MANAGEMENT OF PATIENTS ON ANTICOAGULANT THERAPY UNDERGOING DENTAL SURGICAL PROCEDURES. Review Article.

Dental treatment performed in patients receiving oral anticoagulant drug therapy is becoming increasingly common in dental offices.The aim of oral anticoagulant therapy is to reduce blood coagulability to an optimal therapeutic range within which the patient is provided some degree of protection from thromboembolic events. This is achieved at the cost of a minor risk of haemorrhage. Frequently raised questions concern the safety and efficacy of the various anticoagulation regimens and their accompanying thromboembolic and bleeding risks relative to invasive dental procedures.The aim of this literature review is to evaluate the available evidence on the impact of anticoagulant medications on dental treatment and highlight certain patient management issues closely interrelated to various aspects of dental treatment. For that purpose literature search in the electronic database of Medscape, Pubmed-Medline, Science Direct, and EBSCO host, in the data base of Medical University Plovdiv and specialised published books in general medicine and dentistry was made.A total of 33 publications between 1995 and 2013 were identified: 12 review articles, 11 randomized controlled and non-randomised studies, 6 guidelines and practical guides, 1 meta-analysis and 3 specialised books

LOCAL ANESTHETICS IN PATIENTS WITH CARDIOVASCULAR DISEASES.

A significant problem in the dental medicine is pain alleviation. Many studies in the dental anesthesiology result in the production of new agents for locoregional anesthesia. Objective: This article aim to present the results of the last studies on the effect of the local anesthetics used in the oral surgery on patients with cardiovascular diseases. Material: A general review of the existing literature on the effect of the adrenaline, included as vasoconstrictor in the local anesthetics, used in patients with cardiovascular diseases is made. The benefits of vasoconstrictors for the quality of the anesthetic effect are proven. Conclusion: A small amount of adrenaline in the anesthetic solution does not result in complications development in patients with controlled cardiovascular diseases. Articaine is recommended agent of first choice for local anesthesia in the oral surgery

OPINION SURVEY OF THE CARDIOLOGISTS IN BULGARIA REGARDING THERAPY WITH ACETYLSALICYLIC ACID, CLOPIDOGREL AND ACENOCOUMAROL IN PATIENTS UNDERGOING DENTAL EXTRACTIONS

Purpose: Cardiovascular diseases are the leading cause of mortality and disability worldwide. Major role in the treatment and prophylaxis of these diseases and their complications has antiplatelet and anticoagulation therapy. Routine practice in the past was an interruption of antiplatelet and anticoagulant medication before dental extraction. Today most authors and dental associations recommend maintaining therapeutic levels of antithrombotic drugs in single or multiple teeth extractions due to the fact that the risk of serious embolic complications outweighs the risk of bleeding. The aim f the present study is to determine the opinion and approach of cardiologists in Bulgaria regarding therapy with Aspirin, Clopidogrel and Acenocoumarol in patients undergoing dental extractions. Material and Method: 222 cardiologists were interviewed about their approach in terms of antithrombotic therapy with acetylsalicylic acid (Aspirin), Clopidogrel (Plavix, Trombex) and Acenocoumarol (Sintrom) in patients undergoing dental extractions. Results: There is no consensus and an established protocol the cessation of enrolled medications and how long before dental extraction. Conclusion: There is no approved protocol regarding administration of acetylsalicylic acid (Aspirin) Clopidogrel (Plavix, Trombex) and Acenocoumarol (Sintrom) in patients undergoing teeth extraction. A large number of thromboembolic complications due to interruption of the therapy has been reporte

OPINION SURVEY OF THE GENERAL PRACTITIONERS IN BULGARIA REGARDING THERAPY WITH ACETYLSALICYLIC ACID, CLOPIDOGREL AND ACENOCOUMAROL IN PATIENTS UNDERGOING DENTAL EXTRACTIONS

Purpose: Cardiovascular diseases are leading cause of mortality and disability worldwide. Major role in the treatment and prophylaxis of these diseases and their complications have antiplatelet and anticoagulation drugs. Routine practice in the past was an interruption of antiplatelet and anticoagulant medication before dental extraction. Today most authors and dental associations recommend maintaining therapeutic levels of antithrombotic drugs in single or multiple teeth extractions due to the fact that the risk of serious thromboembolic complications outweighs the risk of bleeding. The aim of the present study is to determine the opinion and approach of the General Practitioners in Bulgaria regarding therapy with Aspirin, Clopidogrel and Acenocoumarol in patients undergoing dental extractions. Material and Method: 282 General Practitioners were interviewed for their approach to the antithrombotic therapy with Acetylsalicylic acid (Aspirin) Clopidogrel (Plavix, Trombex) and Acenocoumarol (Sintrom) in patients undergoing dental extractions. Results: There is no consensus and an established protocol on the cessation of Acetylsalicylic acid (Aspirin) Clopidogrel (Plavix, Trombex) and Acenocoumarol (Sintrom), and for what period of time before dental extraction. Conclusion: Among General Practitioners in Bulgaria there is no approved protocol regarding administration of Acetylsalicylic acid (Aspirin) Clopidogrel (Plavix, Trombex) and Acenocoumarol (Sintrom) in patients undergoing teeth extraction

Unlocking the Future: Bioprinting Salivary Glands—From Possibility to Reality

Salivary gland biofabrication represents a promising avenue in regenerative medicine, aiming to address the challenges of salivary gland dysfunction caused by various factors such as autoimmune diseases and radiotherapy. This review examines the current state of bioprinting technology, biomaterials, and tissue engineering strategies in the context of creating functional, implantable salivary gland constructs. Key considerations include achieving vascularization for proper nutrient supply, maintaining cell viability and functionality during printing, and promoting tissue maturation and integration with surrounding tissues. Despite the existing challenges, recent advancements offer significant potential for the development of personalized therapeutic options to treat salivary gland disorders. Continued research and innovation in this field hold the potential to revolutionize the management of salivary gland conditions, improving patient outcomes and quality of life. This systematic review covers publications from 2018 to April 2024 and was conducted on four databases: Google Scholar, PubMed, EBSCOhost, and Web of Science. The key features necessary for the successful creation, implantation and functioning of bioprinted salivary glands are addressed

Discontinuation of Oral Antiplatelet Agents before Dental Extraction - Necessity or Myth?

Background: The risk of excessive bleeding often prompts physicians to interrupt the antiplatelet agents as acetylsalicilyc acid and clopidogrel before dental extractions which puts patients at risk of adverse thrombotic events

DABIGATRAN AND DENTAL EXTRACTIONS - Case Report

For more than 50 years, vitamin K antagonists have been the gold standard in the treatment of cardiovascular and cerebrovascular diseases and in the prevention of their complications. In the last 5 years new anticoagulants dabigatran, rivaroxaban and apixaban are rapidly implemented in the clinical practice, displacing Vit. K antagonists, due to numerous of advantages they have. Dabigatran is the first and most widely used new oral anticoagulant, so it is important for the dentists to be aware of this drug. The purpose of this article is to review NOA dabigatran, its monitoring and reversal, and provides clinical advice on the management of patients who receives dabigatran and requires dental extractions. Material and methods: The course of five patients on dabigatran who underwent teeth extraction was assessed. The medical charts of these patients were investigated. Morning dose of dabigatran (Pradaxa) was omitted and teeth extraction was performed ≥12 hours after the last intake of the drug. Results: Fourteen teeth were extracted in five patients receiving Dabigatran with normal creatinine clearance. Extractions were performed ≥12 hours after the last administration of dabigatran. Only one patient has slightly prolonged bleeding, successfully controlled with local hemostatic measures. Conclusions: Simple teeth extractions can be safely performed ≥12 hours after the last administration of the medication in patients with normal creatinine clearance without significantly greater bleeding risk than conventional oral anticoagulants. However, currently no established evidence-based guidelines for dental management of these patients are available and further clinical studies are needed

CASE OF ALOPECIA AREATA ORIGINATED FROM DENTAL FOCUS.

For many years the oral infection, especially periodontitis, is considered as a potential contributing factor to a variety of clinically important systemic diseases. Alopecia areata (AA) is an autoimmune disease with unclear etiology and pathogenesis, rarely associated with dental foci. This disease has a strong psychological impact on the patient, because it presents with hair loss and can affect any hair-bearing area, but usually involves the face and scalp, where esthetic considerations play an important role in self perception. In this article is presented a case of alopecia areata resulting from dental foci that was effectively resolved by eliminating a focalized dental infection via dental extraction. In this sense, patients with AA should be subjected to careful exploration of the oral cavity in search of possible dental infections. Close collaboration between dentist, dermatologist, endocrinologist and other medical specialists in the interdisciplinary approach of diagnosis and treatment is needed

INTERDISCIPLINARY APPROACH IN COMPEX TREATMENT OF ORAL LICHEN RUBER PLANUS /Review and a Case report/

Lichen planus(LP)is a common chronic muco­cuta­neous disease of unknown etiology. Usually, it presents with lesions on the flexor surfaces of the upper extremities, genitalia and mucous membranes. Oral lesions can be the initial as well as the only manifestations of this condition. Patients with LP can present first to the general dental practitioner so sufficient knowledge on this condition is important for the proper diagnosis, treatment and prevention of further complications. The clinical management of LRP requires liaison between dental and medical specialists.This article provides a review of the current literature on LP and a case report of a 55 years old female suffering with this condition. A multidisciplinary approach in the diagnosis and management of this case is described