodness-of-fit index, comparative fit index, and P-value. CONCLUSIONS: Our findings showed an empirical fit to Locker's model in Japanese edentulous patients when using the item weighting method, which was more accurate than the sum scoring method. These results could contribute to the generalization of Locker's model. TRIAL REGISTRATION: The experimental procedures were published in the University hospital Medical Information Network (UMIN) Center (UMINCTR Clinical Trial, Unique trial Number: UMIN000028711 ).

A structural equation model to assess the influence of neuroticism on oral health-related quality of life in complete denture wearers.

OBJECTIVE: To investigate the influence of patient neuroticism on oral health-related quality of life (OHRQoL) in complete denture wearers. BACKGROUND: There are some indicators of complete denture prognosis. The relationship between personality traits, mainly neuroticism and OHRQoL in complete denture wearers remains unclear. MATERIALS AND METHODS: A total of 199 edentulous patients participated in this study. Neuroticism was investigated using the Japanese version of the modified short form of the Eysenck Personality Questionnaire (MS-EPQ). OHRQoL was measured according to the Japanese version of the Oral Health Impact Profile for edentulous subjects (OHIP-EDENT-J). Structural equation modelling was used to evaluate the relationship between neuroticism and subscales of the OHIP-EDENT-J. RESULTS: The High and Low neuroticism groups fit the same model for the 5 subscales of the OHIP-EDENT-J-functional limitation, pain, disability, discomfort and handicap-with different path coefficients. The path from functional limitation to handicap via pain, disability and discomfort was the same as previously reported. However, path coefficients for pain to disability differed significantly between the 2 neuroticism groups. The High neuroticism group had higher estimated path coefficients for Pain compared with those for other subscales than did the Low neuroticism group. This finding indicates that the participants who are high in neuroticism felt pain more strongly, and their disability increased. CONCLUSIONS: Neuroticism may influence OHRQoL in complete denture wearers because of patients' perception of pain.

Reliability and validity of a Japanese version of the Oral Health Impact Profile for edentulous subjects.

OBJECTIVE: To evaluate the reliability and validity of the Japanese version of the Oral Health Impact Profile for edentulous (OHIP-EDENT-J) patients. BACKGROUND: Oral Health Impact Profile for edentulous is an appropriate instrument for assessing the Quality of life (QOL) in edentulous patients. However, the reliability and validity of the Japanese version had not been evaluated. METHODS: The study was conducted on 116 edentulous patients (Group A, requiring new dentures, n = 61; Group B, already having dentures, n = 55). Cronbach's alpha (α) was used to measure internal consistency of the summary scores for OHIP-EDENT-J and various subscales in Groups A and B. The interclass correlation coefficient (ICC) and 95% confidence interval of the summary scores for OHIP-EDENT-J and subscales were calculated. The summary scores for OHIP-EDENT-J in Groups A and B were compared with evaluate content validity. The Spearman's correlation coefficient between the summary scores for OHIP-EDENT-J and the satisfaction with dentures (100 mm VAS) was calculated for Groups A and B to evaluate concurrent validity. RESULTS: The reliability of the summary scores for OHIP-EDENT-J was good (α = 0.93). The ICC of the summary scores for OHIP-EDENT-J was 0.85. Summary scores for OHIP-EDENT-J were significantly different (p = 0.027) between Group A and Group B, with Group A having the higher value. The Spearman's correlation coefficient for the degree of satisfaction with dentures and the summary scores for OHIP-EDENT-J, calculated for Groups A and B (n = 107), was -0.609. CONCLUSION: The OHIP-EDENT-J, a questionnaire on oral health-related QOL comprising 19 items, showed good reliability and validity for edentulous patients.

Structural equation modeling of the impact of mandibular ridge form and denture quality on oral health-related quality of life in complete denture wearers.

PURPOSE: To examine the effect of mandibular ridge form and denture quality on oral health-related quality of life (OHRQoL) in complete denture wearers by using structural equation modeling (SEM) analysis of data before and after new complete denture insertion. METHODS: Four hundred thirty-two edentulous patients who visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures were recruited. An intervention study design was conducted, including complete denture fabrication with SEM analysis. Mandibular ridge form, mandibular denture stability, accuracy of jaw relation record, and the Oral Health Impact Profile for edentulous subjects (OHIP-EDENT-J) total score before and after new complete denture insertion were used in the hypothesized model. RESULTS: Two hundred and thirty-seven participants completed the research. SEM analysis demonstrated adequate model fit. Path coefficients of mandibular ridge form to OHIP-EDENT-J before and after insertion, and mandibular denture stability to OHIP-EDENT-J before insertion, were significant. CONCLUSIONS: This study demonstrated that mandibular denture stability and mandibular ridge form are important to ensure successful complete denture therapy.

Relationship Between Oral Health-Related Quality of Life and Usage Period of Complete Dentures.

PURPOSE: To investigate the relationship between oral health-related quality of life (OHRQoL) and usage period of complete dentures. MATERIALS AND METHODS: Data were obtained from 432 edentulous patients who required complete dentures as part of an investigation registered in the University Hospital Medical Information Network (UMIN) Center (UMINCTR clinical trial, unique trial number: 000028711). Mandibular ridge form, denture quality, and usage period of the dentures were recorded and incorporated into a multiple linear regression analysis. RESULTS: Multiple linear regression analysis in the 267 participants who completed the study demonstrated significant effects on OHRQoL of mandibular ridge form, mandibular denture stability and retention, accuracy of jaw relation recording, and usage period of dentures. CONCLUSION: A significant relationship between the usage period of dentures and OHRQoL in complete denture wearers was noted when the effects of mandibular ridge form and denture quality were controlled for.

A structural equation model relating oral condition, denture quality, chewing ability, satisfaction, and oral health-related quality of life in complete denture wearers.

OBJECTIVES: To investigate the relationship between mandibular ridge form, stability and retention of mandibular complete denture, accuracy of jaw relation recording, patients' perception of chewing ability, satisfaction with dentures and oral health-related quality of life (OHRQoL) in complete denture wearers. METHODS: A total of 183 edentulous patients, who visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures, were recruited. Oral examination was performed. Cawood and Howell's method was used to grade the mandibular ridge form. The stability and retention of the mandibular complete denture were assessed using Kapur method. Accuracy of jaw relation recording was evaluated using a newly developed jaw relation index. Patients' perception of chewing ability was rated using a food intake questionnaire. Patients' satisfaction with complete dentures was assessed on a 100-mm visual analogue scale. OHRQoL was measured using the Japanese version of the Oral Health Impact Profile for edentulous subjects. A structural equation model was constructed based on the hypothesis that oral condition and denture quality would be related to chewing ability, satisfaction and OHRQoL. RESULTS: Significant relationships were found between mandibular ridge form, stability of mandibular complete denture, accuracy of jaw relation recording, perceived chewing ability, satisfaction and OHRQoL. Various fit indices were within acceptable limits. CONCLUSIONS: Oral condition and denture quality were related to patients' perception of chewing ability, satisfaction with dentures and OHRQoL in complete denture wearers. CLINICAL SIGNIFICANCE: A favourable oral condition and denture quality are important for successful complete denture therapy.