Oral implant treatment for elderly patients

随着材料和技术的进步,现代口腔种植学得到了快速的发展。种植牙已成为恢复缺失牙的首选治疗方式。尽管在健康成人中,种植牙已经取得了很高的成功率,但对于老龄患者,随着身体机能的下降和伴发其他系统性疾病,种植治疗的风险相应地增加。老龄患者在进行种植治疗时应该考虑哪些影响因素以及如何预防可能的风险和并发症,应引起口腔种植医生的高度重视。本文对老龄患者口腔种植治疗的特殊性、种植成功率、老年患者的全身系统疾病考量和用药考量等方面进行探讨,以供临床参考。     

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目的探讨口腔种植修复中全身并发症的应急对策及风险因素的预防,增强对口腔种植修复中全身并发症发生原因和临床表现的认识,为临床医生提高急救能力和增强防范意识提供参考。方法统计2011年1月至2013年12月在北京大学口腔医学院种植科接受口腔种植修复患者10 402例中,有9例在口腔种植修复治疗过程中发生全身并发症,发生率为0.09%。其中,发生过敏性休克2例,高血压危象亚急症3例,误吞种植体部件3例,过度换气综合征1例。回顾并分析9例患者临床急救处理及预防措施。结果 9例患者经及时救治均脱离危险,并成功完成种植修复。结论全身疾病对种植修复安全性有广泛的影响,对口腔种植过程中出现的全身并发症掌握必要的急救技术和增强防范意识,是种植治疗成功的重要保障。     

根管治疗操作对老年人血压的影响

我国已进入老龄化社会,随着经济的发展,医疗技术的提高,老年口腔病患者就诊率逐渐增加.老年口腔患者常伴有全身疾患,据报道,60岁以上老年人44％患高血压[1],虽然牙髓病的治疗与心血管病之间的关系尚不明确[2],但高血压患者口腔治疗的安全性是我们必须要面对的问题.有关高血压患者的心电监护拔牙的问题研究较多[3,4],但口腔治疗对老年人血压的影响研究较少[5].本研究的目的是观察口腔常规治疗操作对老年人血压的影响.     

浅谈老年患者口腔麻醉椅旁护理要点

在牙病治疗过程中常需进行口腔麻醉。随着社会的老龄化 ,在口腔门诊就诊的老年患者呈上升趋势。本文针对老年患者的生理及心理特点 ,浅谈老年患者口腔麻醉前后的护理要点 :1　老年患者的特点6 0岁以后的人随着年龄的增长 ,各器官组织自然性趋向衰老 ,生理功能都有不同程度的减退 ,抵抗力、应激力较差。且老年人多伴有一种或多种慢性疾病 ,如动脉硬化、高血压、心脏病等 ,适应能力下降。局部麻醉药品具有可能的过敏反应 ,治疗操作又可对患者构成一定的精神刺激 ,从而可能导致血压骤然升高或下降以及心绞痛等并发症。血压骤然升高 ,可发生脑血…     

影响口腔颌面部多间隙感染老年患者治疗结果的因素分析

目的：分析影响口腔颌面部多间隙感染老年患者的治疗结果的转归因素。方法：对上海第九人民医院口腔颌面外科收治的242例诊断为口腔颌面部多间隙感染的病例进行回顾性分析,根据年龄分为老年组和中青年组。研究内容包括一般资料,临床指标（全身系统性疾病、病因、症状发作到人院治疗的时间、受累间隙的数量和分布）,实验室检查（细菌学、入院血糖水平、入院血白细胞总数和中性粒细胞百分比）和治疗结果（切口数量、住院天数和并发症）。对数据进行多元线性回归、logistic回归、t检验和x2检验分析。结果：在老年患者中,切口数量和并发症与受累间隙的数量有关。而在中青年患者中,切口数量和住院天数与受累间隙的数量有关,并发症与入院血糖浓度和人院白细胞总数。结论：分析阐明了影响口腔颌面部多间隙感染老年患者治疗转归的因素。其中,受累间隙的数量是一个重要的影响因素。     

口腔颌面部多间隙感染老年患者与中青年患者的临床比较

目的:通过与中青年患者的比较,分析口腔颌面部多间隙感染老年患者的临床特征。方法:对上海第九人民医院口腔颌面外科收治的242例诊断为口腔颌面部多间隙感染的病例进行回顾性分析。所有病例根据年龄分为老年组和中青年组。研究内容包括一般资料、临床指标(全身系统性疾病、病因、症状发作到入院治疗的时间、受累间隙的数量和分布)、实验室检查(细菌学、入院时血糖水平、入院时白细胞总数和中性粒细胞百分比)和治疗结果(切口数量、住院天数和并发症)。采用SAS 8.0软件包对数据进行t检验、Fisher’s确切概率和χ2检验分析。结果:与中青年患者相比,老年患者患有更多的系统性疾病(P=0.0002),住院时程更长(P=0.02),全身各种并发症情况更多见(P=0.04)。结论:通过与中青年患者比较,揭示了口腔颌面部多间隙感染中的老年患者的临床特征,为临床上治疗老年口腔颌面部多间隙感染提供了重要的参考依据。     

肾上腺素在老年高血压患者口腔局部麻醉中的应用研究

在口腔局部麻醉中 ,利多卡因加肾上腺素应用十分广泛 ,效果确切 ,但在老年高血压病患者中的应用却有很多争议。本文通过临床随机对照试验对局部麻醉药液中加肾上腺素和不加肾上腺素进行比较 ,探讨高血压患者口腔局部麻醉应用肾上腺素的可行性。1　对象和方法1.1　病例选择老年高血压患者行拔牙或牙髓治疗患者 2 0 0例 ,其中拔牙10 4例 ,牙髓治疗 96例 ;男 114例 ,女 86例 ,年龄 5 8～ 81岁 ,平均年龄 5 9.6岁。均为原发性高血压Ｉ期或ＩＩ期患者 ,经系统治疗血压接近正常 ,无明显头痛和头晕症状 ,无心功能不全。随机将患者分为肾上腺素组和…     

老年口腔肿瘤合并糖尿病患者的围手术期处理

目的：探讨老年口腔肿瘤伴有糖尿病的患者，围手术期的临床处理要点。方法：对21例伴有糖尿病的老年口腔肿瘤患者，进行围手术期控制血糖后手术治疗。结果：21例伴有糖尿病的老年口腔肿瘤患者手术过程顺利，术中、术后因合理使用胰岛素而血糖控制良好，均安全度过围手术期，无严重并发症发生。结论：对于伴有糖尿病的老年口腔肿瘤患者，术前较好地控制血糖，术中、术后积极监测及治疗糖尿病，使围手术期的血糖相对稳定，是手术成功及减少术后并发症的关键。     

影响糖尿病患者口腔颌面部多间隙感染治疗结果的因素分析

目的:分析影响口腔颌面部多间隙感染患者治疗结果 (住院天数和并发症)的转归因素,并比较糖尿病患者与非糖尿病患者口腔颌面部多间隙感染的临床特征。方法:对2007—2010年间收治的117例口腔颌面部多间隙感染病例进行回顾分析。研究变量包括一般资料、病因学、临床指标(症状发作到入院治疗的时间、受累间隙的种类和数量)和实验室检查(细菌学、入院时血糖水平、入院时血白细胞总数和中性粒细胞百分比),结果变量为患者住院天数和并发症。采用SAS8.0软件包对数据进行t检验、卡方检验、方差分析、Logistic回归和线性回归分析。结果:糖尿病口腔颌面部多间隙感染患者与非糖尿病患者相比,前者受累的间隙更多,住院时间更长,全身各种并发症情况更多见,严重者可导致死亡。糖尿病存在与否与口腔颌面部多间隙感染的治疗转归(住院时日和并发症)直接相关。入院时血糖水平是影响口腔颌面部多间隙感染并发症严重程度的主要因素。结论:糖尿病患者与非糖尿病患者口腔颌面部多间隙感染的临床特征和转归不同,为临床上治疗糖尿病口腔颌面部多间隙感染提供了重要的参考依据。     

癌症放疗化疗口腔并发症的临床表现与诊断

恶性肿瘤的治疗包括手术治疗、放疗、化疗等。然而 ,大多数放疗化疗可同时作用于肿瘤细胞和正常组织 ,导致正常组织的损伤。口腔并发症是癌症治疗最常见的并发症 ,它不仅降低了患者的生存质量 ,影响治疗计划的实施 ,严重者尚需中断治疗 ,少数患者甚至死于并发症。因此 ,癌症治疗相关人员应意识到口腔保健是癌症治疗计划的重要组成部分 ,采取必要的措施防治口腔并发症 ,这对癌症治疗效果将产生积极影响。1.口腔并发症的发病机制及分类　近年来 ,对癌症治疗相关口腔并发症机制的认识取得了一些进展。一般认为放疗化疗口腔并发症是多因素作用的…     

The impact on dentistry of recent advances in the management of hypertension

Dentistry has played an important role in the detection of patients with hypertension. Patients found to have high blood pressure at or beyond defined levels should be referred for a medical diagnosis and indicated treatment. Once the hypertensive condition is under control, oral and dental evaluation and treatment can be initiated. Beginning in 1976, the percentage of the general population in the United States with undetected hypertension declined steadily. However, this decline reversed, beginning in 1994. In addition, fewer than 50% of the patients who are aware of their hypertension have it medically under control. Thus, a significant number of patients with undetected high blood pressure or uncontrolled hypertension today are seeking dental treatment. These patients are at high risk for significant complications such as stroke, heart disease, kidney disease, and retinal disease. Those with very high blood pressure are at great risk for acute medical problems when receiving dental treatment. For those reasons, dentistry must continue to place an emphasis on the detection and referral of patients with high blood pressure. In addition, increased numbers of medically compromised patients are seeking dental treatment who should have their blood pressure monitored during the more stressful dental procedures, such as oral surgery, periodontal surgery, and placement of dental implants. This article reviews the recent advances in the dental and medical management of hypertension. It is important for dentists to be aware of hypertension in relation to the practice of dentistry.     

Risk patients in dentistry

Authors study the risk diseases in dental practice. They analyze the possible complications and the methods of their prevention in each risk group. They take deal with the importance of antibiotic prophylaxis, the problems of local anaesthesia and the management of patients who suffer from coagulation disturbances. They present the management of risk patients in two cases. They emphasize the importance of anamnestic history in every case before dental treatment.     

Fibrous hyperplasia of the gingiva in organ transplant patients.

Recent improvements in immunosuppressive therapy have improved the survival rate of post organ transplant patients. These developments have introduced a new group of medically compromised patients to the general dental practitioner. This paper reviews the medical and dental complications of organ transplant patients with special reference to heart transplant patients. A case report of the management of Cyclosporin A induced gingival hyperplasia in a post heart transplant patient is presented. Guidelines for dental management of heart transplant patients are suggested.     

Dental management of chemoradiation patients

The utilization of combined chemoradiation therapy has recently increased in the treatment of head and neck cancers. This patient population is significantly more prone to various oral complications during and after medical therapy. Oral complications and long-term effects include mucositis, xerostomia, alterations in taste, vascular compromise, mucosal thinning and increased risk of rampant caries and periodontal disease. The most serious oral complication that can arise is osteoradionecrosis. Managing patients properly prior to medical treatment can help decrease these potential complications during and after treatment. This purpose of this article is to review the different radiation and chemotherapy regimens used to treat patients with head and neck cancers, as well as protocols in the dental management of these patients before, during, and after medical treatment.     

How does diabetes alter treatment in the dental office?

Diabetes mellitus affects approximately seven percent of the American population; thus, patients with diabetes are seen in every dental practice. Advances in medical management of diabetes have resulted in intensification of treatment regimens, with a resulting decrease in long-term complications of the eyes, kidneys, and nervous system. This intensified treatment may place the diabetic patient at increased risk of hypoglycemic emergencies during dental appointments. Dental practitioners should understand methods of preventing hypoglycemia and must be able to recognize and treat hypoglycemia, should it occur in the office.     

Clinical study of anesthetic management during dental treatment of 25 patients with cardiomyopathy

This retrospective study analyzed the management of 25 patients with hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), or dilated phase of hypertrophic cardiomyopathy (dHCM) treated in the outpatient clinic of the Department of Dental Anesthesiology at Hokkaido University. A total of 87 dental treatment sessions were completed. Intravenous sedation was used significantly more often for patients with HCM than those who had DCM. This seemed to be because dental anesthesiologists expected sedative drugs to suppress hyperdynamic circulatory changes caused by mental stress. Intraoperative complications occurred during 19 treatments. The incidence of circulatory complications increased when participants with DCM also reported dental fear. For participants with HCM who reported dental fear, circulatory complications occurred only when sedation was not used. It is not clear whether complications were related to cardiac function or dental treatment. Therefore, it is important to continually monitor patients with these conditions and to be prepared to handle complications that may arise during dental treatment.     

Safety of dental treatment in patients with previously diagnosed acute myocardial infarction or unstable angina pectoris

OBJECTIVE: The purpose of this study was to assess the safety of invasive dental treatments, such as tooth extraction and pulpectomy under local anesthesia, in patients with unstable angina pectoris and within 6 months after onset in patients who had experienced acute myocardial infarction. STUDY DESIGN: Cardiovascular complications during and after dental treatment and preoperative risk factors were explored in 63 patients who had experienced unstable angina pectoris or acute myocardial infarction. RESULTS: A total of 79 dental treatments were performed with no intraoperative complications. Chest pain occurred in 8 patients within 1 week after dental treatment. Risk factors for postoperative complications were identified as a history of chest pain within 2 weeks before the dental treatment and failure to clear the Master Test Single stress test. CONCLUSIONS: Many patients who had experienced unstable angina pectoris or acute myocardial infarction tolerated dental treatment when appropriate stress control measures were used. However, approximately 10% of the patients experienced postoperative problems. Acceptability of dental treatment should be determined on the basis of the comprehensive assessment of each patient.     

Adolescent pregnancy: a review of dental treatment guidelines

More than 6% of adolescent females become pregnant in the United States per year, yet there is no concise guide for their dental treatment. The principles for medical management of these patients are not unlike those used for adult females, but the higher incidence of complications coupled with social and consent issues make their overall management more complex. Whether treating a pregnant adolescent or an adult, the primary goal is to maintain a safe environment for both the fetus and mother. Untreated dental disease can compromise the health of the mother and unborn child; therefore, dental treatment should not be withheld. In complicated pregnancies, dental practitioners should contact the patient's obstetrician prior to providing treatment or prescribing medication. With proper technique, dental radiographs do not place the fetus at risk and should be taken if they are of potential benefit. Preventive care should be delivered throughout pregnancy, and elective routine care is best delivered during the second trimester.     

Thyroid disorders. Part I: hyperthyroidism

The significant thyroid disorders that may be found in dental patients are presented in a series of 3 articles. This article (part I) deals with hyperthyroidism, part II with hypothyroidism and thyroiditis, and part III with neoplastic lesions of the thyroid. The signs and symptoms, laboratory tests used to diagnoses hyperthyroidism, and the medical management of patients with hyperthyroidism are presented in this paper. The dental management of patients with hyperthyroidism is discussed in detail. The dentist, by detecting the early signs and symptoms of hyperthyroidism, can refer the patient for medical diagnosis and treatment and avoid potential complications of treating patients with uncontrolled disease. These complications include the rare thyrotoxic crisis (thyroid storm) that may be precipitated by dental treatment, acute infection, or trauma in the patient with uncontrolled hyperthyroidism. Also, the use of epinephrine or other pressor ammines can cause a hypertensive crisis in the patient with uncontrolled hyperthyroidism. Patients will benefit from the early detection and referral by reducing the risks of the medical complications such as hypertension, cardiac arrhythmias, and congestive heart failure.     

Novel anticoagulants: general overview and practical considerations for dental practitioners

Currently, 4 novel Direct Oral Anticoagulants (DOACs) were approved by the FDA. This review focuses on these agents and proposes a matrix for the general dentists to assess bleeding risk in dental management of patient on DOACs. The outline covers the pharmacology of DOACs (rivaroxaban, apixaban, edoxaban and dabigatran), bleeding complications, risk associated with discontinuation, monitoring/reversal, and implications for the dental practitioners. A total of 18 randomized controlled trials were identified with mixed results in regards to the risk for bleeding. Considering the pharmacology of DOACs and challenges in monitoring and reversing their effect, the dentist should consider carefully the management of patients on DOACs as it may differ from patients on conventional anticoagulants. Based on the type of dental procedure and the medical risk assessment, several general treatment approaches can be considered: continue DOACs, time dental treatment as late as possible after the last DOACs dose, discontinue DOACs for 24hrs, or discontinue DOACs for 48hrs. Based on the current reported dental literature, limited dental surgery may benefit from the first 2 conservative options. However, this needs to be proven in comparative clinical trials.