Dabigatran : a new oral anticoagulant. Guidelines to follow in oral surgery procedures. A systematic review of the literature

Dabigatran is a newly commercialized drug that is replacing other anticoagulants in the prevention of venous thromboembolism, stroke and systemic arterial valve embolism. It acts directly on thrombin presenting in a dynamic and predictable way, which does not require monitoring these patients. Therefore, we consider the need to assess whether their use increases the risk of bleeding involved before any dental treatment. We performed a systematic review with a bibliographic search in PubMed/Medline along with the Cochrane Library. We excluded articles dealing with all anticoagulants other than dabigatran, and works about surgical treatments in anatomical locations other than the oral cavity. We included a total of 13 papers of which 1 was a randomized clinical trial, 9 narrative literature reviews, 1 case series, 2 clinical cases and 1 expert opinion. Because we did not obtain any properly designed clinical trials, we were unable to conduct a meta-analysis. Currently, there is no consensus on the procedure to be followed in patients taking dabigatran. However, all authors agree to treat each case individually in accordance to the risk of embolism, postoperative bleeding and renal function. Also, it is necessary to perform minimally invasive interventions, and take the appropriate local anti-hemolytic measures

Risk factors associated with xerostomia in haemodialysis patients

To determine the prevalence of xerostomia and hyposalivation in Haemodialysis (HD) patients, to clarify risk factors, assess patient´s quality of life, and to establish a possible correlation among interdialytic weight gain (IDWG) and xerostomia. This study was performed on a group of 50 HD patients. Data were collected using a questionnaire containing demographic and clinical variables, a visual analogue scale (VAS) for xerostomia, IDWG, and an oral health impact profile questionnaire (OHIP-14). Unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. A total of 28 HD patients (56%) suffered xerostomia. Dry mouth was associated with hypertension (OR, 5.24; 95% CI, 1.11-24.89) and benzodiazepine consumption (OR, 5.96; 95% CI, 1.05-33.99). The mean xerostomia VAS and OHIP-14 scores were 31.74±14.88 and 24.38±11.98, respectively. No significant correlation was observed between IDWG% and VAS and OHIP total score. Nonetheless, a positive correlation between VAS level of thirst and IDWG% was found (r=0.48 p=0.0001). UWS and SWS means (determined in 30 patients) were 0.16±0.17 and 1.12±0.64, respectively. Decreased values of UWS and SWS were reported in 53.33% and 36.66% of HD patients. Xerostomia in HD has a multifactorial aetiology due to accumulative risks as advanced age, systemic disorders, drugs, fluid intake restriction, and salivary parenchymal fibrosis and atrophy. Therefore, it is important to detect possible xerostomia risk factors to treat correctly dry mouth in HD patients and avoid systemic complications

Oral lesions in Sjögren?s syndrome : a systematic review

Sjögren?s syndrome (SS) is an autoimmune disease related to two common symptoms: dry mouth and eyes. Although, xerostomia and hyposialia have been frequently reported in these patients, not many studies have evaluated other oral manifestations. The aim of this systematic review was to investigate prevalence rates of oral lesions (OL) in SS patients and to compare it to a control group (CG), when available. An exhaustive search of the published literature of the Pubmed, Scopus, Web of Science and the Cochrane Library databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) for relevant studies that met our eligibility criteria (up to September 1st 2017). Seventeen cross-sectional studies and one cohort study were finally included. The results showed that SS patients presented more OL compared to non-SS patients. The most frequent types of OL registered in primary and secondary SS were angular cheilitis, atrophic glossitis, recurrent oral ulcerations and grooves or fissurations of the tongue, also when compared to a CG. OL are common and more frequent in SS patients when compared to a CG. This may be a consequence of low levels of saliva. More studies where these OL and all the possible cofounding factors are taken into account are needed

Osteonecrosis of the jaws produced by sunitinib : a systematic review

Tyrosine kinase receptor family is involved in tumor growth, pathological angiogenesis and the progression (metastasis) of cancer. Sunitinib (Sutent®) inhibits members of the tyrosine kinase receptor family affecting the induction of angiogenesis and tumor progression. It is not clear if sunitinib increases the risk of osteonecrosis of the jaws (ONJ). The aim of this study was to carry out a systematic review about ONJ related to sunitinib, describing existing cases and possible associated risk factors. The PubMed/MEDLINE and Cochrane Library databases were searched without date restriction up to September 2018. We included prospective and retrospective observational studies, cross-sectional studies, clinical cases and series of cases, involving only human subjects. The methodological quality of the studies was assessed using The Joanna Briggs Institute (JBI) and Newcastle-Ottawa tools. A total of 13 studies fulfilled our inclusion criteria of which 7 were clinical cases, 5 case series and a retrospective study. All the articles were published between 2009 and 2018. Of the 102 patients treated with sunitinib analyzed in this study, 58 developed ONJ, being or having been treated with sunitinib and bisphosphonates or exclusively with sunitinib. In this systematic review, we found an increase of ONJ in patients who are medicated with other drugs different than bisphosphonates and denosumab. It is necessary that dentists, oral and maxillofacial surgeons as well as oncologists know the risk of ONJ that these antiresorptive drugs could have. There is a need to continue researching in this field with the aim of an increasing knowledge in this area and creating an adequate protocol of action for this population

Development of a program of mixed radiolucent-radiopaque lesions imaging via radiographic cases for active learning in oral medicine

A través del presente proyecto se ha creado un fichero de imágenes radiográficas mixtas (radiopacas-radiolucidas) que serán utilizadas por los alumnos del tercer curso de Grado de la asignatura Medicina Bucal a fin de mejorar la enseñanza práctica del apartado lesiones radiográficas de los maxilares. Dichos ficheros se incorporarán al Campus Virtual para que el alumno pueda hacer uso de ellos. La elaboración de un fichero de estas características ha exigido en primer lugar la selección de las imágenes radiográficas mixtas de los maxilares más representativas. Se han seleccionado 43 imágenes radiográficas mixtas que se han clasificado en “Mixed Radiolucent-Radiopaque periapical lesions” (15 imágenes), “Mixed Radiolucent-Radiopaque pericoronal lesions” (8 imágenes) y “Mixed Radiolucent-Radiopaque lesions not necessarily contacting teeth“ ( 20 imágenes). Se han realizado 4 flowchart (el tercer grupo se subdividió en dos) para esquematizar las lesiones mixtas más frecuentes con sus características clínicas y radiográficas más habituales. Dichos flowchart ayudarán al alumno a poder llegar al diagnóstico de las lesiones de los casos clínicos seleccionados, cuya historia clínica también se ha reflejado. Todo el trabajo se ha realizado en dos idiomas inglés y español, que ayudará a los alumnos a aprender el vocabulario en inglés relacionado con el tema. Además, facilitará la comprensión de los alumnos de otras nacionalidades que pueden acudir a nuestra facultad y ayudará a los alumnos de la UCM que acuden a otras universidades Europeas o Americanas

Oral lesions in patients with primary Sjögren?s syndrome. A case-control cross-sectional study

To evaluate the presence of oral lesions in a group of patients with primary Sjögren?s syndrome (pSS) and compare these results with a matched control group (CG). An observational cross-sectional study was conducted. 61 pSS patients (60 women, 1 man, mean age 57.64±13.52) diagnosed according to the American European Criteria (2002), and 122 matched control patients (120 women, 2 men, mean age 60.02±13.13) were included. Demographic and medical data, oral lesions and salivary flow rate were collected. Compared with the controls, pSS patients were 3.95 more likely to have oral lesions (OR 3.95; 95% CI 2.06-7.58; p=0.0001). 57.4% pSS patients presented oral lesions compared to 25.4% in CG. The most common were candidiasis (13.1% vs 2.5%), traumatic lesions (13.1% vs 4.1%), apthae (8.2% vs 0), and fissuration of the tongue (8.2% vs 0.8%). pSS patients with oral lesions had lower salivary flow levels (stimulated and unstimulated), although these differences were not significant. Significant associations were found between the presence of oral lesions and systemic manifestations and history of parotid gland enlargement in pSS patients. pSS patients suffer more oral lesions than general population and these lesions may aggravate the pSS disease

Aprendizaje basado en juegos online para la mejora de la adquisición de competencias en Patología Médica Bucal

Estamos viviendo una situación complicada debido a la pandemia por el COVID-19. Durante el presente curso académico parte de nuestras asignaturas han pasado de una docencia presencial a una docencia online, esto ha sucedido en la asignatura Patología Médica Bucal del grado en Odontología. Este paso de la presencialidad a la docencia online requiere de nuevas medidas de motivación para aumentar la adquisición de conocimientos y mantener el aprendizaje activo. El objetivo de este proyecto ha sido aplicar diferentes juegos online para mejorar el aprendizaje en Patología Médica Bucal y la transferencia de conocimiento entre alumnos y profesores

Assessment of Clinical Parameters of Dental Anxiety during Noninvasive Treatments in Dentistry

Dental anxiety is a matter of interest for the dentist since an anxious patient is a potential source of complications in the dental office. The main objectives of this study are to describe the correlation between dental anxiety levels and the values of physiological parameters related to dental anxiety and to study the evolution of blood pressure and heart rate over time during noninvasive dental treatments, i.e., not requiring local anesthesia. A descriptive, longitudinal, and prospective observational study was designed. The study population consisted of 200 patients who attended a university clinic for dental treatment without local anesthesia. The patients were asked to complete the Corah Dental Anxiety Scale. Afterward, blood pressure and heart rate were measured by means of a digital sphygmomanometer. Blood pressure and heart rate were taken throughout the procedure on four occasions. Most of the patients showed mild dental anxiety (5 [IQR: 3] points on Corah Dental Anxiety Scale). Significant but weak correlations were found between the level of dental anxiety and heart rate (Spearman rho: 0.166 and 0.176; p = 0.019 and 0.013; 3 min before and after treatment, respectively), as well as between the level of dental anxiety and the duration of treatment (Spearman rho: 0.191 3 min; p = 0.007). As for the evolution of physiological parameters, all patients showed a progressive decrease in values at different time points during treatment. When the types of treatment were evaluated separately, it was observed that there were statistically significant differences between them with respect to the level of dental anxiety (p = 0.006).Sin financiación4.614 JCR (2021) Q1, 45/182 Public, Environmental & Occupational Health0.814 SJR (2021) Q1, 34/136 Health, Toxicology and MutagenesisNo data IDR 2021UE

Elaboración de un programa de imágenes de lesiones readiopacas mediante casos radiográficos para el aprendizaje activo en medicina oral

Through the creation of this project in English, we have made a file of radiographic images that will be used by third year dental students in order to improve the practical teaching part of the subject of Oral Medicine, essentially by incorporating these files to the Virtual Campus. We have selected the most representative radiopaque radiographic images studied in pathology lectures given. We have prepared a file with 59 radiopaque radiographic images. These lesions have been divided according to their relationship and number with the tooth, into the following groups: “Anatomic radiopacities”, “Periapical radiopacities”, “Solitary radiopacities not necessarily contacting teeth”,“Multiple separate radiopacities”, and “Generalized radiopacities”. We created 4 flowcharts synthesizing the mayor explanatory bases of each pathological process in relation to other pathologies within each location. We have focused primarily in those clinical and radiographic features that can help us differentiate one pathology from another. We believe that by giving the student a knowledge base through each flowchart, as well as provide clinical cases, will start their curiosity to seek new cases on the Internet or try to look for images that we have not been able to locate due to low frequency. In addition, as this project has been done in English, it will provide the students with necessary tools to do a literature search, as most of the medical and dental literature is in English; thus far, providing the student with this material necessary to make the appropriate searched using keywords in English.A través del presente proyecto realizado en Inglés se ha creado un fichero de imágenes radiográficas que serán utilizadas por los alumnos del tercer curso de Grado de odontología a fin de mejorar la enseñanza práctica de la asignatura de Medicina Bucal, esencialmente mediante la incorporación de estos ficheros al Campus Virtual. Se han seleccionado las imágenes radiográficas radiopacas más representativas de la patología que se estudia en las clases teóricas impartidas. Hemos elaborado un fichero con 59 imágenes radiográficas radiopacas originales. Dichas lesiones se han dividido según su relación con el diente y número en los siguientes grupos: “Anatomic radiopacities”, “Periapical radiopacities”, “Solitary radiopacities not necessarily contacting teeth”,“Multiple separate radiopacities”, y “Generalized radiopacities”. Hemos realizado 4 flowcharts que sintetizan las bases explicativas más importantes de cada proceso patológico, en relación a otras patologías de su misma localización. Nos hemos centrado fundamentalmente es aquellos rasgos clínicos y radiográficos que nos pueden ayudar a diferenciar, una patología de otra. Creemos que al dar al alumno una base de conocimientos, a través de los flowchart, y al aportar los casos clínicos (clinical cases) abriremos la curiosidad en el alumno por buscar nuevos casos en Internet o intentar poder observar imágenes que nosotros no hemos podido localizar por su baja frecuencia. Además, como el trabajo ha sido ejecutado en inglés facilitará a nuestros alumnos la búsqueda bibliográfica, ya que la mayoría de la literatura médica y odontológica se encuentra en inglés y el alumno con este material dispondrá de las palabras clave en inglés necesarias para realizar las pertinentes búsquedas.Depto. de Especialidades Clínicas OdontológicasFac. de OdontologíaFALSEsubmitte