Special Issue "Medically Compromised Patients in Dentistry"

A special issue of Dentistry Journal (ISSN 2304-6767).

Deadline for manuscript submissions: closed (31 December 2015).

Special Issue Editor

Guest Editor
Prof. Dr. Dr. Claude Jaquiéry

Department of Cranio—Maxillofacial Surgery and Hightech Research Center of CMF—Surgery, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
Website | E-Mail
Phone: 0041 61 328 72 33

Special Issue Information

Dear Colleagues,

For the near future, particularly in Western communities, we will be confronted with significant demographic changes [1]. Higher life expectancies will constantly increase the percentage of people reaching ages exceeding eighty or ninety years. As a consequence, incidences of cardiovascular disorders, tumors, and endocrine diseases will increase as well. These patients require specific treatments, which may interfere with many dental therapies; oral surgery interventions will be particularly affected. This Special Issue focuses on a couple of issues, which are increasingly important for oral surgeons and dentists. First, new anticoagulants, such as Factor Xa inhibitors, will be progressively used in patients after orthopedic surgery [2]. These agents require different managements, as compared to patients under warfarin treatment. Second, pain control in elderly, medically compromised patients with multiple diagnoses will be increasingly demanding for the dentist, excluding the easy and effective use of NSAR [3]. Third, medically compromised patients tend to be at risk during dental treatment, thus provoking physical and mental stress, which could end in emergency situations, thus necessitating close communication between medical specialists and dentists, so as to anticipate and prevent emergencies during dental treatment. However, dentists should be capable of providing basic life support in their dental practice [4].

Dr. Claude Jaquiéry
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Dentistry Journal is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

References:

1      Peters, E.; Pritzkuleit, R.; Beske, F.; Katalinic, A. Demografischer wandel und krankheitshäufigkeiten. Bundesgesundheitsbl 2010, 53, 417–426.

2      Oswald, E.; Velik-Sachner, C.; Innerhofer, P.; Tauber, H.; Auckenthaler, T.; Ulmer, H.; Streif, W. Results of rotational thromboelastometry, coagulation activation markers and thrombin generation assays in  orthopedic patients during thromboprophylaxis with rivaroxaban and enoxaparin: A prospective cohort study. Blood Coagul. Fibrinol. 2015, 26, 136–144.

3      Breivik, H. Treat the whole patient and be aware of drug interactions. J. Pain. Palliat. Care Pharmacother. 2015, doi: 10.3109/15360288.2014.1003681.

4      Reddy, S.; Doshi, D.; Reddy, P.; Kulkarni, S.; Reddy, S. Awareness of basic life support among staff and students in a dental school. J. Contemp. Dent. Pract. 2013, 14, 511–517.


Keywords

  • anticoagulants
  • factor Xa inhibitors
  • pain management
  • NSAR
  • basic life support

Published Papers (6 papers)

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Research

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Open AccessArticle
A Study of the Management of Patients Taking Novel Oral Antiplatelet or Direct Oral Anticoagulant Medication Undergoing Dental Surgery in a Rural Setting
Dent. J. 2015, 3(4), 102-110; https://doi.org/10.3390/dj3040102
Received: 17 August 2015 / Revised: 21 September 2015 / Accepted: 24 September 2015 / Published: 6 October 2015
Cited by 3 | PDF Full-text (99 KB) | HTML Full-text | XML Full-text
Abstract
Purpose: Novel oral antiplatelet (NOAP) (prasugrel and ticagrelor) and direct oral anticoagulant drugs (DOAC) (dabigatran, rivaroxaban and apixaban) have emerged in the last decade. This study was undertaken to determine current approaches taken to the management of patients taking these agents in dental [...] Read more.
Purpose: Novel oral antiplatelet (NOAP) (prasugrel and ticagrelor) and direct oral anticoagulant drugs (DOAC) (dabigatran, rivaroxaban and apixaban) have emerged in the last decade. This study was undertaken to determine current approaches taken to the management of patients taking these agents in dental practice in a remote and rural setting. Methods: A small retrospective study was carried out in a small island population that identified patients taking one of the above drugs. All national health service and private dental records were examined to determine the type of treatment carried out and whether drug therapy, treatment plans or actual treatment were modified as a result of NOAP or DOAC therapy. In addition other outcomes such as referral to another service for advice or treatment and any adverse bleeding events were noted. Results: 156 dental encounters for 95 patients taking one of the drugs were identified. Significant events were identified in sixteen encounters and the management of patients taking each drug type differed significantly between cases but no patients returned with troublesome post-operative bleeding. Conclusions: The approaches taken by dental surgeons in Orkney in the management of the NOAPs and DOACs varied and this is likely to be a reflection of the limited literature available. Full article
(This article belongs to the Special Issue Medically Compromised Patients in Dentistry)

Review

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Open AccessReview
Contemporary Correction of Dentofacial Anomalies: A Clinical Assessment
Dent. J. 2016, 4(2), 11; https://doi.org/10.3390/dj4020011
Received: 8 January 2016 / Revised: 18 April 2016 / Accepted: 22 April 2016 / Published: 28 April 2016
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Abstract
Contemporary computer-assisted technologies can support the surgical team in the treatment of patients affected by dentofacial deformities. Based on own experiences of 350 patients that received orthognathic surgery by the same team from 2007 to 2015, this clinical review is intended to give [...] Read more.
Contemporary computer-assisted technologies can support the surgical team in the treatment of patients affected by dentofacial deformities. Based on own experiences of 350 patients that received orthognathic surgery by the same team from 2007 to 2015, this clinical review is intended to give an overview of the results and risks related to the surgical correction of dentofacial anomalies. Different clinical and technological innovations that can contribute to improve the planning and transfer of corrective dentofacial surgery are discussed as well. However, despite the presence of modern technologies, a patient-specific approach and solid craftsmanship remain the key factors in this elective surgery. Full article
(This article belongs to the Special Issue Medically Compromised Patients in Dentistry)
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Open AccessReview
Direct Oral Anticoagulants in Dental Patients Including the Frail Elderly Population
Dent. J. 2016, 4(1), 7; https://doi.org/10.3390/dj4010007
Received: 5 December 2015 / Revised: 11 February 2016 / Accepted: 14 March 2016 / Published: 19 March 2016
Cited by 1 | PDF Full-text (518 KB) | HTML Full-text | XML Full-text
Abstract
Direct oral anticoagulants (DOACs) have led to a paradigm shift in the field of anticoagulation, providing safe and convenient anticoagulation without the need for regular blood testing. Currently, there are three major DOACs available—Factor Xa inhibitors (apixaban and rivaroxaban) and direct thrombin inhibitors [...] Read more.
Direct oral anticoagulants (DOACs) have led to a paradigm shift in the field of anticoagulation, providing safe and convenient anticoagulation without the need for regular blood testing. Currently, there are three major DOACs available—Factor Xa inhibitors (apixaban and rivaroxaban) and direct thrombin inhibitors (dabigatran)—that are available for use in atrial fibrillation and venous thromboembolism. While these agents have been shown to be as effective as warfarin, with a similar or better bleeding profile, there remains some concern of the use of these drugs in vulnerable populations, such as the frail elderly patients; particularly since reversal agents and drug monitoring are not routinely available. We aim to provide a review of the use of DOACs and the impact of DOACs on dental treatment in the elderly population. Full article
(This article belongs to the Special Issue Medically Compromised Patients in Dentistry)
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Open AccessReview
New Direct Oral Anticoagulants (DOAC) and Their Use Today
Dent. J. 2016, 4(1), 5; https://doi.org/10.3390/dj4010005
Received: 10 January 2016 / Revised: 5 March 2016 / Accepted: 9 March 2016 / Published: 11 March 2016
Cited by 2 | PDF Full-text (465 KB) | HTML Full-text | XML Full-text
Abstract
The ideal anticoagulant is oral, has a wide therapeutic range, predictable pharmacokinetics and pharmacodynamics, a rapid onset of action, an available antidote, minimal side effects and minimal interactions with other drugs or food. With the development of the novel direct oral anticoagulants (DOAC), [...] Read more.
The ideal anticoagulant is oral, has a wide therapeutic range, predictable pharmacokinetics and pharmacodynamics, a rapid onset of action, an available antidote, minimal side effects and minimal interactions with other drugs or food. With the development of the novel direct oral anticoagulants (DOAC), we now have an alternative to the traditional vitamin K antagonists (VKA) for the prevention and treatment of thrombosis. DOACs have limited monitoring requirements and very predictable pharmacokinetic profiles. They were shown to be non-inferior or superior to VKA in the prophylaxis or treatment of thromboembolic events. Particularly in terms of safety they were associated with less major bleeding, including intracranial bleeding, thus providing a superior benefit for the prevention of stroke in patients with atrial fibrillation. Despite these advantages, there are remaining limitations with DOACs: their dependence on renal and hepatic function for clearance and the lack of an approved reversal agent, whereas such antidotes are successively being made available. DOACs do not need regular monitoring to assess the treatment effect but, on the other hand, they interact with other drugs and interfere with functional coagulation assays. From a practical point of view, the properties of oral administration, simple dosing without monitoring, a short half-life allowing for the possibility of uncomplicated switching or bridging, and proven safety overwhelm the disadvantages, making them an attractive option for short- or long-term anticoagulation. Full article
(This article belongs to the Special Issue Medically Compromised Patients in Dentistry)
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Open AccessReview
Management of Antithrombotic Agents in Oral Surgery Maria Martinez and Dimitrios A. Tsakiris *
Dent. J. 2015, 3(4), 93-101; https://doi.org/10.3390/dj3040093
Received: 21 August 2015 / Revised: 13 September 2015 / Accepted: 23 September 2015 / Published: 6 October 2015
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Abstract
Systemic anticoagulation with intravenous or oral anticoagulants and antiplatelet agents is an efficient treatment against thromboembolic or cardiovascular disease. Invasive dental procedures or oral surgery might be associated with bleeding complications if carried out under anticoagulants. Patients on vitamin K antagonists, new direct [...] Read more.
Systemic anticoagulation with intravenous or oral anticoagulants and antiplatelet agents is an efficient treatment against thromboembolic or cardiovascular disease. Invasive dental procedures or oral surgery might be associated with bleeding complications if carried out under anticoagulants. Patients on vitamin K antagonists, new direct anticoagulants or antiplatelet agents having dental interventions with low-risk for bleeding do not need interruption of anticoagulation. In case of bleeding complications local hemostatic measures, such as local surgical sutures, fibrin glue, local antifibrinolytic treatment with tranexamic acid, or e-aminocaproic acid suffice to stop bleeding. In patients with high risk of bleeding an individual assessment of the benefit/risk ratio of interrupting anticoagulation should be carried out. Bridging the long-term anticoagulation with short-term anticoagulants should be planned according to national or international guidelines. The introduction of the newer direct oral anticoagulants having more flexible pharmacokinetic properties has facilitated bridging, allowing short-term interruption without increasing the risk of relapsing thrombotic or cardiovascular events. Full article
(This article belongs to the Special Issue Medically Compromised Patients in Dentistry)

Other

Jump to: Research, Review

Open AccessCase Report
Implant Supported Fixed Dental Prostheses Using a New Monotype Zirconia Implant—A Case Report
Dent. J. 2015, 3(3), 79-92; https://doi.org/10.3390/dj3030079
Received: 6 August 2015 / Revised: 4 September 2015 / Accepted: 10 September 2015 / Published: 17 September 2015
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Abstract
Currently, titanium or specific titanium alloys are the most often used materials for the fabrication of dental implants. Many studies have confirmed the osseointegrative capacity and clinical long-term performance of moderately rough titanium implants. However, disadvantages have also been reported with regard to [...] Read more.
Currently, titanium or specific titanium alloys are the most often used materials for the fabrication of dental implants. Many studies have confirmed the osseointegrative capacity and clinical long-term performance of moderately rough titanium implants. However, disadvantages have also been reported with regard to peri-implant infections and the titanium metal properties. Tooth colored ceramic implants have attracted the interest of clinicians since the end of the 1960s. Initially, alumina was used for the fabrication of ceramic implants; however, due to the poor biomechanical properties, alumina implants are not commercially available any more. Since end of the 1990s, zirconia has been established in dentistry due to its superior biomechanical properties compared to other oxide ceramics such as alumina. Currently, zirconia is the material of choice for the fabrication of ceramic implants. Zirconia implants show superior biocompatibility compared to titanium and other metals. Additionally, it has been reported that zirconia implants with a micro-rough surface topography show at least a comparable osseointegrative capacity and similar clinical survival rates to moderately rough titanium implants. The present case reports a fixed implant-supported reconstruction of a large edentulous space with compromised local bone conditions using new monotype zirconia dental implants with a micro-rough surface topography. Full article
(This article belongs to the Special Issue Medically Compromised Patients in Dentistry)
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