Implications of apixaban for dental treatments

Anticoagulation therapy is used in several conditions to prevent or treat thromboembolism. Recently, new oral anticoagulants have been introduced as alternatives to warfarin and acenocoumarol. In Europe, the European Medicines Agency has approved dabigatran, rivaroxaban and apixaban. Their advantages include: predictable pharmacokinetics, drug interactions and limited food, rapid onset of action and short half-life. However, they lack a specific reversal agent. A literature search was conducted through November 2015 for publications in the ISI Web of Knowledge, PubMed, Scopus and Cochrane Library using the keywords “apixaban”, “rivaroxaban”, “dabigatran”, “new oral anticoagulants”, “dental treatment” and “dental implications”. We included studies published in English and Spanish over the last 10 years. Apixaban has been recently introduced in the daily medical practices for the control of thromboembolism. The number of patients taking apixaban is increasing. Management of patients on anticoagulation therapy requires that dentists can accurately assess the patient prior to dental treatments. It is important for dentists to have a sound understanding of the mechanisms of action and management guidelines for patients taking new oral anticoagulants. The dentist should consider carefully the management of patients on apixaban. This paper sets out a clinical guidance of dental practitioners treating these patients. There is a need for further clinical studies in order to establish more evidence-based guidelines for dental patients requiring apixaban

Influence of the usual motivation for dental attendance on dental status and oral health-related quality of life

Objectives: To evaluate the influence of dental visiting patterns on the dental status and Oral Health-related Qua- lity of Life (OHQoL) of patients visiting the University Clinic of Salamanca (Spain). Study Design: This cross-sectional study consisted of a clinical oral examination and a questionnaire-based inter - view in a consecutive sample of patients seeking a dental examination. Patients were classified as problem-based dental attendees (PB) and regular dental attendees (RB). Clinical and OHQoL (OHIP-14 & OIDP) data were compared between groups. Pair-wise comparisons were performed and a Logistic Regression Model was fitted for predicting the Odds Ratio (OR) of being a PB patient. Results: The sample was composed of 255 patients aged 18 to 87 years (mean age: 63.1 ± 12.7; women: 51.8%). The PB patients had a poorer dental status (i.e. caries, periodontal and prosthetic needs), brushed their teeth less,and were significantly more impaired in their OHQoL according to both instruments. The logistic regression coef - ficients demonstrated that on average the OR of being a PB patient was high in this dental patient sample, but this OR increased significantly if the patient was a male (OR= 1.1-5.0) or referred pain-related impacts according to the OHIP and, additionally, the OR decreased significantly as a function of the number of healthy fillings and the number of sextants coded as CPI=0. Conclusions: Regular dental check-ups are associated with better dental status and a better OHQoL after control - ling for potentially related confounding factors

The role of topical simvastatin on bone regeneration: a systematic review

Objectives: The aim of this systematic review was to summarize the results concerning the use of simvastatin for promoting bone regeneration and to discuss the level of scientific evidence supporting such findings. Material and Methods: A Pubmed search using "Simvastatin"[Mesh] AND "Bone Regeneration"[Mesh] as Boolean operators was constrained to the last 10 years and only included papers written in English. Results: Of the 41 relevant papers reviewed, most of them (76.2%) have been published in the last 5 years, and most of them address animal studies (66.6%) performed on rats or rabbits in extraoral regions. Only 4 randomized controlled trials (RCTs) assessed the role of topical simvastatin in periodontal patients. Conclusions: A large part of the evidence concerning the role of topical simvastatin on bone regeneration comes from animal studies (mainly rats) focusing on extraoral bone defects. Only the use of subgingival simvastatin after root scaling has been properly supported by RCT

Aplicación para el control de asistencia, vigilancia y salud de pacientes en centros hospitalarios y residencias de ancianos

Debido a la velocidad con lo que avanzan las nuevas tecnologías y pasan a formar parte de nuestra vida cotidiana, esto nos ofrece una gran variedad de posibilidades con las que poder trabajar y crear soluciones para mejorar nuestra calidad de vida y facilitarnos nuestro día a día. Este proyecto nació con el objetivo de ofrecer ayuda y atención a las personas mayores, o personas con algún tipo de problema que requieran de atención y cuidados, haciendo uso de pulseras inteligentes con las que se ha conseguido obtener en tiempo real las constantes vitales, número de pasos, distancia y calorías diarias, recoger el tipo de actividad que realizan, comprobar mediante el uso de la tecnología GPS, que los pacientes se encuentran en todo momento dentro del centro y ofrecer un sistema de avisos con el que se informa al personal encargado acerca de un problema y/o anomalía que puedan sufrir los pacientes. Además, este proyecto se puede utilizar contra la Pandemia del Covid-19 en ayuda a las residencias de ancianos, ya que, gracias a este proyecto, podemos detectar síntomas del virus y reaccionar con rapidez para prestarle la atención sanitara requerida lo antes posible, y así, poner a salvo sus vidas. El proyecto consiste en el desarrollo de dos aplicaciones para el S.O Android. La primera aplicación, Aplicación cliente, se instalará en el dispositivo móvil que llevará el paciente y se conectará con la pulsera inteligente que éste llevará, mediante Bluetooth LE, y con la que se recogerán los datos del paciente en tiempo real mediante los sensores de ésta. Todos los datos se procesarán y se enviarán al servidor para almacenarlos y poder trabajar con ellos. La segunda aplicación, Aplicación de Gestión, está destinada al personal administrativo encargado. Con la que podrán gestionar todos los datos de los pacientes que estén dados de alta en el sistema, así como, ver su toda su historial e informes en referencia a las pulsaciones, pasos, etc, mediante gráficas y textos, y poder realizar acciones con los clientes, además, de poder realizar todas las acciones CRUD. Este proyecto puede implementarse en multitud de áreas, como, por ejemplo, en las residencias de ancianos o en los hospitales, entre otras, gracias a las oportunidades que ofrece.Ingeniería, Industria y Construcció

Curricula for the teaching of complete dentures in Spanish and Portuguese dental schools

Objectives: Given the need to ensure that dentists are sufficiently skilled to offer the best possible care to their patients, this study aims to evaluate the teaching methods and clinical experience achieved by undergraduate dental students in Spain and Portugal as regards complete dentures. Study design: In February 2011, a questionnaire seeking information about the preclinical and clinical teaching of complete dentures was e-mailed to all Spanish and Portuguese dental schools with fully developed undergraduate degree dental programs. Results: A response rate of 82.6% was obtained. The distribution of lectures and hours spent at the laboratory and in clinical activities revealed that teaching complete dentures is eminently a practical issue, this being mostly performed by full-time prosthodontists. All surveyed schools teach the design of the record base, and most of them instruct students in the mounting of teeth in wax. Most schools (94.7%) used a semiadjustable articulator, alginate for primary impressions (73.7%) and elastomeric materials in border-molded custom trays for final impressions (68.4%). In most schools, within the clinical setting students work in pairs, the mean student/ professional staff member ratio being 2.3 ± 0.7. Most schools perform a competence-based assessment (83.3%), although innovative techniques such as problem-based learning are still rarely applied. On average, the students emplaced 1.8 ± 1.2 complete dentures during their clinical training, ranging from 0 to 4, although no clear trend was seen as regards the minimum number of dentures to be made for graduating. Conclusions: Variations in teaching programs and clinical experience concerning complete denture curricula among Spanish and Portuguese dental schools are evident, but all the schools base their teaching mainly on preclinical and clinical practice. However, the low number of dentures made by student per year seems insufficient to ensure clinical skills and cope with social needs

The "TORONTO PROSTHESIS", an appealing method for restoring patients candidates for hybrid overdentures: a case report

The implant is a therapeutic resource in constant evolution, and the different types of implants and techniques have been increasingly used in cases of both fully or partially edentulous patients. In some cases they provide more conservative treatment, and in others better stability, retention, and function. To achieve a satisfactory result, there are several factors that should be taken into account: the type and quality of the bone, bone density, the placement location of implants, retrievability of restorations, the patient's motivation, and economic issues. Trainees should be aware of the limitations of the techniques that can be used for successful prosthetic rehabilitation. This work describes the prosthetic rehabilitation of a fully edentulous mandible treated with dental implants using the 'Toronto Bridge' technique for restoring both function and aesthetics. This type of prosthesis is a screwed-in mesostructure with milled abutments for the cementation of single or multiple suprastructures. This device could also be named 'abutment-hybrid overdenture' The main advantages and disadvantages of this protocol are discussed

Dental management of patients taking novel oral anticoagulants (NOAs): dabigatran

A new group of oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban) with clear advantages over classic dicoumarin oral anticoagulants (warfarin and acenocoumarol) has been developed in recent years. Patients being treated with oral anticoagulants are at higher risk for bleeding when undergoing dental treatments. A literature search was conducted through April 2016 for publications in the ISI Web of Knowledge, PubMed and Cochrane Library using the keywords “dabigatran”, “rivaroxaban”, “apixaban”, “edoxaban”, “new oral anticoagulants”, “novel oral anticoagulants”, “bleeding” and “dental treatment”. There is no need for regular coagulation monitoring of patients on dabigatran therapy. Whether or not to temporarily discontinue dabigatran must be assessed according to the bleeding risk involved in the dental procedure to be performed. The number of patients under treatment with new oral anticoagulants will increase in the coming years. It is essential to know about the pharmacokinetics and pharmacodynamics of new oral anticoagulants and about their interactions with other drugs. It is necessary to develop clinical guidelines for the perioperative and postoperative management of these new oral anticoagulants in oral surgical procedures, and to carefully evaluate the bleeding risk of dental treatment, as well as the thrombotic risk of suppressing the new oral anticoagulant

Hybrid layers of etch-and-rinse versus self-etching adhesive systems

Objective: To evaluate the effectiveness in the formation of resin tags, adhesive lateral branches and hybrid layers of five adhesive systems, when bonding to dentine. Material and Methods: Flat dentin surfaces from 25 molars were bonded with several adhesive systems according to the manufacturers? instructions. Composite build-ups were constructed incrementally with Tetric Ceram. The Specimens were sectioned parallel to the long axis. One section was treated with phosphoric acid and sodium hypochlorite in order to reveal the hybrid layer formation. The other section was stored in 30% hydrochloric acid to detect resin tags and adhesive lateral branch formation. Results: The two etch-and-rinse self-priming adhesives exhibited thicker hybrid layers than those found in self-etching adhesive systems. The all-in-one adhesive showed droplet formation between the adhesive and the resin composite. The resin tags formed with the etch-and-rinse adhesives were much longer than those found with the self-etching adhesives. Lateral branch formation was observed in etch-and-rinse adhesives and in one of the self-etch adhesives Clearfil SE Bond (SEB). Conclusion: The formed hybrid layer obtained with the two-step selfetching adhesives and the etch-and-rinse systems were continuous and uniform in thickness. Droplets within the all-in-one adhesive layer may occur as a result of water absorption from dentin through osmosis, and may interfere with proper resin polymerization. Resin tags obtained with SEB and the etch-and-rinse adhesive systems showed lateral branches, which is a sign of proper resin infiltration

Implementación de un modelo de aprendizaje interactivo responseware para adquirir competencias en odontología infantil

Memoria ID-001. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2021-2022