Inherited, congenital and acquired disorders by hemostasis (vascular, platelet & plasmatic phases) with repercussions

The hemostasis alterations, either congenital or hereditary origin, and acquired, are circumstances that hinder oral care to patients who suffer them and also generates in the professional who has to attend, high stress. Bleeding control once established and dental treatment planning, both in the aspect of preparation, as the realization of the odonto-stomatological therapeutic, has suffered updates that do need to remember certain aspects of the care of these patients. But we must not forget that the hematologist or internist who controls the patient's medical condition, is a cornerstone for the planning and implementation of treatment plans. We must also remember that, in certain circumstances, treatment should be performed in a hospital setting. In this review, we aim to provide the odonto-stomatologist guidance on how to address the problem and provide simple and updated guidelines to apply in the treatment of these people

Clinical diseases with thrombotic risk and their pharmacologycal treatment: how they change the therapeutic attitude in dental treatments

The new antiplatelets and anticoagulant drugs have been recently introduced in the daily medical practices for the control of thromboembolism associated with different diseases. The dental assistance of these patients forces us to know these drugs, understand their action mechanisms and try to decrease the risks that entail ours actions in these patients, making a thorough analysis of the risk of bleeding that is going to be related to our medical intervention, as well as the use of all the control measures of the hemorrhage from our knowledge with these patients, and to be prudent. The communication with the medical specialist that supervises these patients must be maxim, being necessary to make clinic trials for establishing protocols or guides of the handling with these patients during the odontological treatment

Tratamientos bajo "Anestesia no convencional" en pacientes discapacitados del programa de atención bucodental infantil (PADI) de la Comunidad Autónoma de Murcia: estudio retrospectivo de 10 años

El programa de Atención Dental Infantil (PADI) de la Región de Murcia recoge desde el año 2003 la necesidad de prestación de tratamiento bucodental a pacientes discapacitados que no son susceptibles de recibir tratamiento odontoestomatológico convencional, pero que se pueden beneficiar de técnicas terapéuticas especiales. Se ha procedido a revisar las historias clínicas de 143 pacientes con discapacidad tratados bajo anestesia general, y de edades comprendidas entre 6 y 14 años, por la Unidad Docente de pacientes especiales de la Clínica Odontológica de la Universidad de Murcia desde el año 2004 hasta el año 2013, siendo el objetivo principal el valorar las necesidades de tratamiento oral y los resultados obtenidos en la terapéutica efectuada en este grupo de población, durante el primer decenio de su instauración. Los parámetros objeto de estudio han sido: género, edad, patologías médicas asociadas, número y tipos de tratamientos bucodentales realizados y piezas dentarias afectadas, tiempo medio de demora entre la solicitud, concesión y realización de la intervención, tiempo medio de duración de la intervención, y conocer las posibles complicaciones postratamiento, al igual que las necesidades de reintervención. Como resultados, podemos observar que en cuanto al género hay un predominio de varones tratados, existiendo un mayor número de intervenciones en el rango de edad de los 6-7 años, con un incremento de pacientes asistidos conforme avanzaba la implantación del programa de salud bucodental. Las patologías médicas asociadas con mayor frecuencia han sido el retraso psicomotor, las encefalopatías y la epilepsia, siendo habitual la confluencia de 2 o más entidades clínicas por paciente. Se han efectuado un total de 1528 tratamientos bajo anestesia no convencional. Las obturaciones, seguidas de las pulpotomías con coronas odontopediátricas y las exodoncias, constituyen más del 90% de los procedimientos en dentición temporal. En dentición permanente la mayoría de los tratamientos han sido restauradores (90,9%), seguido de las exodoncias (6,93%). Los segundos molares temporales y los primeros molares permanentes han sido las piezas dentarias con mayor necesidad de tratamiento. La media en la demora de la realización del procedimiento terapéutico, desde su solicitud a su ejecución, ha sido de 2 meses y sólo un 13,2% superan los 4 meses de espera, mientras que el tiempo medio de duración empleado en las intervenciones ha sido de 107 ± 32 minutos, con un rango de 35 a 256 minutos. No hemos registrado complicaciones postratamiento durante la hospitalización ni en las visitas de revisión efectuadas a la semana y menos del 10% de los pacientes han precisado reintervención. Podemos concluir que, con unos criterios de selección adecuados de los pacientes con necesidades especiales, el tratamiento bajo anestesia general es seguro, mejora la calidad de vida y la salud oral de los mismos, pero requiere en todos los casos de revisiones periódicas y de un correcto mantenimiento de la higiene oral.Since 2003, the Children's Dental Care Program (PADI) of the Region of Murcia has collected the need to provide oral treatment to disabled patients who are not likely to receive conventional odontostomatological treatment but who can benefit from special therapeutic techniques. We have proceeded to review the medical records of 143 patients with disabilities treated under general anesthesia, and aged between 6 to 14 years old by the Department of Special Patients of the Dental Clinic of the University of Murcia from 2004 to 2013, being the main objective to assess the needs for oral treatment and the results obtained in the therapy carried out in this population group during the first decade of its establishment. The parameters under study have been: gender, age, associated medical pathologies, number and types of oral treatments performed and affected teeth, average time of delay between the request, granting and performance of the intervention, average duration of the intervention, and know the possible post- treatment complications, as well as the needs for reoperation. As results, we can observe that in terms of gender, there is a predominance of males treated with a more significant number of interventions in the age range of 6-7 years, with an increase in patients assisted as the implementation of the oral health program progressed. The most frequently associated medical pathologies have been psychomotor retardation, encephalopathies and epilepsy, with the confluence of 2 or more clinical entities per patient being common. A total of 1528 treatments have been carried out under non-conventional anesthesia. Fillings, followed by pulpotomies with pediatric dental crowns and extractions, constitute more than 90% of procedures in primary dentition. In permanent dentition, most treatments have been restorative (90.9%), followed by extractions (6.93%). Temporary second molars and permanent first molars have been the teeth with the greatest need for treatment. The average delay when carrying out the therapeutic procedure, from its request to its execution, has been 2 months, and only 13.2% exceed 4 months of waiting, while the average duration time used in the interventions has been 107 ± 32 minutes, with a range of 35 to 256 minutes. We have not recorded post-treatment complications during hospitalization or in the weekly check-up visits; and less than 10% of the patients have required reintervention. We can conclude that, with an adequate selection criteria for patients with special needs, treatment under general anesthesia is safe and improves their quality of life and oral health, but in all cases requires regular check-ups and correct maintenance of oral hygiene

Dental Treatments under General Anesthesia on Children with Special Health Care Needs Enrolled in the Spanish Dental Care Program

The purpose is to analyze the medical characteristics of children with special health care needs (CSHCN) recommended for dental treatment under general anesthesia (GA), postoperative complications, and dental treatment outcomes under the regulation of the Spanish Dental Care Program (PADI). 111 clinical records were selected. The study population was divided into three age groups. The quantitative data was specified as the mean ± SD. For the qualitative variables, the Chi-Square test was used. One-way ANOVA and Bonferroni tests were used to examine the effect of the “age group” and the number of treatment procedures. A total of 1473 treatment procedures were performed, of which 110 (7.5%) were cleanings, 898 (61%) were restorative procedures, 332 (21.7%) were extractions, 22 (1.6%) were endodontic treatments, 62 (4.2%) were pulpotomies, and 59 (4%) were stainless steel crowns. Regarding the mean number of incisor root canal treatments (RCT), age group 3 received a significantly higher mean number of incisor RCTs than age group 1 (p = 0.02). Age group 1 received a higher average of pulpotomies and stainless-steel crowns (p = 0.00) compared to groups 2 and 3. GA is a safe procedure for the dental treatment of CSHCN, with minimal postoperative complications, which should be included among dental public programs