Preoperative management aspects of medically complex patients diagnosed with maxillofacial infections

Department of Oral and Maxillo-facial Surgery and Oral Implantology Arsenie Gutan, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Inflammatory processes in the maxillofacial region are a pressing problem in a specialist surgeon’s daily work due to the high number of patients with this diagnosis, but also because of the life-threatening complications that may occur - airway compromise, cavernous sinus thrombosis, mediastinal spread of infection, and even death. These complications occur even at “healthy” patients, with no other comorbidities. what about medically complex patients, who besides the current infection have multiple chronic diseases? Aim of the study. Identify the differences in the preoperative management of medically compromised patients and review the literature to gather up-to-date solutions and protocols for the better management of various patient categories. Materials and methods. A retrospective epidemiological study was conducted on 50 patients diagnosed with maxillofacial infections, who were hospitalized in the maxillofacial department of the IMSP IMU during 2015-2017 and 28 out of 50 have been found to have comorbidities. A review of the literature was done and there were systematized protocols for each chronic condition, with an emphasis on drug interactions and possible complications. Results. The research conducted confirmed the initial hypothesis that medically complex patients require a different approach while treating maxillofacial infections. Preoperative evaluation is of extreme importance and the oral surgeon should possess good clinical skills and knowledge of internal medicine, as there is a large number of patients who are unaware of their chronic medical conditions. A complete blood count, bleeding time and complete metabolic panel are crucial prior to the surgical intervention, as well as an electrocardiogram and blood pressure monitoring. Based on lab results, the operator will assess the risks and follow an individual protocol, altering the medication dosage or prescribing medication that would diminish possible surgical complications. Knowledge of drug interactions with agents used in oral surgery has been proven to be of great importance and have been systematized in this study, allowing clinicians to prevent further side effects. Conclusions. Most chronic diseases have a significant impact on the evolution of maxillofacial infections and every oral surgeon should always follow individualized protocols in order to prevent complications. For a better patient care, the operative team is encouraged to request the consultation of internists in every complex case

Preoperative assessment of patients with inflammatory processes in the maxillo-facial region: a minireview

The statistical data show the continuosly increasing number of patients with chronic diseases and this fact has a significant impact on the workload of all clinicians, including maxillofacial surgeons. On the other hand, inflammatory processes in the maxillofacial region are an important problem for maxillofacial surgeons due to the high number of patients who present with this diagnosis, but also because of the life-threatening complications that may occur. Besides the usual complications, a maxillofacial surgeon has to be aware of other comorbidities of the patients diagnosed with inflammatory processes, falling into the category of medically complex patients. The preoperative assessment main purpose is to identify those patients for whom the perioperative period may present an increased risk of morbidity and mortality, aside from the known complications already associated with inflammatory processes. This article aims to emphasize the importance of performing a complete and meticulous preoperative assessment of every single patient, even the apparently healthy ones, since the patient himself may be unaware of a comorbidity he might have. In order to facilitate this process, the use of standardized questionnaires for different groups of patients is encouraged for the prompt assessment of the patient’s condition. Another suggestion is the use of standardized protocols for emergency situations that may occur with these patients, including the use of tables with possible drug interactions between the medication used for the management of their chronic disease with the medication administered in the maxillofacial surgery unit

Age and periodontal health

State University of Medicine and Pharmacy “Nicolae Testemițanu”, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. The world's population is aging, with people aged 65 and over being the fastest growing age group. In Republic of Moldova, in 2019 it represented 20.8% of the total number of the population with habitual residence. Material and methods Total sample: 78 patients from Day care institution; Age: 65 years or older; CPITN index assessment; Dichotomic questionnaire regarding lifestyle. Results. The mean age of the patients was 73.2 years. The mean CPITN index score for the sample was 1.71 with a mode of 3 observed in 36 (46.15%) patients,. 26 patients (33.33%) were periodontal healthy. Conclusions. The present survey indicated a poor oral hygiene among elderly population. Nevertheless, further studies are needed to be performed on larger population

Vârsta și sănătatea parodontală

Background. The world's population is aging, with people aged 65 and over being the fastest growing age group. At the beginning of 2019, 558.4 thousand people aged 60 and over lived in the Republic of Moldova, which represents 20.8% of the total number of the population with habitual residence. Objective of the study. The aim of the study was to assess periodontal status in a sample of geriatric population. Material and Methods. The periodontal status of 78 patients (29 males, 49 females) 65 years or older was assessed using the CPITN index that records the presence of periodontal pockets, calculus and gingival bleeding around 10 specific teeth. Relevant aspects of lyfestyle and systemic health were examined through a dichotomic survey. Results. The mean age of the patients was 73.2 years. One of the participants was smoker (1.3%). However, 14 females (18%) and one male (1.3%) suffered diabetes. The mean CPITN index score for the sample was 1.71 with a mode of 3 observed in 36 (46.15%) patients, indicating the presence of periodontal pockets of 4-5 mm and urgent need for periodontal treatment. 26 patients (33.33%) were periodontal healthy. Conclusion. The present survey indicated a poor oral hygiene among elderly population. Further studies are needed to obtain results that will allow to elaborate recommendations guidelines for dental general practitioners in the prevention of periodontal and dental health in geriatric population. Introducere. Populația lumii îmbătrânește, persoanele cu vârsta peste 65 de ani fiind o grupă de vârstă cu cea mai rapidă creștere. La începutul anului 2019, 558,4 mii de persoane cu vârsta peste 60 de ani locuiau în Republica Moldova, ceea ce reprezintă 20,8% din numărul total al populației. Scopul lucrării. Scopul studiului a fost evaluarea stării parodontale într-un eșantion de populație geriatrică. Material și Metode. Statusul parodontal al 78 de pacienți (29 bărbați, 49 femei) cu vârsta de 65 de ani sau mai mult a fost evaluat folosind indicele CPITN, care înregistrează prezența pungilor parodontale, tartrului și sângerării gingivale în jurul a 10 dinți specifici. Aspecte relevante ale stilului de viață și ale sănătății sistemice au fost examinate printr-un studiu dihotomic. Rezultate. Vârsta medie a pacienților a fost de 73,2 ani. Unul dintre participanți a fost fumător (1,3%). Cu toate acestea, 14 femei (18%) și un bărbat (1,3%) au suferit de diabet. Scorul mediu al indicelui CPITN pentru eșantion a fost de 1,71, cu un scor de „3” observat la 36 (46,15%) pacienți, ceea ce indică prezența pungilor parodontale de 4-5 mm și necesitatea urgentă de tratament parodontal. 26 de pacienți (33,33%) au prezentat parodonțiu sănătos. Concluzii. Studiul de față a indicat o igienă orală slabă în rândul populației vârstnice. Sunt necesare studii suplimentare pentru a obține rezultate care să permită elaborarea de recomandări pentru medicii generali stomatologi în prevenirea sănătății parodontale și dentare la populația geriatrică