The changing face of oral anticoagulants

Summary of: Side effects of external tooth bleaching: a multi-centre practice-based prospective study

OBJECTIVE

The study was performed to assess the risk of at-home and in-office bleaching procedures, and to recognise potential predictors for side effects.

DESIGN

Multi-centre, questionnaire-based prospective study with follow-ups at around 14 days and around one year post-treatment.

SETTING

General practices and university clinics during the years 2007-2009 in Scandinavia.

SUBJECTS

Patients with tooth bleaching as part of the treatment plan.Results The prevalence of experienced tooth sensitivity at first follow-up was independent of bleaching procedure (at-home = 50.3% [n = 143]; in-office = 39.3% [n = 28]; p >0.05; 95% CI [OR]: 0.198-1.102) whereas prevalence of gingival irritation was higher after in-office treatment (at-home = 14.0%; in-office = 35.7%; p <0.05) (mean age: 37.3 years; 73.7% women; n = 171). At the second follow-up, two and three patients reported side effects attributed to the bleaching treatment in the at-home and in-office groups, respectively. Predictors for side effects were tooth sensitivity, surface loss and gingivitis when observed at inclusion. Treatment-related predictors were bleaching concentration and contact between tray and gingiva.

CONCLUSIONS

Bleaching treatment, irrespective of method, caused a high prevalence of side effects. Patients associated with the predictors at inclusion mentioned above should be notified of the risk for side effects and treated only if bleaching is indicated based on a proper diagnosis.

Direct Oral Anticoagulants in Dental Patients Including the Frail Elderly Population

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.

A New Generation of Antiplatelet, and Anticoagulant Medication and the Implications for the Dental Surgeon

The management of dental patients taking either antiplatelet medication, anticoagulant medication or both has been well established in the previous literature. Recently, new generations of drugs have emerged which are becoming increasingly common, including direct thrombin inhibitors, factor X inhibitors and a new class of oral thienopyridines. The implications of these drugs for the dental surgeon are not yet fully known. Awareness remains low and there is very little information available within the literature on safe use during surgery. This review paper aims to provide some guidance for dental practitioners performing invasive procedures. CPD/CLINICAL RELEVANCE: A new generation of anticoagulant and antiplatelet drugs have serious implications for patients undergoing surgery and their use is increasing.

The management of dental patients taking new generation oral anticoagulants

Recently, new oral anticoagulants have been introduced as alternatives to warfarin. While national guidelines for treatment of dental patients taking warfarin as an anticoagulant are well-established, no such information is available for these novel therapeutic agents. At present, the local guidance available is contradictory between different health boards/health planning units, and liaison with the medical practitioner managing the individual patient's anticoagulation is imperative if any invasive procedure is proposed. This paper examines the available evidence regarding these drugs and sets out proposals for clinical guidance of dental practitioners treating these patients in primary dental care.