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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. 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%). 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. 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. 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.

Methods to optimize healing through dietary strategies present an attractive option for patients, such that healing from delicate oral surgeries occurs as optimally as possible with minimal patient-meditated complications through improper food choices. This review discusses findings from studies that have investigated the role of diet, either whole foods or individual dietary components, on periodontal health and their potential role in wound healing after periodontal surgery. To date, research in this area has largely focused on foods or individual dietary components that may attenuate inflammation or oxidant stress, or foster de novo bone formation. These studies suggest that a wide variety of dietary components, including macronutrients and micronutrients, are integral for optimal periodontal health and have the potential to accelerate oral wound healing after periodontal procedures. Moreover, this review provides guidance regarding dietary considerations that may help a patient achieve the best possible outcome after a periodontal procedure.

Introduction: Antibiotics are a class of medications widely used by dentists. The class of agents has a number of listed side effects. This case report details an unusual adverse effect of tetracycline-induced psychosis recognized due to the diligence of a practitioner. To our knowledge, this is the first reported case by a dentist.Case Presentation: A 44-year-old patient was started on tetracycline therapy for prophylaxis before a periodontal procedure. The patient began having paranoid and psychotic experiences. The patient sought psychiatric medical care and was diagnosed with tetracycline-induced psychosis. He was treated with an antipsychotic drug, which resolved his symptoms.Conclusion: Dental medical histories are a resource that is underused and can often be of value in the continual assessment of drug safety and pharmacovigilance.

Supragingival plaque control is a requisite for the success of any periodontal procedure. However, little is know about the effect of this procedure alone on periodontitis. The aim of this study was to determine the effect of supragingival plaque control on clinical and biochemical parameters of chronic periodontitis. Twenty-five subjects exhibiting at least 4 pockets > 5mm, non-smokers and with no relevant systemic diseases, were selected for the study. The clinical and biochemical assessments were done before and 21 days after removal of plaque retentive factors, extraction of affected teeth and instruction in oral hygiene. The statistical analysis was done with the Student paired t-test (p

Anterior crown fractures are a common form of traumatic dental injuries that mainly affect the maxillary central incisors, in children and teenagers. Since the development of the adhesive dentistry, many case reports of crown fractures restored using adhesive reattachment techniques were published. Complex cases, in which more than one tooth are involved, with fractures differing from each other, require specific treatment of each fracture, taking different advantages of the different remaining tooth structures. This case report describes a patient with dissimilar crown fractures of both superior central incisors. After the endodontic treatment, the patient was treated using the combination of several techniques: periodontal surgery (crown lengthening with apically repositioned flap and osseous resective surgery), adhesive technique and cast restoration plus esthetic crown. The periodontal procedure re-created the biologic width and proved to be a reliable adjunctive procedure to the adhesive and the prosthetic techniques used.

Background Gingival recession is an intriguing and complex phenomenon. Patients frequently are disturbed by recession owing to sensitivity and esthetics. Many techniques have been introduced to treat gingival recession, including connective tissue grafting, or CTG; various flap designs; orthodontics; and guided tissue regeneration, or GTR. The authors reviewed human clinical studies to assess which techniques provided optimal results. Types of Studies Reviewed The authors reviewed controlled clinical trials to assess the outcome of gingival grafting. They also included histological studies in this article to elucidate the type of healing after those procedures were performed. Results The studies showed that the combination of CTG and coronally positioned flaps yielded a higher percentage of root coverage compared with other techniques. When GTR using bioabsorbable or nonbioabsorbable membranes was compared with CTG, the studies were inconclusive. Some studies found that GTR was as effective as CTG, while the others found that CTG was superior. Clinical Implications Gingival grafting to treat recession is a predictable and reliable periodontal procedure.

1 ^he severely undercut labial ridge is a perplexing problem in prosthetic dentistry. This problem may evolve with natural-rooted segments present, or in the edentulous ridge not influ­ enced by teeth or roots. A prosthesis constructed with this type of undercut is inserted by compromising the labial flange configuration in one of two ways; either the flange is increased in thickness to allow selective relief dur­ ing the insertion phase to pass over the undercut, or the labial flange is under­ extended. These options are unsatis­ factory. The first can create a bulbous appearance to the lower lip. Both compromise the border seal, decrease resistance to horizontal movement, and allow food to be impacted under the denture base. An alternative is to modify the shape of the labial ridge. This is accomplished by modifying the labial topography. Ostectomy I osteop­ lasty is contraindicated because this type of ridge is usually narrow and the loss of more osseous tissue would compromise crestal integrity. Aug­ mentation of the ridge with denuda­ tion requires an increased surgical site, surgical risk, and discomfort, and may have the unpredictable result of further ridge resorption. The technique of ridge augmenta­ tion used by the authors is an adapta­ tion of the gingival autograft.1 This periodontal procedure is a technique used to increase the zone of attached gingiva in areas that have mucogingival deficiencies. The use of a graft from a suitable donor site, in this case the palate, can elim inate the undercut area . A m ed iu m -th ick n ess graft (epithelium and adjacent corium) is used to fill the concavity while provid­ ing functional mucosa after repair. An additional result of this technique is an increase of the amount of attached gingiva, which deepens the vestibule.