Objective. To review the literature and collect expert advice for proposing preventive and curative treatments of mouth and dental involvement in patients with systemic sclerosis (SSc; scleroderma). Methods. The literature pertaining to mouth and/or dental involvement related to SSc was reviewed, and recommendations were developed according to the suggestions of a French multidisciplinary working group of experts and validated by a lecture committee. Results. Dentists face 3 main issues in caring for SSc patients: oral mucosa involvement, manducatory apparatus and mouth involvement responsible for limitations in mouth opening, and treatment-related adverse events. An increased risk of tongue carcinoma has been noted. In patients with severe limitation in mouth opening (<30 mm), recommended treatments are a specific mouth-opening rehabilitation program, flexible sectional dentures, and splint therapy. Indications for dental implants depend on the severity of SSc, comorbidities, and/or ongoing bisphosphonate treatment. Prevention of mouth infections and caries implies patient education and teaching about mouth and dental hygiene, periodontal maintenance, and treatment of sicca syndrome. Cessation of tobacco use is mandatory. Patient-tailored rehabilitation may improve limitations in mouth opening. Systematic dental panoramic radiography allows for the early detection of dental caries. Conclusion. Prevention of oral and dental complications is a major issue in patients with SSc. Dental treatment should be tailored to limitations in mouth opening, disease severity, and ongoing treatments.

The combination of 20 ml lidocaine 2%, 10 mg pethidine and 20 mg tenoxicam given intra-articularly provided superior analgesia and reduced oral analgesic requirement during the first day after arthroscopy compared with lidocaine and pethidine alone.

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Avulsions dentaires et kystectomies chez les patients présentant un déficit constitutionnel en facteurs de l'hémostase : conduite à tenir SOCIÉTÉ FRANCOPHONE DE MÉDECINE BUCCALE ET DE CHIRURGIE BUCCALE Article pédagogique Remerciements : Le groupe de travail tient à remercier pour leur collaboration à ce travail Mesdames Marie Claude LINCHET (secrétaire médicale, Hôpital Cochin), Geneviève JOLIVET (cadre infirmier, Hôpital Cochin) et Elisabeth TONNEL (manipulatrice en radiologie, Hôpital Cochin).

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Résumé -Introduction :Le clopidogrel est un agent antiplaquettaire (AAP) indiqué dans la prévention de l'athé-rothrombose et des thromboses de stents coronaires. Il augmente le risque hémorragique lors des actes chirurgicaux. Son arrêt, même transitoire, peut entraîner un accident thrombotique aigu potentiellement grave. Sujets et méthodes : Une étude prospective bicentrique était réalisée. L'objectif était d'évaluer le risque hémorragique postavulsionnel chez des patients des deux sexes, sans limite d'âge, sous clopidogrel en monothérapie ou bithérapie, bénéficiant d'une hémostase à base de colle chirurgicale. Les critères de non-inclusion étaient les patients ayant bénéficié d'un relais (héparine, flubiprofène) ou ayant arrêté leur traitement anti-agrégant. Quatre-vingt-neuf patients étaient inclus, 128 interventions réalisées, 284 dents extraites. Résultats : Douze épisodes hémorra-giques post-opératoires (9,5 %) étaient constatés dont 11 stoppés par le patient à domicile par compressions avec de l'acide tranexamique à 10 %. Deux tiers des hémorragies (8/12) concernaient des patients sous bithérapie antiagrégante. Un patient présentait une hémorragie persistante ayant nécessité une reprise de l'hémostase au fauteuil. Discussion : Cette étude confirme qu'un protocole d'hémostase locale adapté permet de réaliser les avulsions avec maintien du clopidogrel qu'il soit ou non associé à un autre AAP. En cas de bithérapie, les procédures d'hémos-tase doivent être renforcées. Conclusion : Ces résultats confirment les recommandations de la Société française de chirurgie orale (SFCO).Abstract -Dental avulsions in patients receiving clopidogrel: prospective bicentric study. Introduction: Clopidogrel is an antiplatelet drug used in the prevention of atherothrombosis and thrombosis after coronary stent implantation. It increases the risk of bleeding during surgical procedures. In 2015, the French Society of Oral Surgery (SFCO) published a practice guideline which clearly stated that "interruption of clopidogrel before a surgical procedure is not justified". However, there is limited data on tooth avulsions in patients receiving clopidogrel. Subjects and Methods: A prospective bicentric study was performed. The objective was to evaluate the risk of bleeding after tooth avulsion with an hemostatic procedure including surgical glue, in patients treated with clopidogrel alone or associated with aspirin. Patients under switch treatment (heparine, flurbiprofen) or who interrupted their treatment were not included in this study. 99 patients were included, 128 surgical procedures performed and 284 teeth extracted (2 ± 1 per intervention). Results: 12 post-surgical haemorrhages, 11 of which stopped by patient at home by compression with 10% tranexamic acid where noted. 2/3 of these haemorrhage concerned occurred in patients receiving dual antiplatelet therapy. Only one patient required a new local hemostasis procedure at hospital without transfusion or hospitalisation. Discussion: According to these results discontinuation of clopi...

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