1/6. Managing patients on warfarin therapy: a case report.Coagulotherapy is a common therapeutic regimen most frequently utilizing warfarin. This therapy may have important dental ramifications. An understanding of the mechanisms of action and drug interactions may help avoid problems. Questions commonly arise as to what dental procedures may be safely considered when a patient is on anticoagulant therapy. The coagutherapy level is measured in values of the international normalized ratio (INR). Any question about the appropriateness of dental procedures should be referred to the physician prescriber of the anticoagulant therapy. Generally, controlling bleeding is less of a problem than the management of thrombi and vascular occlusion from decreased coagutherapy. A case is presented in which the INR reached a critical value as the result of drug interactions and miscommunication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. tongue piercing and its adverse effects.Piercing has become so popular during the last 20 to 30 years that many physicians are now treating patients with piercings and dealing with its side effects. We present 3 cases that illustrate the complications of tongue piercing (ie, infection, bleeding, and embedded ornaments). We describe the methods for inserting the ornaments to illustrate the possible adverse effects. Treatment recommendations and their application to those 3 patients are described.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Acute idiopathic thrombocytopenic purpura.A 35-year-old man had hemorrhagic bullae of the buccal and sublingual mucosa as the first sign of acute idiopathic thrombocytopenic purpura. Twenty-four hours later the more typical cutaneous manifestations of petechiae of the lower extremities were present. Although it is unusual for the initial symptoms of this disease to be limited to the oral region, the physician and dentist should be keenly aware of the clinical appearance described in this article, as it may be the only clue of an underlying systemic disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Management of traumatic oral-facial injury in the hemophiliac patient with inhibitor: case report.This report describes identification of factor viii inhibitor in a patient who then received immune tolerance therapy. The precipitating event was a traumatic orofacial injury that was nonresponsive to traditional factor-replacement therapies. An inhibitor complicates medical and dental management of the hemophiliac patient because it counteracts usual techniques of hemorrhage control using coagulation agents derived from factor viii (Monoclate--Armour, Blue Bell, PA). Successful identification and management of the inhibitor patient require communication and consultation between the physician and dentist, up-to-date knowledge regarding the hemophiliac patient's bleeding and infusion history and aggressive application of local adjunctive hemostatic therapies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Persistent haemorrhage following dental extractions in patients with liver disease: two cautionary tales.Two cases are reported in which patients known to suffer from chronic liver disorders underwent local anaesthetic dental extractions. In both cases the procedure was followed by severe, intractable post-operative haemorrhage, resistant to local haemostatic measures and requiring hospital admission for intravenous fluid replacement and administration of clotting factors. The importance of not only eliciting details of a patient's medical history, but also of acting appropriately upon that information is emphasised and a recommendation is made that patients with active liver disorders, such as cirrhosis, who require oral surgery procedures should be managed in hospital departments, where access to haematological assessment and appropriate surgical and medical care is readily available. Close liaison with liver physicians and haematologists is recommended.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Fatal staphylococcus aureus infective endocarditis: the dental implications.Infective endocarditis remains an important and life-threatening infection despite improvements in diagnosis and management. There is currently a greater role for nosocomial acquisition of organisms and immunosuppression in the pathogenesis of this disease and emergence of a broader spectrum of infective organisms including those not commonly isolated from the mouth such as staphylococci. We report a case of infective endocarditis caused by staphylococcus aureus in which the patient developed disseminated intravascular coagulation and multiple septic infarcts resulting in a frontal lobe brain abscess. Multiple dental extractions were complicated by delayed postextraction hemorrhage and the immediate cause of death was abdominal hemorrhage. The dental management in infective endocarditis should be planned in consultation with the attending physician, and should take into account both the causative organism and the presence of complications. When the oral cavity cannot be proven as the bacterial source for infective endocarditis, the immediate dental management should be directed toward improving the patient's oral hygiene and providing pain relief. Definitive long-term treatment, including any extractions, is ideally delayed until the patient has fully recovered from the infective endocarditis and its attendant complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |