OBJECTIVE: To analyze the clinical characteristics and risk factors of patients with oral bleeding. METHODS: A retrospective study was performed on patients with oral bleeding in the Department of Oral Emergency in Peking University School and Hospital of Stomatology from January 2019 to December 2022. The distribution of the patients ' gender, age, cause of bleeding, systemic condition, treatment methods and risk factors of hemostasis methods, and number of visits were analyzed. RESULTS: A total of 4 764 patients with oral bleeding were enrolled, including 2 660 males (55.84%) and 2 104 females (44.16%), with an average age of 40.7 years. The most common causes of oral bleeding were bleeding after tooth extraction (3 080 cases, 64.65%), followed by gingival bleeding (1 386 cases, 29.09%), bleeding after outpatient surgery (194 cases, 4.07%), maxillofacial mass bleeding (33 cases, 0.69%), postoperative bleeding of inpatient (24 cases, 0.50%), and bleeding from other causes (47 cases, 0.99%). Simple hemostatic methods were applied in 1 867 cases (39.19%) while 2 897 cases (60.81%) used complex methods, among which iodine strip tamponade and suture were the most commonly used methods of hemostasis. Logistic regression analysis showed that the male patients had a higher proportion of complex methods than the female patients; gingival bleeding were often stopped by simple hemostatic methods while complex methods were more likely to be applied in the patients with bleeding after tooth extraction. The patients with hypertension and coagulation disorders were more likely to visit the hospital for repeated bleeding. Gender and age did not affect the number of visits. CONCLUSION Oral bleeding was one of the common diseases in oral emergency. The common causes were bleeding after tooth extraction and gingival bleeding. Most patients could be treated by compression, local suture and packing of iodine strips while some cases with severe bleeding needed further treatment to stop bleeding. A minority of patients with oral bleeding could induce systemic complications, which should be paid full attention by clinicians.
Humans ; Male ; Female ; Retrospective Studies ; Adult ; Risk Factors ; Middle Aged ; Tooth Extraction/adverse effects* ; Oral Hemorrhage/epidemiology* ; Young Adult ; Adolescent ; Aged ; Child ; Hemostatic Techniques ; Emergencies ; Postoperative Hemorrhage ; Aged, 80 and over ; Child, Preschool ; Gingival Hemorrhage/etiology*

The accidental displacement of tooth roots into the mandibular canal is a serious complication during tooth extractions in oral and maxillofacial surgery, often resulting in direct damage to the structural and functional integrity of the inferior alveolar neurovascular bundle (IANB). This article reviews the anatomical features of the mandibular canal, the IANB, and adjacent tooth roots; identifies high-risk factors and anatomically vulnerable sites for root displacement; and outlines the clinical manifestations and radiographic characteristics of intraoperative root intrusion into the mandibular canal. Furthermore, management principles, surgical approaches and techniques, inferior alveolar nerve injury treatment, and prognostic considerations are discussed. The aim of this review is to provide a comprehensive clinical reference for improving surgical outcomes, and reducing postoperative complications.
Humans ; Tooth Extraction/adverse effects* ; Mandible/surgery* ; Tooth Root ; Mandibular Nerve/anatomy & histology* ; Postoperative Complications/prevention & control* ; Intraoperative Complications ; Mandibular Nerve Injuries/etiology*

Objective: To evaluate the risk factors of inferior alveolar nerve injury (IANI) after surgical removal of the mandibular third molars (M3) and present a new risk scoring system to predict the probability of IANI. Methods: Patients who underwent extraction of M3 in the Stomatology Hospital, Zhejiang University School of Medicine from April 2017 to December 2019 were involved. The investigators enrolled a sample composed of 949 mandibular third molars. Prediction model was used for univariate and multivariate analysis of gender, age, M3, inferior alveolar canal (IAC), and the contact between M3 and IAC, to assess the risk factors of IANI. Combined with the risk factors determined by the outcomes of prediction model, the risk scoring system was constructed. The diagnostic performance of each cut-off score was examined to conduct a risk stratification of IANI risk scores. The predictive ability and reliability of the model were evaluated. Results: In prediction model, twenty nine cases (4.4%, 29/664) experienced postoperative IANI. Number of root (P<0.01), depth of impaction (P<0.05), contact between M3 and IAC (P<0.01) and their contact position (P<0.05) were statistically significant as contributing risk factors of IANI. Specifically, the incidence of temporary IANI was higher in those who aged under 25 years (P<0.001), while female suffer more permanent injury (P<0.05). Based on the IANI risk scoring system, patients were stratified into low-risk, middle-risk and high-risk groups at cutoff scores of 3 and 4. The area under the receiver operator characteristic curve of the risk scoring system were 0.81 [95%CI (0.70-0.90), P=0.002] and 0.80 [95%CI (0.68-0.92), P=0.007] towards good discrimination. Conclusions: Age, gender, number of root, depth of impaction, and contact between M3 and IAC were risk factors of IANI. IANI risk scoring system might help in preoperative assessment, recognition of high-risk cases and decision-making to reduce IANI.
Aged ; Female ; Humans ; Mandible/surgery* ; Mandibular Nerve ; Molar, Third/surgery* ; Reproducibility of Results ; Risk Factors ; Tooth Extraction/adverse effects* ; Trigeminal Nerve Injuries/etiology*

OBJECTIVE: To investigate the effectiveness of preemptive analgesia with loxoprofen sodium orally, which was a kind of non-steroid anti-inflammatory drugs, in extractions of mandibular impacted third teeth. METHODS: There were questionnaires about postoperative pain for patients whose mandibular impacted third teeth were extracted from July 2017 to August 2017 in First Clinical Division of Peking University School and Hospital of Stomatology. All the patients did their routine clinical examinations and imaging examinations. After their mandibular impacted third teeth were extracted, the questionnaires were sent to them. The questionnaires were filled in by the patients on their own and returned one week later. There were 120 questionnaires that were sent and 105 questionnaires returned, of which 98 questionnaires were filled in completely. According to the inclusive criteria and exclusion criteria, 66 questionnaires were totally selected in this study. According to the time when the patients took their loxoprofen sodium orally firstly, the patients were divided into 3 groups. The first group was for patients who didn't take loxoprofen sodium during their extractions (non-medicine group). The second group was for patients who took 60 mg loxoprofen sodium 30 min before their extractions (preoperative group). The third group was for patients who took 60 mg loxoprofen sodium 30 min after their extractions (postoperative group). The operation time among the 3 groups was analyzed by Kruskal-Wallis method. The postoperative time points were 2, 4, 12,24 and 48 h after operation. The scores of visual analogue scales (VAS) for postoperative pain in each group at different postoperative time points were analyzed by Friedman method. At each postoperative time point, VAS scores in the different groups were analyzed by Kruskal-Wallis me-thod. The numbers of the patients taking loxoprofen sodium home and drug adverse reactions were also analyzed. RESULTS: The operation time of the 3 groups was 15.0 (5.0,30.0) min and had no significant differences (P=0.848).VAS scores of non-medicine group 2,4, 12,24 and 48 h after operation were 1.75 (0.1,10.0), 6.25 (1.5,10.0), 2.00 (0.1,8.0), 2.00 (0.1,6.0) and 0.5 (0.1,5.5) separately and had significant differences (P<0.001).The VAS score at 4 h after operation was higher than the VAS scores at other time points after operation (P<0.005). Four hours after the operations, the VAS scores of preoperative group [2.0 (0.1,10.0)] and postoperative group [2.0 (0.1,5.0)] were lower significantly than those of non-medicine group [6.25 (1.5,10.0)] (P<0.001).The numbers of the patients taking loxoprofen sodium home were 9(40.9%) in non-medicine group,5(21.8%) in preoperative group and 7(33.3%) in postoperative group. The number of the patients who had drug adverse reactions in preoperative group (n=3,13.0%) and in postoperative group (n=4,19.0%) was less than the number of the patients who had drug adverse reactions in non-medicine group (n=8,36.4%). CONCLUSION There were two protocols of preemptive analgesia with loxoprofen sodium orally in extractions of mandibular impacted third teeth, which were taking 60 mg loxoprofen sodium orally 30 min before the extractions and taking 60 mg loxoprofen sodium orally 30 min after the extractions. Both of the two preemptive analgesia protocols could decrease the postoperative pain significantly.
Analgesia ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage* ; Humans ; Pain, Postoperative/prevention & control* ; Phenylpropionates/administration & dosage* ; Tooth Extraction/adverse effects* ; Tooth, Impacted

Humans ; Mandibular Diseases ; prevention & control ; Osteoradionecrosis ; prevention & control ; Radiotherapy ; adverse effects ; Tooth Extraction

OBJECTIVETo investigate the effect of thalidomide on the development of bisphosphonate-related osteonecrosis of the jaws (BRONJ).

METHODSThirty-six rats were randomly divided into groups A, B and C, and treated with saline, zoledronate and zoledronate plus thalidomide, respectively. Three weeks later, the left maxillary first molars of the rats were extracted. Four and eight weeks after tooth extraction, samples were harvested for evaluation of osteonecrosis of the jaws, microvessel density, and cell apoptosis.

RESULTSAt both of the time points, no exposed dead bone was observed at the extraction socket areas in the rats except for some small fistulas in groups B and C. Histological examination confirmed the absence of dead bone in group A, whereas small areas of dead bone were observed around the extraction socket in groups B and C. Compared with those in group A, the percentage of empty lacunae and the area of dead bone were significantly increased (P<0.01), whereas bone lacunae density was significantly decreased (P<0.01) in groups B and C at both time points. Microvessel density in groups B and C were also significantly decreased (P<0.01) by 25.87% and 55.27% at week 4, and by 45.62% and 72.84% at week 8, respectively; the apoptotic cells in groups B and C increased by 54.80% and 87.89% at week 4 (P<0.01), and by 208.08% and 250.58% at week 8 (P<0.01), respectively.

CONCLUSIONThalidomide can aggravate zoledronate-induced early-stage BRONJ, and their osteonecrosis-inducing effect of the jaw may be attributed, at least partly, to the inhibition of angiogenesis.

Animals ; Apoptosis ; Bisphosphonate-Associated Osteonecrosis of the Jaw ; pathology ; Bone Density ; Diphosphonates ; Disease Models, Animal ; Imidazoles ; Molar ; Neovascularization, Physiologic ; Rats ; Thalidomide ; adverse effects ; Tooth Extraction

OBJECTIVETo establish a miniature pig model of mandibular osteoradionecrosis (ORN).

METHODSA single dose of irradiation (IR25 Gy, 28 Gy) was delivered via an electronic linear accelerator to the right mandible of 24 miniature pigs by utilizing three dimensional conformal radiotherapy (3D-CRT). The first molar of the mandible was extracted 2 months after radiation. Mandibular ORN was diagnosed through gross observation, X-ray film, CT, and histopathologic examination.

RESULTSAt 3-4 months after radiation, all animals suffered from mandibular ORN after dental extraction. The symptoms of ORN were more severe in the 28 Gy group than in the 25 Gy group.

CONCLUSIONA miniature pig model of mandibular ORN can be established through 25 Gy irradiation + dental extraction.

Animals ; Mandible ; Mandibular Diseases ; pathology ; Molar ; Osteoradionecrosis ; pathology ; Particle Accelerators ; Radiation Injuries, Experimental ; pathology ; Radiotherapy, Conformal ; adverse effects ; Swine ; Swine, Miniature ; Tooth Extraction

Anti-Bacterial Agents ; therapeutic use ; Antibiotic Prophylaxis ; Dry Socket ; drug therapy ; etiology ; Humans ; Inflammation ; drug therapy ; Mandible ; Molar, Third ; microbiology ; surgery ; Surgical Wound Infection ; drug therapy ; etiology ; Tooth Extraction ; adverse effects ; Tooth, Impacted ; microbiology ; surgery

OBJECTIVETo investigate the feasibility of continuation of aspirin before tooth extraction in the elderly.

METHODSThe patients enrolled in this study were the elderly requiring a single non-impacted tooth extraction. 300 elderly outpatients used lidocaine local infiltration anesthesia, 200 patients without using aspirin before tooth extraction served as control group I, 100 patients with prolong use of aspirin before tooth extraction as observation group I. 300 elderly outpatients used compound articaine local infiltration anesthesia, 200 patients without using aspirin before tooth extraction served as control group II, 100 patients with prolong use of aspirin before tooth extraction as observation group II.Bleedings at 5, 10, 30 min, 24 h after tooth extraction were observed and the relationship between postoperative bleeding and intake of aspirin was analyzed.

RESULTSThere was no significant difference at 5, 10, 30 min, 24 h in postoperative bleeding after extraction between control group I and observation group. The incidence of bleeding of observation group II after tooth extraction at 5 min was higher than that of control group II and there was no significant difference at 10, 30 min, 24 h between the two groups.

CONCLUSIONSContinuation of aspirin have no influence on postoperative bleeding. Therefore we suggest that there was no indication to discontinue aspirin for the elderly before a single non-impacted tooth extraction.

Aged ; Aged, 80 and over ; Anesthesia, Local ; Aspirin ; adverse effects ; Female ; Humans ; Lidocaine ; Male ; Middle Aged ; Oral Hemorrhage ; etiology ; Platelet Aggregation Inhibitors ; adverse effects ; Postoperative Hemorrhage ; etiology ; Tooth Extraction ; adverse effects

Dental surgery is very common, and it is important for our dental colleagues to understand the medical history and chronic medications of our co-managed patients. Antibiotic prophylaxis is currently recommended only for patients at high risk for infective endocarditis when undergoing high-risk dental procedures. Good dental hygiene can prevent more infective endocarditis than prophylactic antibiotic therapy, as transient bacteraemia is common in daily activities such as the brushing and flossing of teeth. Most dental surgeries can generally be performed on patients taking a daily dose of aspirin, but the dentist must be able to assess the risk-benefit ratio of employing local measures of haemostasis versus stopping the antiplatelet therapy. Patients on antiplatelet with recent coronary artery stenting should be referred to their primary cardiologist regarding the cessation of these agents before any surgery.
Angioplasty ; Antibiotic Prophylaxis ; methods ; Aspirin ; therapeutic use ; Dental Care for Chronically Ill ; methods ; Dentists ; Drug Interactions ; Endocarditis ; prevention & control ; Humans ; Hyperlipidemias ; complications ; Macrolides ; adverse effects ; Male ; Mitral Valve Prolapse ; complications ; Myocardial Ischemia ; complications ; Platelet Aggregation Inhibitors ; adverse effects ; Simvastatin ; adverse effects ; Streptococcal Infections ; prevention & control ; Tooth Extraction ; methods ; Viridans Streptococci ; metabolism