Knowledge Is Power!

I have a couple of respectable articles from the Journal of Oral and Maxillofacial Surgery, and this is actually from October 2018.

The first article is titled Assessing the Quality of Life in Patients With Dental Facial Deformities Before and After Orthognathic Surgery. Basically, in English, this is just looking at the quality of life of people when they have a jaw deformity and require orthognathic surgery both before and afterward. The purpose of this study was to assess the effect of the health-related quality of life among patients with dentofacial deformities who underwent orthognathic surgery compared with a control group without dentofacial deformities by use of generic oral health and condition-specific approach.

In this prospective study, they had two questionnaires that were administered to 85 patients, 31 male, 54 female, who were evaluated before undergoing jaw surgery. The short-form oral health impact profile questionnaire and the orthognathic quality of life questionnaire were administered before and five to seven months after jaw surgery. The control group comprised 96 young university student volunteers without a dentofacial deformity.

The results were statistically significant, and patients with dentofacial deformities had a poorer quality of life compared with the healthy population, especially in the functional and psychological aspect. Orthognathic surgery had a significant positive impact on the quality of life. Patients with a class 3 malocclusion who underwent double jaw surgery seemingly benefited the most after surgery.

Now, the next article that I'd like to review is titled Do Antiplatelet Drugs Increase the Risk of Bleeding After Dental Implant Surgery, a Case and Crossover Study. This is by Tabrizi et al., and the purpose of this study was as follows. Cessation versus continuation of antiplatelet drugs in patients undergoing dental implant surgery is a controversial issue. The present study evaluated postoperative bleeding during and after dental implant surgery in patients taking aspirin or generic Plavix. Patients who were using antiplatelet drugs and receiving two bilateral dental implants in the posterior region of the mandible were studied.

During Session One, dental implants were placed without stopping the intake of the antiplatelet drugs, and during Session Two, the antiplatelet drugs were stopped for five days. In Group One, the antiplatelet activity was measured by an assay based on flow cytometry and represented the platelet reactivity index. In Group Two, platelet function analysis was used to monitor the antiplatelet effect of aspirin. Bleeding severity was assessed using a visual analog scale for 72 hours after dental implant placement during Session One and Two. The use of antiplatelet drugs was the predictive factor of the study, and bleeding severity and platelet function were the outcomes of the study.

So the results. 22 patients comprised Group One, which was the generic Plavix, and 20 composed Group Two, which was aspirin at 80 milligrams. In Group One, the bleeding severity was 4.86 plus or minus 0.77 during Session One and 4.59 during Session Two. Data analysis showed no difference in bleeding severity between Sessions One and Two in Group One. In Group Two, the bleeding severity was 4.05 during Session One and 3.9 during Session Two. There was no difference in bleeding severity between Session One and Session Two in patients taking aspirin.

So the results suggest that continuing the intake of antiplatelet drugs did not increase bleeding after the placement of dental implants. Just as a side note, I do not stop patients from taking aspirin or antiplatelet medication or coumadin or any of the direct oral anticoagulants as well prior to surgery as long as they're in their normal therapeutic range, whether it's dental implants, third molars, or any other dentoalveolar surgery.

The last article is just kind of interesting, talking about using dexmedetomidine as an additive to the local anesthetic. So this study was aimed to compare the effect of dexmedetomidine added to lidocaine against epinephrine added to lidocaine on local anesthetic potency, and to look for future prospects of dexmedetomidine as an additive to local anesthetics in dentistry. The study included 25 healthy volunteers in whom the extraction of all first premolars was scheduled as a part of their orthodontic treatment plan. In this split-mouth, double-blind, crossover, randomized controlled trial, patients were randomized into two groups. Group One received an injection of lidocaine plus dexmedetomidine, and Group Two was administered lidocaine plus epinephrine. Patients were assessed for the onset of anesthesia, the duration of anesthesia, pain perception, and vital signs.

The mean values for the onset of the local anesthetic in Groups One and Two were 113 and 141 seconds respectively for the mandible. For the maxilla, the values were 113 and 165 seconds for Groups One and Two. The duration of anesthesia was longer in Group One, which is with the dexmedetomidine, in which the requirement for the first analgesic on request was seen after a long time interval compared to Group Two. Pain perception elicited statistically significant results with less perception of pain in Group One versus Group Two. There was no statistical difference in vitals.

So in conclusion, this study observed that the addition of dexmedetomidine to lidocaine for maxillary and mandibular nerve blocks significantly prolonged the block duration and shortened the onset of action, as well as improved the postoperative analgesia in terms of the need for fewer analgesics in the postoperative period. So, interesting. I don't think we're there yet where we're actually administering dexmedetomidine with our local anesthetic, but food for thought.

There is no guarantee as to the accuracy of this information, and no treatment decision should be based on this information presented. Although every attempt is made to be accurate and factual, some items discussed are the opinion of the author and no liability will be as