Obstructive sleep apnea (OSA) is a sleeping breathing disorder. In children, adenotonsillar hypertrophy remains the main anatomical risk factor of OSA. The aim of this study was to assess the current scientific data and to systematically summarize the evidence for the efficiency of adenotonsillectomy (AT) and orthodontic treatment (i.e., rapid maxillary expansion (RME) and mandibular advancement (MA)) in the treatment of pediatric OSA. A literature search was conducted in several databases, including PubMed, Embase, Medline, Cochrane and LILACS up to 5th April 2020. The initial search yielded 509 articles, with 10 articles being identified as eligible after screening. AT and orthodontic treatment were more effective together than separately to cure OSA in pediatric patients. There was a greater decrease in apnea hypoapnea index (AHI) and respiratory disturbance index (RDI), and a major increase in the lowest oxygen saturation and the oxygen desaturation index (ODI) after undergoing both treatments. Nevertheless, the reappearance of OSA could occur several years after reporting adequate treatment. In order to avoid recurrence, myofunctional therapy (MT) could be recommended as a follow-up. However, further studies with good clinical evidence are required to confirm this finding.
BackgroundA new group of oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban) with clear advantages over classic dicoumarin oral anticoagulants (warfarin and acenocoumarol) has been developed in recent years. Patients being treated with oral anticoagulants are at higher risk for bleeding when undergoing dental treatments.Material and MethodsA literature search was conducted through April 2016 for publications in the ISI Web of Knowledge, PubMed and Cochrane Library using the keywords “dabigatran”, “rivaroxaban”, “apixaban”, “edoxaban”, “new oral anticoagulants”, “novel oral anticoagulants”, “bleeding” and “dental treatment”.ResultsThere is no need for regular coagulation monitoring of patients on dabigatran therapy. Whether or not to temporarily discontinue dabigatran must be assessed according to the bleeding risk involved in the dental procedure to be performed.ConclusionsThe number of patients under treatment with new oral anticoagulants will increase in the coming years. It is essential to know about the pharmacokinetics and pharmacodynamics of new oral anticoagulants and about their interactions with other drugs. It is necessary to develop clinical guidelines for the perioperative and postoperative management of these new oral anticoagulants in oral surgical procedures, and to carefully evaluate the bleeding risk of dental treatment, as well as the thrombotic risk of suppressing the new oral anticoagulant. Key words:Dabigatran, rivaroxaban, apixaban, edoxaban, novel oral anticoagulants, bleeding.
The aim of the present study was to compare the area and volume of remaining cement after lingual and buccal multibracket appliance debonding. Further, the area and volume of cement remaining and the area and volume of enamel were also analyzed using a morphometric digital measurement technique. Ten buccal and 10 lingual multibracket appliances were cemented in 20 extracted teeth embedded into an epoxy resin model simulating a dental arch. The models were scanned before bonding the lingual and buccal multibracket appliances, after debonding the lingual and buccal multibracket appliances, and after polishing the remaining cement. Afterwards, the standard tessellation language (STL) digital files were aligned, segmented, and realigned by using engineer morphometry software. A comparative analysis was performed using Student’s t test statistical analysis. Lingual appliances showed statistically significantly (p < 0.001) less area (7.07 ± 4.85 mm2) and volume (0.87 ± 1.34 mm3) of remaining cement than the area (21.99 ± 4.18 mm2) and volume (p = 0.002) (3.48 ± 0.96 mm3) of buccal appliances. Moreover, lingual appliances showed statistically significantly (p = 0.001) less area (4.48 ± 3.08 mm2) and volume (0.13 ± 0.15 mm3) of remaining cement after polishing than the area (12.22 ± 5.98 mm2) and volume (p = 0.004) (0.70 ± 0.56 mm3) of buccal appliances. Lingual multibracket appliance therapy leads to less area and volume of cement remaining after multibracket appliance debonding and less area and volume of cement remaining after cement polishing than buccal multibracket appliance therapy; however, the area and volume of enamel removed after cement polishing were similar between both lingual and buccal multibracket appliance therapies.
BackgroundAnticoagulation therapy is used in several conditions to prevent or treat thromboembolism. A new group of oral anticoagulants with clear advantages over classic dicoumarin oral anticoagulants (warfarin and acenocoumarol) has been developed in recent years. The Food and Drug Administration has approved edoxaban, dabigatran, rivaroxaban and apixaban. Their advantages include: predictable pharmacokinetics, drug interactions and limited food, rapid onset of action and short half-life. However, they lack a specific reversal agent.Material and MethodsThis paper examines the available evidence regarding rivaroxaban and sets out proposals for clinical guidance of dental practitioners treating these patients in primary dental care. A literature search was conducted through July 2016 for publications in PubMed and Cochrane Library using the keywords “edoxaban”, “dabigatran”, “rivaroxaban”, “apixaban”, “new oral anticoagulants”, “novel oral anticoagulants”, “bleeding” and “dental treatment” with the “and” boolean operator in the last 10 years.ResultsThe number of patients taking edoxaban is increasing. There is no need for regular coagulation monitoring of patients on edoxaban therapy. For patients requiring minor oral surgery procedures, interruption of edoxaban is not generally necessary. Management of patients on anticoagulation therapy requires that dentists can accurately assess the patient prior to dental treatments.ConclusionsTheir increased use means that oral care clinicians should have a sound understanding of the mechanism of action, pharmacology, reversal strategies and management of bleeding in patients taking edoxaban. There is a need for further clinical studies in order to establish more evidence-based guidelines for dental patients requiring edoxaban. Key words:Edoxaban, dabigatran, rivaroxaban, apixaban, novel oral anticoagulants, bleeding.
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