The use of anti-platelet therapy has reduced the mortality and morbidity of cardiovascular disease remarkably. A considerable number of patients presenting before a dentist or periodontist give a history of anti-platelet therapy. A clinical dilemma whether to discontinue the anti-platelet therapy or continue the same always confronts the practitioner. Diverse opinions exist regarding the management of such patients. While one group of researchers advise continuation of anti-platelet therapy rather than invite remote, but possible, thromboembolic events, another group encourages discontinuation for variable periods. This study aims at reviewing the current rationale of anti-platelet therapy and the various options available to a clinician, with regard to the management of a patient under anti-platelet therapy. Current recommendations and consensus favour no discontinuation of anti-platelet therapy. This recommendation, however, comes with a rider to use caution and consider other mitigating factors as well. With a large number of patients giving a history of anti-platelet therapy, the topic is of interest and helps a clinician to arrive at a decision.
Background: Dental treatment in patients on antiplatelet drug therapy is a long standing debate. Discontinuation of medication increases the risk of thrombotic complications, whereas continuation leads to increased postoperative bleeding. Aim: We conducted this prospective cross-sectional study to assess risk of bleeding in patients continuing antiplatelet medication while performing minor oral surgical procedures such as single or multiple teeth extraction, transalveolar extraction of third molar, biopsy, and alveoloplasty. Materials and Methods: We calibrated the steps taken to achieve hemostasis, time taken to arrest bleeding, and correlated time taken to achieve hemostasis in patients under antiplatelet drug therapy (Group A [n = 64] - aspirin, Group B [n = 36] - aspirin and clopidogrel) and in patients without any drug therapy (Group C [n = 100] healthy patients). Results: Out of 200 patients, Level 1 hemostatic measures were required for 129 (64.5%) patients, Level 2 hemostatic measures were taken for 68 (34.0%) patients, and Level 3 hemostatic measures were taken for 3 (1.5%) patients. Chi-square test conducted to compare the local hemostatic measures taken for minor oral surgical procedure for all groups was statistically significant ( P ≤ 0.001). Conclusion: Overall, there was no postoperative bleeding within 24 h of extraction in any patient group. In conclusion, surgical procedures can be safely accomplished in patients receiving single or dual antiplatelet therapy when appropriate local hemostatic measures are taken.
Treatment of periodontal disease involves complex mechanical, surgical, and medical modalities. Some of the treatment regimens are patient centered, some involve a great amount of technical expertise and competence from a practitioner, and often involve complex procedures like use of tissue-engineered products. In spite of several advances, treatment of periodontal disease depends on scaling and root planing and various surgical procedures as the mainstay, but results of treatment are not always predictable and are often frustrating. The ultimate aim of periodontal treatment is regeneration of periodontal tissues and more particularly lost alveolar bone support. The treatment options include a myriad of approaches and scientists and researchers have tried various tools and agents to improve alveolar bone status and improve periodontal health. These approaches vary from simple monotherapy with systemic antibiotic usage to exotic and novel procedures like shock wave therapy, photodynamic therapy and application.
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