Balasubramanian Krishnan

Exodontia and Antiplatelet Therapy

PURPOSE The fear of excessive bleeding often prompts the physician to stop long-term, low-dose antiplatelet therapy before any surgical procedure. This may put the patient at risk of an adverse thromboembolic event. We undertook an assessment of the incidence of prolonged postoperative bleeding after dental extractions among patients on uninterrupted antiplatelet therapy, and evaluated the need to stop such medications before dental extractions. PATIENTS AND METHODS Eighty-two patients requiring dental extractions were included in this study, of whom 57 were on antiplatelet therapy (aspirin). Patients were divided into 3 groups. Group 1 consisted of patients in whom antiplatelet therapy was interrupted (n = 25), group 2 consisted of those continuing their medication (n = 32), and group 3 comprised healthy patients not on antiplatelet therapy (n = 25). Preoperative bleeding time and clotting time were determined in all patients. The surgical procedure involved single or multiple teeth extractions under local anesthesia with a vasoconstrictor. All patient groups were similar regarding age, gender distribution, dosage of antiplatelet drug, and medical condition for which the drug was prescribed. Events of single or multiple teeth extractions were also comparable among the 3 groups. Pressure packing was performed in all cases as in routine dental extractions. One-way analysis of variance was performed to determine the significance of prolonged bleeding among groups. RESULTS The mean bleeding times in groups 1, 2, and 3 were 3 minutes, 2 minutes and 45 seconds, and 1 minute and 49 seconds, respectively. The mean clotting times in groups 1, 2, and 3 were 5 minutes and 4 seconds, 4 minutes and 52 seconds, and 3 minutes and 42 seconds, respectively. No patient in any group had any episode of prolonged or significant bleeding from the extraction sites. Local hemostasis had been satisfactorily obtained in all cases with the use of a pressure pack for 30 minutes. CONCLUSIONS Routine dental extractions can be safely performed in patients on long-term antiplatelet medication, with no interruption or alteration of their medication. Such patients do not have an increased risk of prolonged or excessive postoperative bleeding.

Diabetes mellitus and odontogenic infections—an exaggerated risk?

IntroductionThe diabetic host is considered to be at an increased risk for the development of odontogenic infections due to his medically compromised state. This perceived risk of higher infections often results in dentists delaying much-needed surgical treatment in this patient population.DiscussionA critical examination of literature does not seem to support the role of diabetes mellitus as a definitive risk factor for odontogenic infections. A simplistic extrapolation of infection rates observed in other sites may not be justified in the orofacial region.

An unusual cause of epistaxis in a young patient: the supernumerary nasal tooth

Eruption of supernumerary teeth into the nasal cavity is a rare pathological condition. Identification of such teeth is important as they can sometimes cause significant morbidity. This report describes a young female patient with a complaint of epistaxis from the right nasal cavity. The diagnosis of a supernumerary nasal tooth was confirmed by computed tomography and the tooth was removed endoscopically with minimal morbidity.

Dental patients: Transgender issues.

DENTAL PATIENTS Transgender issues Sir, recently, a case in which a hospital dentist needing to make an admission was unsure of the patient’s gender raised issues of awareness. The patient identified herself as female and this was respected throughout her uneventful stay in hospital and treatment but the case highlighted a number of pending issues related to the dental care of intersex, transgender and trans-sexual individuals: 1. Have we given due consideration to these patients in our routine practice? 2. Is our curriculum adept in sensitising us to the issues of this community? 3. Are hospital policies explicit in the way such individuals must be handled? 4. Are the medical, psychosocial and legal aspects of dental care for these patients clearly understood? 5. Is it feasible and recommended to have special wards earmarked for them? 6. How do we ensure a nondiscriminatory healthcare environment for these patients? 7. How can they be mainstreamed in the medical milieu?

Knowledge of basic dental physiology among teachers can improve preliminary management of acute dental avulsion in school children

Background and Aim: Acute dental injuries occur frequently in school going children. Teachers are often the first person to initiate emergency care before medical help is available. This study was carried out to evaluate the knowledge and attitude to emergency management of dental trauma among a group of school teachers in Pondicherry, India. Methods: A structured questionnaire was administered to 60 teachers. Results: Nearly 85% of teachers did not have any formal first-aid training during their career. Furthermore, 81% of teachers had never experienced an episode of acute dental injury in the school environment. Concerning knowledge, 50 participants favored an immediate/early management of acute dental injury. Control of bleeding seemed to be the primary concern in 37% of teachers. Knowledge of optimal storage media for avulsed permanent teeth was poor. Twelve teachers were unsure if they should be exposed to first-aid training. This may be due to reluctance to take up responsibilities in addition to their routine duties. Conclusion: Teachers should be exposed to education programs in dental first-aid management. Knowledge of basic dental physiology and the physiological events following the repositioning of an avulsed tooth will help in better management of dental trauma.

Unexpected Blooming Artifact in Brain Magnetic Resonance Imaging

Unexpected foreign bodies are occasionally discovered during magnetic resonance imaging (MRI). These are often present unknown to the patient, missed during routine pre-MRI screening and result in unnecessary delay during MRI. The authors present a patient with traumatically embedded foreign body in the scalp that escaped pre-MRI screening and caused susceptibility artifacts during brain MRI. The object was surgically removed to allow the imaging to be completed. Patients with suspicion or history of facial trauma or with dental restorations are referred to concerned specialists for compatibility of hardware, restorations and for assessing risks during MRI due to these. This patient is presented as a reminder for clinicians to probe further during anamnesis and have a high index of suspicion for foreign bodies that may be present even after trivial injuries.

Psychological Consequences of Maxillofacial Trauma in the Indian Population: A Preliminary Study

The aim of this article is to identify the prevalence of posttraumatic psychological symptoms following maxillofacial trauma among an Indian population sample and assess changes in these symptoms over a period of time. Forty-eight adult patients were assessed within 2 weeks of injury with two follow-up visits (4–6 weeks and 12–14 weeks). Patients were administered three self-reporting questionnaires in local language (GHQ-12; HADS; TSQ) on all occasions. Relevant sociodemographic and clinical data were obtained. Forty patients were included in the final analysis. Emotional distress was present in nine participants and five participants satisfied the TSQ criteria for a diagnosis of stress disorder. Anxiety and depression were observed in 10 and 4 patients, respectively. Characteristics associated with abnormal high scores included substance abuse, low education and income levels, facial scars, and complications needing additional intervention. These findings reveal the abnormal psychological response to maxillofacial trauma in immediate and follow-up periods. The use of such screening tools can be considered by the maxillofacial surgeon for early identification of psychological symptoms and referral to the psychiatrist.

The Role of a Conservative Minimal Interventional Management Protocol in the Fractures of the Dentate Portion of the Adult Mandible.

Mandibular fractures are commonly encountered by the maxillofacial surgeon. Maxillomandibular fixation (MMF) and open reduction and internal fixation (ORIF), or a combination of both, are the accepted standard treatments. This study aims to assess the role of a conservative minimal intervention protocol in the management of undisplaced/minimally displaced fractures of the dentate portion of the adult mandible and the complications associated with such minimalistic intervention. Thirty-four patients with undisplaced/minimally displaced fractures of the dentate portion of the adult mandible were advised to restrict mouth opening and limit themselves to a soft diet for a minimum of 4 weeks. All patients were advised follow-up at regular intervals for at least 3 months. Five patients were lost to follow-up. Symphysis and parasymphysis fractures were the most common fracture locations. Fourteen patients needed tension band stabilization with a mandibular arch bar/bridle wiring and three patients required extraction of luxated teeth. All patients showed satisfactory healing except three in whom additional intervention (ORIF) was performed. The improvement in mouth opening was statistically significant. Complications were seen more frequently among smokers and alcoholics. For patients with minimally displaced mandibular fractures, it is necessary to consider if the perceived benefits of intervention justify the associated added costs and possible complications. Patients have to be fully informed about the possible complications while using this minimal intervention protocol. This study concludes that a conservative minimal intervention management protocol for such fractures of the dentate portion of the mandible can produce satisfactory results.

Traumatic dislocation of the mandibular lateral incisor into the nasal floor

A 23-year-old man reported for the management of panfacial fractures allegedly sustained from repeated assault with an iron rod 10 days earlier. Clinical examination revealed partially healed lacerations in the forehead, lower lip and palate, and multiple facial fractures including a palatal split. Intraoral examination revealed luxation and grade III mobility of the maxillary central incisors and a crown fracture in the left maxillary lateral incisor. The right mandibular lateral incisor was missing, with the fracture line passing …

Glass fragment embedded in the cheek: a missed radiographic finding.

A 20-year-old man reported to the outpatient clinic, with concerns regarding a 10×13 mm glass fragment that had allegedly expulsed from his right cheek wound 10 days prior (figure 1). His medical records revealed that he had sustained a road traffic accident (RTA) and had been operated for fractures of the mandible 3 weeks earlier. He was unable to recollect …