Evaluation of knowledge, attitude and practices of dental students toward dental management of patients on antithrombotic therapy

Giriş: Antitrombotik ilaçlar, arteriyal/venöz trombozun önlenmesinde uzun süreli kullanılmaktadır. Diş hekimine başvuran hastaların cerrahi müdahale planlamalarında, bu ilaçların kesilmesi/düzenlenmesi önemlidir. Çalışmamızda İstanbul Medipol Üniversitesi’ndeki diş hekimliği lisans ve doktora öğrencilerinin antitrombotik/ antikoagülan kullanan hastaların yönetimine ilişkin bilgi düzeyi, tutum ve uygulamalarının değerlendirilmesi amaçlanmaktadır. Gereç ve Yöntem: Kesitsel çalışma için gönüllü 4. ve 5. sınıf diş hekimliği ve doktora öğrencilerine üç bölümden oluşan çevrimiçi (Google form) anket uygulanmıştır. Bölüm 1’de öğrencilerin demografik özelliklerine, Bölüm 2’de mesleki deneyimlerine ve Bölüm 3’te bu ilaçları kullanan hastaları yönetmedeki bilgi düzeyleri, tutum ve uygulamalarına yönelik çoktan seçmeli sorulara ulaşılmaktadır. Verilerin istatistiksel analizindeki-kare testi kullanılıp, anlamlılık düzeyi p<0,05 olarak belirlendi. Bulgular: Çalışmamıza %62,6’sı 4. sınıf, %25,5’i 5. sınıf, %11,9’u doktora öğrencilerinden oluşan toplam 302 öğrenci dahil edildi. 4. sınıfların %54,5’i, 5. sınıfların %70,1’i, doktora öğrencilerinin %77,8’i antitrombotik tedavi gören hastalarla karşılaşmaktadır. Bilgi düzeylerine yönelik sorular değerlendirildiğinde; 5. Sınıf öğrencilerin %59,7’sinin Clopidogrel kullanan hastaya ilacı kesmesini önerdiği, doktora öğrencilerinin %66,7’sinin önermediği belirlendi. 4. sınıf öğrencilerin %54,5’inin Aspirin kullanan hastaya ilacı kesmesini önerdiği, %88,9 oranında doktora öğrencilerinin ise önermediği belirlendi. 5. Sınıf öğrencilerin %28,6’sının iskemik kalp hastalığı olan hastalarda Clopidogrel tedavisinin optimal tedavi süresinin ilaç kaplı stentlerden (Drug –eluting stents) sonra ne kadar sürdüğünü bildiği, %97,2 oranında doktora öğrencilerinin bilmediği belirlendi. Tutum düzeylerine yönelik sorular değerlendirildiğinde; 4.sınıfların %51,9’unun kan tetkikleri istediği, doktora öğrencilerinin ise %80,6’sının istemediği görüldü. Uygulama düzeylerine yönelik sorular değerlendirildiğinde; katılımcıların %60,3’ü hasta tarafından alınan ilaç ne olursa olsun, kan tetkikleri terapötik sınırlar içindeyse dental girişimi gerçekleştireceğini, %49’unun invaziv olmayan girişim gerekirse ilacı kesmeden tedaviye devam edeceğini, %89,7’sinin işlemden önce hastayı konsültasyona yönlendireceğini bildirdi. Sonuç: Klinik pratiğe yeni başlayan diş hekimlerinin hasta yönetimlerinde bilgi çeşitliliği ve hastalara yaklaşım farklılıkları sergilenmektedir. Hekim ve hekim adaylarının yeni nesil ilaçlara dair kanıta dayalı rehberlik sunulmasını, bu konudaki eksik bilgi, tutum ve uygulamalar için eğitici programlar planlanması gerektiğini düşünmekteyiz.Introduction: Antithrombotic medicines are long term treatments for arterial/venous thrombosis prevention. It’s important to conduct a risk assessment before discontinuing or regulating these drugs for surgical intervention planning. This study aimed to evaluate the knowledge level, attitudes, practices of dentists undergraduate and PhD students at Istanbul Medipol University regarding the management of patients using antithrombotic/ anticoagulant. Material and Method: This cross-sectional study, an online questionnaire consisting of three parts was applied to volunteer 4th,5th grade dentistry and PhD students. In Part 1, demographic characteristics of the students; in Part 2 their professional experience; in Part 3, multiple-choice questions about their knowledge, attitudes and practice were examined in managing patients who taking these medications. Chi-square test was used in statistical analysis, level of significance was determined p<0.05. Results: Total of 302 students, 62.6% 4th, 25.5% 5th, 11.9% PhD were included. 54.5% 4th grade, 70.1% 5th grade, 77.8% PhD encounter patients who take medication. In knowledge level questions, it was determined that 59.7% 5th grade students recommended discontinuing Clopidogrel, while 66.7% graduate students didn’t. 54.5% 4th grade students recommended discontinuing aspirin, while 88.9% PhD didn’t. 28.6% 5th grade students knew how long optimal treatment duration of Clopidogrel in patients with ischemic heart disease lasted after drugeluting stents, and 97.2% graduate students didn’t. In attitude level questions, 51.9% the 4th grade students wanted blood tests, while 80.6% the graduate students didn’t. In attitude questions, 60.3% participants stated that they'll perform intervention if blood tests are within therapeutic limits, regardless of medication, 49% them will continue the treatment without stopping if noninvasive intervention is required, 89.7% them will refer the patient to consultation. Conclusion: Patient management of dentists who have just started clinical practice, there is a diversity of knowledge and differences. We think that evidence-based guidance on new generation drugs should be provided, educational programs should be planned

Evaluation of the working posture and upper extremity musculoskeletal complaints among dentistry students

Objective: The prevalence of musculoskeletal disorders (MSDs) among dentists is high and adversely affects the quality of life. In this study, we aimed to evaluate musculoskeletal complaints, working postures, and the risk of MSDs among dentistry students across different departments. Methods: 180 dentistry students were divided into six groups according to their departments. For evaluation of the musculoskeletal complaints, we used the standardized Nordic musculoskeletal disorders questionnaire. The working postures and the potentiality of MSDs were evaluated using the ‘Rapid Upper Limb Assessment’ (RULA). Results: We found that 92.8% of the students had musculoskeletal pain during the last 12 months, and the highest prevalence of symptoms was reported for the neck (68.3%) and the upper back (62.2%). The mean RULA score of the students was 5.02 ± 1.31, indicating a high risk of MSDs. The highest RULA mean score was in the pedodontics group. Conclusion: Our study found a high prevalence of musculoskeletal complaints and high RULA scores among all the dentistry students. Therefore, ergonomic solutions should be developed to regulate their working postures according to the relevant department to prevent future disorders and if necessary, students should encourage to seek professional medical help.Amaç: Diş hekimleri arasında kas-iskelet sistemi (KIS) rahatsızlıklarının görülme sıklığı yüksektir ve yaşam kalitesini olumsuz etkilemektedir. Bu çalışmanın amacı farklı branşlarda çalışan diş hekimliği öğrencilerinde KIS ile ilgili şikayetleri, öğrencilerin çalışma postürlerini ve KIS rahatsızlıklarının gelişme riskini değerlendirmektir. Yöntem: 180 diş hekimliği öğrencisi bölümlerine göre altı gruba ayrıldı. Kas-iskelet sistemi şikayetlerinin değerlendirilmesi için, standardize edilmiş İskandinav kas-iskelet sistemi hastalıkları anketi kullanıldı. Çalışma duruşları ve KIS rahatsızlıklarının gelişim potansiyeli “Hızlı Üst Ekstremite Değerlendirmesi” (RULA) kullanılarak değerlendirildi. Bulgular: Diş hekimliği öğrencilerinin 92.8%’i son 12 ay içinde kas-iskelet sistemi ağrısı yaşamıştır ve en fazla semptom boyunda (68.3%) ve üst sırtta (62.2%) bildirilmiştir. Öğrencilerin ortalama RULA skoru 5.02 ± 1.31 olup KİS hastalıkları için ‘yüksek risk’ olarak kategorize edilmişti. En yüksek RULA skor ortalaması pedodonti bölümünde bulunmuştur. Sonuç: Çalışmamız, öğrencilerde yüksek oranda KIS şikayetleri ve yüksek RULA skorları bulmuştur. Bu nedenle ileride oluşabilecek rahatsızlıkları önlemek için çalışma duruşlarını ilgili bölüme göre düzenleyecek ergonomik çözümler geliştirilmeli ve gerekirse öğrenciler profesyonel tıbbi yardım almaya teşvik edilmelidir

Evaluation of the hepatitis B, hepatitis C, HIV seroprevalences and level of knowledge, attitudes and behaviors of hepatitis B ınfection of a faculty of dentistry students: Cross-sectional clinical study

Hepatit B virüsü (HBV) enfeksiyonu, toplumumuzda yaygın olarak görülen ve dental işlemler yoluyla diş hekimlerinden hastalara ya da hastalardan diş hekimlerine bulaşabilen bir viral enfeksiyondur. Bu çalışmada, diş hekimliği fakültesi 4 ve 5. sınıf öğrencilerinin HBV enfeksiyonu ile ilgili bilgi düzeylerinin, bu konudaki tutum ve davranışlarının değerlendirilmesi amaçlandı. Buna ek olarak, yüksek bulaşıcılık oranına sahip HBV, hepatit C virüsü (HCV) ve insan immün yetmezliği virüsü [human immunodeficiency virus (HIV)] seroprevalansları değerlendirildi. Gereç ve Yöntemler: Bu kesitsel klinik araştırmada, gönüllülere demografik bilgiler, HBV hakkındaki bilgi düzeyleri, tutum ölçeği ve davranış ölçeği olmak üzere 4 bölümden oluşan çevrim içi anket uygulandı. Öğrencilerin HBV, HCV ve HIV seroprevalanslarının değerlendirilmesinde ise ELISA testi kullanıldı. Bulgular: 4. Sınıf öğrencilerinin bilgi düzeyi skorları ile tutum puan ortalamaları arasında istatistiksel olarak anlamlı farklılık gözlendi (p=0,0001). Bilgi düzeyi yüksek olan öğrencilerin tutum puanı ortalamaları, bilgi düzeyi orta olan öğrencilerden istatistiksel olarak anlamlı derecede yüksek bulundu (p=0,0001). 4. Sınıf öğrencilerinden bilgi düzeyi düşük olan öğrencilerin davranış puanı ortalamaları, bilgi düzeyi orta ve yüksek olan öğrencilerden istatistiksel olarak anlamlı derecede düşük bulundu (p=0,012, p=0,001). 5. Sınıf öğrencilerinin ise bilgi düzeyi, tutum ve davranış puan ortalamaları arasında istatistiksel olarak anlamlı farklılık gözlenmedi (p=0,156, p=0,574). Sonuç: HBV genel bilgi seviyesi ve serolojik test sonuçları yeterli düzeyde görünse de kliniğe yeni başlayan 4. sınıf öğrencilerinden HBV enfeksiyonu hakkında bilgi düzeyi düşük olanların tutum ve davranışlarının daha yetersiz olduğu görüldü. Bu sonuç, sürekli enfeksiyon kontrolü eğitiminin gerekliliğini vurgulamaktadır.Hepatitis B virus (HBV) infection is a common viral infection in our society that can be transmitted from dentists to patients or from patients to dentists during the dental procedures. In this study, the aim was to evaluate the knowledge, attitudes, and behaviors of HBV virus infection among 4th and 5th grade students in School of Dentistry. Additionally, seroprevalences of highly contagious HBV, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) were evaluated. Material and Methods: In this cross-sectional clinical study, an online questionnaire consisting of four parts: demographic information, knowledge of HBV, attitude scale and behavior scale was applied to the volunteers. The ELISA test was used to evaluate the students' HBV, HCV and HIV seroprevalences. Results: Significant difference was observed between knowledge scores of 4th grades and attitude scores (p=0.0001). Attitude score with high knowledge was found to be significantly higher with medium knowledge (p=0.0001). Average behavioral scores of 4th grade with low knowledge were found to be significantly lower than medium and high knowledge (p=0.012, p=0.001). No significant difference was observed between knowledge, attitude, and behavior scores in 5th grades (p=0.156, p=0.574). Conclusion: Although the overall knowledge of HBV and serological test results seemed to be adequate, 4th grade students with lower knowledge showed inadequate attitudes and behaviors. This result highlighted the necessity of infection control education in a regular basis

Oral health during pregnancy and the lactation

Oral health is an integral part of overall health, and its deterioration negatively affects the general health and the quality of human life. Therefore, the relationship between pregnancy and oral health has been frequently investigated, and possible mechanisms are discussed. The purpose of this chapter is to briefly discuss this relationship and shed light on the importance of preserving oral health during pregnancy

Evaluation of inter-maxillary fixation techniques for multi-piece Le Fort I osteotomies using finite element analysis

OBJECTIVE: A strong postoperative occlusal relationship is essential for the long-term stability of the jaw relations post orthognathic surgery. In multi-piece Le Fort I osteotomy, obtaining a satisfactory inter-maxillary fixation (IMF) of the mobilized segments in the correct position and according to the preoperative plan is difficult. Herein, we aimed to evaluate three different IMF techniques (tooth-supported, bone-supported, or hybrid IMF) using finite element analysis (FEA) of the occlusal surfaces of four models: three multi-piece (lateral incisor-canine, central incisor-central incisor, and canine-first premolar) and a single one-piece Le Fort I osteotomy scenario. MATERIALS AND METHODS: Three different IMF techniques were applied separately to three different multi-piece models and a single one-piece Le Fort I model designed using related software. Simulation brought the lower and upper jaw models to the planned occlusion. Each model's occlusal force was applied to determine their distributions under 100 N, 300 N, and 800 N loads. Forces on the maxilla and mandible during fixation, the effect of these forces on the force distribution in the occlusion, and the accumulated stresses in these regions were determined with Algor Fempro and Rhinoceros software to determine the ideal fixation method. Data obtained were interpreted and evaluated according to the advantages and disadvantages of the actual surgical scenario. RESULTS: In all four models studied, the hybrid IMF technique was found to be the ideal IMF technique, followed by the teeth- and bone-supported IMF techniques. CONCLUSIONS: FEA allows the manipulation of single parameters, which clinical methods cannot obtain, thereby allowing each to be examined separately. Further clinical trials are required to validate these findings

Superficial cervical plexus block on pain control in patients with temporomandibular joint internal derangement with headache: A retrospective cohort study

OBJECTIVES: Temporomandibular disorders (TMDs) are a group of disorders with varied pathophysiology and clinical manifestations. Masticatory and cervical motor systems have a functional relationship. Superficial cervical muscles have greater hyperactivity in myogenous and mixed TMDs than in healthy individuals, demonstrating an abnormal pattern of contraction. This study aimed to demonstrate the effects of superficial cervical plexus block (SCPB) anesthesia during arthrocentesis in patients with temporomandibular joint (TMJ) internal derangement and headache. METHOD AND MATERIALS: This retrospective cohort study included 2 men and 23 women with cervicogenic headache and TMJ internal derangement treated by arthrocentesis, and 40 TMJs with established cervicogenic headaches. The average follow-up period was 9.36 ± 2.679 months. TMJ and muscle pain during mastication, maximum and non-assisted mouth opening, and lateral excursion were recorded. Pain and dysfunction were determined using the visual analog scale. Patients were monitored before, during, and after arthrocentesis while inducing SCPB anesthesia, and vital findings were recorded. In addition, skin surface temperature was measured. RESULTS: Patients experienced a significant increase in their clinical values. Changes in non-assisted mouth opening (mean from 29.65 ± 6.31 to 33.3 ± 5.21 mm) (P < .05), assisted mouth opening (mean from 38.98 ± 7.62 to 43.35 ± 6.17 mm), right excursions (mean from 7.28 ± 2.08 to 9.13 ± 1.86 mm), and left excursions (mean from 7.48 ± 1.71 to 8.90 ± 1.82 mm) were statistically significant (P < .05). Patients were relieved after SCPB, resulting in decreased pain and hemodynamic values. Increase in mean temperature after SCPB was statistically significant (P = .002, P < .05). CONCLUSION: This study presents a straightforward novel protocol, clinically efficient for arthrocentesis on pain control in patients with TMJ internal derangement and cervicogenic headache

Modified high-level Le Fort I advancement without malar augmentation: Assessment of effect on midfacial aesthetics

The 'beauty arch', an aesthetic feature of the midface, is a double-S-shaped curve that extends downward from the lateral canthus. This retrospective study evaluated whether modified high Le Fort I advancement (combined with impaction or down-grafting) without malar augmentation can approximate a patient's 'ideal' beauty arch (IBA). Pre- and postoperative profile (natural head position) photographs for 36 patients with midfacial hypoplasia were aligned digitally. For each individual, standardized methods were used to identify landmarks and draw the preoperative real beauty arch (RBA), postoperative RBA, and IBA. Distances from a defined landmark to each arch were measured and means were compared. The mean advancement range was 4.2 +/- 2.2 mm, and the mean pre- and postoperative RBA distances were significantly different (138.7 +/- 24.1 vs 145.0 +/- 25.8 pixels, respectively; P = 0.0001). In the impaction and down-grafting subgroups, there was no significant correlation between amount of maxillary movement and the difference between pre- and postoperative RBA distances (P > 0.05 for both). The postoperative RBA was satisfactorily close to the IBA in 35 cases (97.2%); one patient required later augmentation. The findings suggest that modified high Le Fort I advancement surgery without malar augmentation provides satisfactory malar projection for most patients with maxillary hypoplasia

Effect of orthognathic surgery on movement of the cheilion

The cheilion (Ch), corner of the mouth, is the soft-tissue landmark where the upper and lower lips intersect. Orthognathic surgery can modify Ch position, which can affect facial esthetics. The aims were to evaluate Ch movements resulting from Le Fort I maxillary advancement with maxillary impaction or downgrafting, and with mandibular advancement or setback, and to investigate relationships between surgical movements and Ch movements. The 45 patients had undergone bilateral sagittal split ramus osteotomy with Le Fort I advancement surgery. They were divided into 4 groups according to surgical movement direction. Preoperative and postoperative photographs were calibrated. Standardized methods were used to identify and measure preoperative and postoperative Ch positions. Significant correlations were detected between extent of maxillary downgrafting and inferior movement of the Ch in group 1 (r=0.988, P=0.001) and group 3 (r=0.915, P=0.001). Also, significant correlations were detected between extent of mandibular advancement and anterior movement of the Ch in group 3 (r=0.561, P=0.046) and group 4 (r=0.661, P=0.005). The findings indicate that, in patients who undergo bilateral sagittal split ramus osteotomy/Le Fort I surgeries, mandibular advancement moves Ch anteriorly and maxillary downgrafting moves Ch inferiorly

Comparison of scleral show alterations following Le Fort I osteotomy with either maxillary impaction or lengthening

This study aimed at evaluating changes in scleral show following Le Fort I osteotomy with either impaction or lengthening of the mid face. Patients who underwent Le Fort I osteotomy were included. The patients were divided according to the direction of the movement: group 1 underwent maxillary advancement and impaction, while group 2 underwent maxillary advancement and lengthening. Standardized preoperative and 6-month postoperative photos were superimposed using Microsoft Power-Point. The inferior visible scleral area was assessed with landmarks and measured separately using ImageJ software. Marked scleral surface area was determined using pixel count. A total of 36 consecutive patients were included. The mean maxillary advancement in the patients was 4.16 +/- 2.14 mm. The mean impaction in group 1 (n = 21) was 1.06 +/- 1.49 mm, while the mean vertical lengthening in group 2 (n = 15) was 1.54 +/- 1.65 mm. The difference in improvement in the inferior scleral show between the groups was not statistically significant. Preoperative (180 +/- 118.2 mm) and postoperative (147.75 +/- 92.2 mm) scleral show significantly improved (p = 0.012) in both groups. Scleral show can be overlooked for movements under 6 mm while planning for maxillary orthognathic movement, as it improves regardless of the desired movement