Tag Archives | complications

Dental Extraction Complications in Patients on Double Antiplatelet Therapy

An interesting article titled “Hemorrhagic Complications of Dental Extractions in 181 Patients Undergoing Double Antiplatelet Therapy” written by Olga Olmos-Carrasco and et al. appears in the 2015 Journal of Oral and Maxilofacial Surgery (vol. 73, pp. 203-210). The study sought to explore if dental extractions can be done safely on patients with double antiplatelet therapy. Double antiplatelet therapy is the combination of 100 mg per day of acetylsalicylic acid and a second antiplatelet agent. This type of therapy is done to prevent blood cells from forming a clot in certain types of patients who have a history of coronary artery disease, or have had a heart attack or stroke. A total of 181 patients with a mean age of roughly 67 were included in the study.  Most of the patients (76.8%) were male. A total of 217 teeth were extracted in the study which was conducted in Madrid. During the course of extraction, a total of 165 patients  had light hemorrhage which lasted less than 30 minutes. In 15 patients (8.3%) the hemorrhage continued for more than 30 minutes. After 24 hours, 162 patients reported an absence of bleeding, while 15 patients (8.3%) had light hemorrhage, and 4 patients (2.2%) […]

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Comparing Complications from Anesthesia with Wisdom Teeth Extractions

An article titled “Anesthesia Complications of Diazepam Use for Adolescents Receiving Extraction of Third Molars,” appears in the 2016 Journal of Oral and Maxilofacial Surgery by Gino Inverso and et. al, vol. 74, pp. 1140-1144. The article seeks to evaluate the safety of midazolam and diazepam for adolescents during wisdom teeth extraction and whether any differences in complications exist when using the 2 benzodiazepines alone or in combination. Compared with diazepam, midazolam has a faster onset of action, greater incidence of amnesia, and shorter recovery time. The authors hypothesized that diazepam, when used as an intravenous sedative agent for third molar extraction, would be associated with a higher rate of anesthetic complication than midazolam. The study included patients enrolled in the OMSOS from January 2001 through December 2010. To be included, patients had to be adolescents (<21 yr old) who underwent at least 1 third molar extraction by an oral and maxillofacial surgeon in the ambulatory setting. The study cohort was divided into 3 groups: patients who received diazepam as the only parenteral benzodiazepine, patients who received midazolam as the only parenteral benzodiazepine, and patients who received a combination of diazepam and midazolam. The primary outcome was perioperative anesthetic complications. Complications […]

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How safe is deep sedation or anesthesia in dentistry?

An interesting article titled “How safe is deep sedation or general anesthesia while providing dental care?” appears in the Sept. 2015 issue of JADA (volume 146, issue 9, Pages 705–708) and written by Jeffrey D. Bennett and et al. The article discusses how deep sedation and general anesthesia are given daily in dental offices or practices and this is usually done by oral and maxillofacial surgeons and dentist anesthesiologists. Sedation and anesthesia is given to patients to be able to more easily perform procedures and keep the patient safe and comfortable. Unfortunately in rare cases problems can happen and hence the authors were interested in exploring this. The authors state “Using the available data and informational reports, the authors estimate that the incidence of death and brain injury associated with deep sedation or general anesthesia administered by all dentists most likely exceeds 1 per month.” The authors feel that a patient safety database for anesthetic management in dentistry would provide a more complete assessment of the mortality and morbidity involved. This would be beneficial to developer safer anesthetic care. The authors further state “Optimization of patient care requires appropriate patient selection, selection of appropriate anesthetic agents, utilization of appropriate monitoring, and a highly trained […]

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Exploring the Alternative to Medical Injury Claims in New Hampshire

In a post last year I dicussed briefly the early offer system in New Hampshire see The Optional Alternative to Medical Injury Claims. This is the first of the kind system in the United States that is an alternative to the traditional medical malpractice system. An article in the 2013 issue 4 of the American Journal of Law and Medicine has explored this titled “Evaluating New Hampshire’s First-In-The-Nation Early Offer Alternative to Medical Malpractice Litigation,” and written by John W. Masland. The article states “Many states have enacted medical malpractice reforms, recognizing that their tort systems result in protracted litigation, high costs, and a large number of uncompensated victims. One proposed reform, an “early offer” system, allows a medical provider to make a financial offer covering an injured patient’s economic damages, which, if the patient accepts, precludes litigation…On June 27, 2012, the New Hampshire General Assembly overrode former Governor John Lynch’s veto and established the country’s first early offer payment system for medical malpractice claimants.  After a medical injury, patients may now request an early offer payment from their medical providers for economic damages.” The article goes into more specific details of the early offer program as implemented in New Hampshire. […]

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Ingestion of Foreign Body During Dental Procedures

In the complications of wisdom teeth page on this site http://www.teethremoval.com/complications.html I have discussed cases of teeth being displaced into various places of the body. A tooth can also either be aspirated and end up in the respiratory tract or ingested and likely pass several days after being swallowed. Dental instruments can also break off during surgery and end up in various places of the body. Some recent studies and cases have emerged for other dental procedures where foreign bodies were ingested. An article titled ” Precautions for accidental ingestion of a foreign body,” appears in J Can Dent Assoc 2013;79:d5, located over at http://www.jcda.ca/article/d5. This article describes a case where a 58 year old man underwent treatment for a dental crown and accidentally ingested a 20 mm stainless steel post intended to support the prosthesis. An imaging study revealed the post in the mid-abdomen and the patient, since he was not in distrust, was told to monitor for it to be passed. The patient never saw the post pass in his GI tract but subsequent imaging studies did not reveal it so it is presumed to have passed. This of course, opens up the possibility that maybe there is a […]

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