Objectives To evaluate the evidence for a 50,000/μl platelet count threshold for platelet transfusion for invasive dental procedures in thrombocytopenic patients. Subjects and Methods We searched in MEDLINE/PubMed, EMBASE, the Cochrane Library (Wiley) and Scopus from 1960 through April 2018 for studies on patients with quantitative platelet disorders not related to medical co‐morbidities or medications and undergoing invasive dental procedures. Two reviewers conducted assessments independently. Results We found a total of 176 non‐duplicate articles, of which 9 cohort studies met our inclusion criteria. The incidence of postoperative bleeding in thrombocytopenic patients was low (4.9%), and we found no difference in bleeding incidence between patients who had platelet transfusion and those who did not. There was no difference in the mean platelet count for patients with and without bleeding. Different modalities are now available to prevent and control bleeding, which may reduce the need for platelet transfusion. Conclusions There is no evidence to support the long‐standing dogma of a need for a platelet count ≥ 50,000/μl for safe invasive dental procedures. Platelet transfusion effectiveness for haemostasis support could not be determined based on available data. Local measures and antifibrinolytics are the mainstay for the prevention and management of bleeding.

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Objective To evaluate the current evidence regarding the effectiveness of non‐opioid interventions for the therapeutic management of pain in head and neck cancer patients with oral mucositis resulting from radiotherapy only or chemoradiotherapy. Materials and Methods A literature search was conducted which included randomised controlled trials that assessed patient‐related outcome of pain in patients with oral mucositis associated with radiation therapy only or chemoradiotherapy. Literature searches were conducted in MEDLINE via Pubmed, Embase, Scopus and CINAHL. Results The electronic searches identified 846 articles. Screening revealed that six articles met all eligibility inclusion criteria. Interventions showing statistically significant benefits to reduce oral mucositis associated pain compared to placebo included doxepin (p < 0.001, 95% CI −6.7 to −2.1), amitriptyline (p = 0.04), diclofenac (p < 0.01) and benzydamine (p = 0.014). Conclusions Non‐opioid interventions, including topical doxepin, amitriptyline, diclofenac and benzydamine, were found to provide relief of pain due to mucositis, and when effective may allow for reduction in the use of opioids in pain management.

Objectives This systematic review aimed to evaluate the current literature regarding the importance of discontinuing or not discontinuing direct oral anticoagulants (DOACs) before invasive oral procedures, and to establish the frequency and type of postoperative bleeding events in patients. Material and Methods We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up until November 5, 2018. Selection of the studies, extraction of data, qualitative, and bias assessment was performed independently by two authors. Results Twenty‐one studies were included. No randomized controlled studies were identified. Six studies reported a direct comparison between patients taking DOACs and those who discontinued DOACs. The meta‐analysis of these studies resulted in an OR of 0.92 (95% CI = 0.37–2.27, I2 = 9%) for postoperative bleeding events for patients taking DOACs. We found that 59/497 (11.8%) postoperative bleeding events occurred in patients who continued DOACs, while 27/200 (13.5%) events were reported for patients who discontinued treatment. All postoperative bleeding events were controlled with local measures. Conclusion Results from the included studies did not discern any important differences in postoperative bleeding events in patients who continued versus patients who discontinued DOACs. Furthermore, no thromboembolic events were recorded. However, the low quality of the studies must be considered.

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Dental practitioners will be exposed to patients experiencing neuropathic pain of the orofacial region at some point in their careers. The pain can be distressing and affect quality of life. Therefore, an understanding of the clinical presentation, diagnosis, and management of neuropathic orofacial pain is essential since some patients will convincingly express this pain to be originating from a dental source. Neuropathic pain may be episodic such as trigeminal neuralgias, or continuous, which includes peripheral painful trigeminal traumatic neuropathy, persistent idiopathic facial pain, neuritis, and burning mouth syndrome. Research has revealed that these various neuropathic pains often have specific treatment modalities. Hence, establishing an accurate diagnosis and understanding the pathophysiology of the disorders are critical in the management of pain as these will avoid the initiation of unnecessary dental interventions.

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