Abstract Purposes The main goal of this study was to compare the incidence of postoperative bleeding events after dental extractions between patients treated with direct oral anticoagulants (DOACs) ...and those treated with vitamin K antagonists (VKAs) without withdrawal of oral anticoagulant therapy (OAT). Our second objective aimed to evaluate risk factors affecting postoperative hemorrhage after tooth extraction in patients taking DOACs. Methods This prospective observational study included 51 patients being treated with oral anticoagulant who required dental extractions. They were divided into two groups: 31 patients receiving a DOAC and 20 control patients taking VKA with an international normalized ratio (INR) value between 2.0 and 3.0. In both groups, extractions were performed under continued OAT and the same local hemostatic measures were applied. All procedures were performed in an outpatient facility. A bleeding event was defined as persistent oozing or marked hemorrhage over 20 minutes after tooth extraction despite local hemostasis procedures, or all bleeding episode occurring during the first postoperative week. Results Five patients taking DOACs showed 7 bleeding episodes and 4 patients receiving VKAs presented 5 bleeding episodes during the postoperative follow-up period. The difference in the number of bleeding events between the two groups was not statistically significant (adjusted odds ratio OR = 0.77; 95 % confidence interval CI 0.19 to 3.19; P = .723). Eleven (91.67 %) bleeding events were mild and controlled by mechanical compression with gauzes and one (8.33 %) was managed with a revision of the wound, applying of fibrin glue and resuturing No bleeding required hospitalization or blood transfusion. All bleeding episodes occurred during the first three postoperative days. Conclusion According to our preliminary outcome data, dental extractions can be performed safely in an outpatient facility, in patients treated with DOAC, by applying local hemostatic measures, without interrupting or modifying OAT.
Objectives
Studies on the perioperative management of patients on direct oral anticoagulants (DOACs) receiving oral invasive procedures are sparse. Moreover, the recommendations of the scientific ...societies on DOACs are discordant, and the practices are highly variable. We conducted a survey of general and specialized dentists in France to compare their practices concerning the management of patients receiving vitamin K antagonists (VKAs) and DOACs.
Materials and Methods
Members of two dental surgical societies were invited to participate in the survey. One hundred forty-one practitioners answered an online questionnaire focusing on the periprocedural management of oral anticoagulated patients (participation rate, 17.8%).
Results
Practitioners at hospitals or mixed practices and specialists treated significantly more anticoagulated patients and more frequently performed procedures with high hemorrhagic risk than practitioners with private practice and general dentists. Greater than 90% of practitioners did not modify the treatment for patients on VKAs and controlled the International Normalized Ratio (INR) preoperatively. Regarding DOACs, 62.9% of practitioners did not change the treatment, 70.8% did not prescribe any biological tests, and 13.9% prescribed an INR. Practitioners at hospitals and mixed practices and specialists had better training and knowledge about DOACs.
Conclusions
This survey showed that anticoagulated patients were managed mostly by specialists in private or hospital care, notably when requiring oral procedures at high hemorrhagic risk.
Clinical relevance
A growing proportion of anticoagulated patients are being treated by dentists in primary care. Consequently, they need training, especially concerning DOACs. Additionally, consensus recommendations are necessary for better coordination of stakeholders and patient safety.
Trial registration on
ClinicalTrials.gov
: NCT03150303.
Cherubism is a rare autosomal dominant disorder of the jaws caused by mutation of the SH3BP2 gene. The bone is replaced by a fibrous granuloma containing multinucleated giant cells. Cells of the ...cherubism granuloma have never been systematically analyzed. Hence, the aim of this study was to characterize the cells in human cherubism granulomas, to determine the osteoclastic characteristics of the multinucleated giant cells and to investigate the potential role of TNF-α in human cherubism.
Seven granulomas were analyzed in pathology, molecular biology and immunohistochemistry. Granulomas were composed mainly of macrophages or osteoclasts within a fibroblastic tissue, with few lymphoid cells. Myeloid differentiation and nuclear NFATc1 localization were both associated with disease aggressiveness. OPG and RANKL immunohistochemical expression was unexpected in our specimens. Five granuloma cells were cultured in standard and osteoclastogenic media. In culture, cherubism cells were able to differentiate into active osteoclasts, in both osteoclastogenic and standard media. IL-6 was the major cytokine present in the culture supernatants.
Multinucleated giant cells from cherubism granulomas are CD68 positive cells, which differentiate into macrophages in non-aggressive cherubism and into osteoclasts in aggressive cherubism, stimulated by the NFATc1 pathway. This latter differentiation appears to involve a disturbed RANK-L/RANK/OPG pathway and be less TNF-α dependent than the cherubism mouse model.
Abstract Introduction The present study reports the results of a randomized clinical trial comparing local intraosseous methylprednisolone injection and emergency pulpotomy in the management of acute ...pulpitis on efficacy, safety, and efficiency end points. Methods After providing prior informed written consent, 94 patients consulting for acute irreversible pulpitis pain at university-affiliated teaching hospital dental clinics in Dakar, Senegal were randomly assigned to either the methylprednisolone treatment group ( n = 47) or the pulpotomy treatment group ( n = 47). Patients were followed up at 1 week and assessed 6 months later to evaluate the therapeutic outcome of their treatment. Results At day 7 the patients in the methylprednisolone group reported less intense spontaneous and percussion pain in the day 0–day 7 period than the patients in the pulpotomy group. Methylprednisolone treatment took approximately 7 minutes (4.6–9.3) less to accomplish than pulpotomy (or about half the time). No difference in the therapeutic outcome was found between the 2 treatment groups at 6 months (all credible intervals span 0). Conclusions This study establishes that methylprednisolone injection for acute pulpitis is relieved by a minimally invasive pharmacologic approach more effectively than by the reference pulpotomy and conserves scarce dental resources (ie, endodontic equipment and supplies, dental surgeon's time).
Cherubism is a rare genetic disease characterized by bilateral giant cell reparative granuloma of the jaws consisting of a fibrotic stroma with giant multinucleated cells (GMCs) and osteoclastic ...features. Cherubism severity is highly variable, and recurrence after surgery is the most important risk. Currently there are no prognostic indicators. The aims of this study were to evaluate the osteoclastogenesis phenotype by histologic examination of NFATc1 localization and TRAP activity, and to correlate the results to disease aggressiveness in order to define prognostic indicators. Based on cherubism evolution one year after surgery, three classes of cherubism aggressiveness were identified: mild (group A), moderate (group B), and severe (group C). Histologically, in grade A and B cherubism lesions, GMCs were negative for both TRAP activity and NFATc1 nuclear localization. In contrast, in grade C cherubism lesions, GMCs were all positive for TRAP activity and NFATc1 nuclear localization, and displayed osteoclast-like features. Other histopathological findings were not different among the three groups. Our results establish that TRAP activity and NFTAc1 nuclear localization are associated with aggressive cherubism and therefore could be added to routine pathological examination to aid in prognosis and management of the disease. The finding of NFATc1 nuclear localization in aggressive tumors supports the addition of anti-calcineurin treatment to the therapeutic arsenal for cherubism.
Introduction:
Maxillary palatal tori are benign bone tumors that elevate the median of the palate. Although there are clinical variations, palatal tori are characterized by pathognomonic clinical and ...radiographic criteria.
Observations:
Here, we present the cases of two patients with a voluminous palatal torus that caused functional problems in one and formed an anatomical obstacle to the fitting of a removable prosthetic in the other. Given their size, these tori were surgically removed under general anesthesia. The postoperative course was simple.
Discussion:
The etiology of palatal torus is usually multifactorial: genetic factors, masticatory forces, and para-functions could all be factors in their development and growth. Considered as anatomical variations, palatal tori are asymptomatic in most cases and require no intervention.
Conclusion:
Surgical management is sometimes necessary to restore physiological orofacial functions or to allow the fitting of a prosthetic without harmful compromise.
Signaling pathways that underlie postnatal dental and periodontal physiopathology are less studied than those of early tooth development. Members of the muscle segment homeobox gene (Msx) family ...encode homeoproteins that show functional redundancy during development and are known to be involved in epithelial-mesenchymal interactions that lead to crown morphogenesis and ameloblast cell differentiation. This study analyzed the MSX2 protein during mouse postnatal growth as well as in the adult. The analysis focused on enamel and periodontal defects and enamel proteins in Msx2 -null mutant mice. In the epithelial lifecycle, the levels of MSX2 expression and enamel protein secretion were inversely related. Msx2+/− mice showed increased amelogenin expression, enamel thickness, and rod size. Msx2−/− mice displayed compound phenotypic characteristics of enamel defects, related to both enamel-specific gene mutations (amelogenin and enamelin) in isolated amelogenesis imperfecta, and cell-cell junction elements (laminin 5 and cytokeratin 5) in other syndromes. These effects were also related to ameloblast disappearance, which differed between incisors and molars. In Msx2−/− roots, Malassez cells formed giant islands that overexpressed amelogenin and ameloblastin that grew over months. Aberrant expression of enamel proteins is proposed to underlie the regional osteopetrosis and hyperproduction of cellular cementum. These enamel and periodontal phenotypes of Msx2 mutants constitute the first case report of structural and signaling defects associated with enamel protein overexpression in a postnatal context.
Introduction:
One of the dental surgeon's roles is to identify, diagnose and supervise the treatment of oral pathologies (OP), and/or to refer patients to the appropriate specialists. Today, the ...delay in diagnosing patients with OP is very long and may impact their prognosis.
Objective:
We conducted a national survey of French practitioners to estimate their knowledge and practices regarding the management of these pathologies.
Methods:
About 15,000 dentists were contacted by email to complete a questionnaire designed to assess the diagnoses and management of OP.
Results:
Overall, for 560 answers (3.8%), DS did not declare any significant difficulties in diagnosing and managing any kind of pathologies. However, we were able to distinguish statistical differences among practitioners depending on the type of lesions and between the practitioners themselves. The associated factors were gender, graduation year, mode of practice and continuing education over the last 5 years. The majority of DS justified their diagnostic difficulties by the fact that they do not encounter patients with these types of pathology frequently enough, and by insufficient education.
Conclusion:
According to our study, it is necessary to reinforce the training and the continuing medical education of DS regarding OP, especially through the use of practical cases.
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