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Journal of Clinical Periodontology Aug 2022To describe associations of gingival bacterial composition and diversity with self-reported gingival bleeding and oral hygiene habits in a Norwegian regional-based...
AIM
To describe associations of gingival bacterial composition and diversity with self-reported gingival bleeding and oral hygiene habits in a Norwegian regional-based population.
MATERIALS AND METHODS
We examined the microbiome composition of the gingival fluid (16S amplicon sequencing) in 484 adult participants (47% females; median age 28 years) in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) study in Bergen, Norway. We explored bacterial diversity and abundance differences by the community periodontal index score, self-reported frequency of gingival bleeding, and oral hygiene habits.
RESULTS
Gingival bacterial diversity increased with increasing frequency of self-reported gingival bleeding, with higher Shannon diversity index for "always" β = 0.51 and "often" β = 0.75 (p < .001) compared to "never" gingival bleeding. Frequent gingival bleeding was associated with higher abundance of several bacteria such as Porphyromonas endodontalis, Treponema denticola, and Fretibacterium spp., but lower abundance of bacteria within the gram-positive phyla Firmicutes and Actinobacteria. Flossing and rinsing with mouthwash twice daily were associated with higher total abundance of bacteria in the Proteobacteria phylum but with lower bacterial diversity compared to those who never flossed or never used mouthwash.
CONCLUSIONS
A high frequency of self-reported gingival bleeding was associated with higher bacterial diversity than found in participants reporting no gingival bleeding and with higher total abundance of known periodontal pathogens such as Porphyromonas spp., Treponema spp., and Bacteroides spp.
Topics: Adult; Female; Gingival Hemorrhage; Habits; Humans; Male; Microbiota; Mouthwashes; Oral Hygiene; Self Report; Treponema denticola
PubMed: 35569028
DOI: 10.1111/jcpe.13644 -
Journal of Thrombosis and Haemostasis :... Mar 2024Intracranial hemorrhage (ICH) is the most feared and lethal complication of oral anticoagulant (OAC) therapy. Resumption of OAC after ICH has long posed a challenge for... (Review)
Review
Intracranial hemorrhage (ICH) is the most feared and lethal complication of oral anticoagulant (OAC) therapy. Resumption of OAC after ICH has long posed a challenge for clinicians, complicated by the expanding range of anticoagulant agents available in modern clinical practice, including direct OACs and, more recently, factor XI and XII inhibitors. A review of the current literature found support for resuming OAC in the majority of patients after ICH based on pooled retrospective data showing that resumption is associated with a lower risk of mortality and thromboembolism without a significantly increased risk of recurrent hemorrhage. The optimal time to resume OAC is less clear; however, the available evidence suggests that the composite risk of both recurrent hemorrhage and thromboembolism is likely minimized, somewhere between 4 and 6 weeks, after ICH in most patients. Specific considerations to guide the optimal resumption time in the individual patient include ICH location, mechanism, and anticoagulant class. Patients with mechanical heart valves and intracerebral malignancy represent high-risk groups who require more nuanced decision making. Here, we appraise the literature with the aim of providing a practical guide for clinicians while also discussing priorities for future investigation.
Topics: Humans; Retrospective Studies; Atrial Fibrillation; Intracranial Hemorrhages; Anticoagulants; Hemorrhage; Thromboembolism; Administration, Oral; Cerebral Hemorrhage; Stroke
PubMed: 37913910
DOI: 10.1016/j.jtha.2023.10.020 -
Journal of the Massachusetts Dental... 2016
Topics: Ecchymosis; Hematoma; Humans; Mouth Mucosa; Oral Hemorrhage; Purpura
PubMed: 27400555
DOI: No ID Found -
Clinics in Laboratory Medicine Sep 2014
Topics: Administration, Oral; Anticoagulants; Blood Coagulation; Drug Monitoring; Hemorrhage; Humans
PubMed: 25168951
DOI: 10.1016/j.cll.2014.06.016 -
JDR Clinical and Translational Research Jan 2022Nationwide prevention programs in Germany aim to promote oral health. The group prevention program starts in kindergarten and ends when the children are about 12 y old....
OBJECTIVES
Nationwide prevention programs in Germany aim to promote oral health. The group prevention program starts in kindergarten and ends when the children are about 12 y old. While in a recent study, toothbrushing behavior of 12-y-old children was analyzed, the present study's objective was to examine the children's ability to achieve oral cleanliness and to analyze how toothbrushing behavior and compliance with the toothbrushing recommendations taught in the group prevention programs predict oral cleanliness.
METHODS
Twelve-year-old randomly selected children ( = 174) were asked to brush their teeth to the best of their abilities, and simultaneously a video was recorded for behavioral analyses. Plaque levels were measured before and immediately after toothbrushing. In addition, dental status and gingival bleeding were assessed.
RESULTS
After brushing to the best of their abilities, there was plaque on 50% (±24.72%) of all measured sites at the gingival margin (Marginal Plaque Index). Regression analyses revealed approximately 22% of the variance of marginal plaque on the outer surfaces to be explained by the time brushed by circular movements (β = -0.41; < 0.001) and the number of sextants brushed for at least 7.5 s (β = -0.171; < 0.05). Circular movements explained most additional variance (Δ = 0.113; < 0.001). With respect to inner surfaces, none of the behavioral aspects explained any variance of oral cleanliness.
CONCLUSION
Despite regular group prevention measures, 12-y-old children show limited skills to clean their teeth adequately. Furthermore, none of the recommended behaviors relates to oral cleanliness after toothbrushing at inner surfaces. As a consequence, it is necessary to explore further which behavioral sequences effectively improve oral cleanliness.
KNOWLEDGE TRANSFER STATEMENT
This study illustrates that children's compliance to toothbrushing recommendations is not necessarily related to toothbrushing effectiveness. Clinicians should therefore assess the effectivity of recommendations individually and provide individual guidance for improvement.
Topics: Child; Dental Plaque; Dental Plaque Index; Gingival Hemorrhage; Health Behavior; Humans; Toothbrushing
PubMed: 33251929
DOI: 10.1177/2380084420975333 -
Journal Des Maladies Vasculaires Jul 2016Direct oral anticoagulants (DOAC) are recommended for stroke prevention in atrial fibrillation and for the treatment of venous thromboembolism. However, they are... (Review)
Review
Direct oral anticoagulants (DOAC) are recommended for stroke prevention in atrial fibrillation and for the treatment of venous thromboembolism. However, they are associated with hemorrhagic complications. Management of DOAC-induced bleeding remains challenging. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. Therapeutic options also include antidotes: idarucizumab, antidote for dabigatran, has been approved for use whereas andexanet alpha, antidote for anti-Xa agents, and aripazine, antidote for all DOAC, are under development. Other options include hemodialysis for the treatment of dabigatran-associated bleeding and administration of oral charcoal if recent DOAC ingestion. DOAC plasma concentration measurement is necessary to guide DOAC reversal. We propose an update on DOAC-associated bleeding, integrating the availability of dabigatran antidote and the critical place of DOAC concentration measurements.
Topics: Anticoagulants; Antidotes; Atrial Fibrillation; Charcoal; Dabigatran; Hemorrhage; Humans; Prothrombin; Renal Dialysis; Stroke; Venous Thromboembolism
PubMed: 27297642
DOI: 10.1016/j.jmv.2016.05.008 -
International Journal of Environmental... Sep 2022The aim of the paper is to present the oral health profile of 12- and 15-year-old schoolchildren in Serbia. Basic Methods for Oral Health Surveys of the WHO were...
The aim of the paper is to present the oral health profile of 12- and 15-year-old schoolchildren in Serbia. Basic Methods for Oral Health Surveys of the WHO were implemented to record: Decayed, Missing, and Filled Teeth/Surfaces Index (DMFT/DMFS), gingival bleeding, enamel fluorosis and other structural anomalies, dental erosion, dental trauma, and oral mucosal lesions. In addition, Silness and Löe plaque index and orthodontic status were assessed. A total of 36% of 12-year-olds and 22% of 15-year-olds in Serbia were caries-free. The mean DMFT was 2.32 ± 2.69 for 12-year-olds and 4.09 ± 3.81 for 15-year-olds. DMFT was made up largely by the decayed component. Gingival bleeding was present in 26% of examined 12-year-old and 18% of 15-year-old children. Dental plaque was observed in 63% of both 12- and 15-year-olds. Fluorosis, structural anomalies, dental erosion, dental trauma, and oral mucosal lesion were rarely detected. Low prevalence of malocclusions was found. Oral disease is still a common public health problem among schoolchildren in Serbia. A significant increase in the prevalence of caries disease between 12- and 15-year-old groups implies that preventive care for adolescents requires special attention. Corrective actions and reforms to the current school-based oral health prevention program are needed to further improve oral health in Serbian children.
Topics: Adolescent; Child; DMF Index; Dental Caries; Gingival Hemorrhage; Humans; Oral Health; Prevalence; Serbia
PubMed: 36231568
DOI: 10.3390/ijerph191912269 -
International Journal of Stroke :... Apr 2019The most recent years have significantly expanded knowledge regarding risks and benefits of resuming oral anticoagulation (OAC) after intracerebral hemorrhage (ICH). No... (Review)
Review
BACKGROUND
The most recent years have significantly expanded knowledge regarding risks and benefits of resuming oral anticoagulation (OAC) after intracerebral hemorrhage (ICH). No randomized data is yet available, though several large observational studies and meta-analyses have investigated the impact of resuming OAC on thromboembolic versus hemorrhagic complications in these high-risk patients after ICH.
AIMS
The present review will summarize the most important studies conducted over the last years and will focus on relevant factors help guiding on decision-making on whether to start OAC after ICH.
SUMMARY OF REVIEW
Several important factors (demographic, co-morbidities, clinical characteristics) need to be considered before individual decision-making for or against OAC is employed. Existing observational data suggest that patients after ICH with indication for long-term oral anticoagulation benefit from OAC given significant reductions of thromboembolic events without significantly increasing bleeding complications. Studies even suggest that thereby also clinical outcomes may be improved. Prospective trials currently recruiting patients will clarify whether OAC after ICH - or left atrial appendage closure as a meaningful alternative - is of clinical net-benefit.
CONCLUSIONS
Large sized and well-executed investigations (moderate quality of evidence) are showing that OAC resumption after ICH decreases thromboembolic complications and long-term mortality without significantly increasing bleeding complications. Further, data suggest that resumption may be safer in non-lobar ICH compared to lobar ICH, but overall, thoughtful selection, strict blood pressure control, and precise communication are paramount before starting a patient on OAC after ICH.
Topics: Administration, Oral; Anticoagulants; Cerebral Hemorrhage; Clinical Decision-Making; Comorbidity; Humans; Risk Factors; Stroke
PubMed: 30762497
DOI: 10.1177/1747493019828555 -
Australian Dental Journal Jun 2016Several new oral anticoagulants have been studied in the past decade, and have now started to enter the market. These drugs are reported to be as effective as, or more... (Review)
Review
Several new oral anticoagulants have been studied in the past decade, and have now started to enter the market. These drugs are reported to be as effective as, or more effective than, warfarin. In Australia, the Therapeutic Goods Administration has approved dabigatran, rivaroxaban and apixaban. The use of these newer anticoagulants is likely to increase in time, and it is important for dentists to have a sound understanding of the mechanisms of action, reversal strategies, and management guidelines for patients taking oral anticoagulants. This article discusses the process of coagulation, available anticoagulants and their monitoring and reversal, and provides clinical advice on the management of patients on anticoagulants who require dental treatment.
Topics: Administration, Oral; Anticoagulants; Australia; Dentistry; Humans; Oral Hemorrhage
PubMed: 26042924
DOI: 10.1111/adj.12344 -
Current Opinion in Neurology Feb 2017An increasing number of patients are receiving oral anticoagulants. Since non-vitamin K antagonist oral anticoagulants (NOACs) were approved, primary prevention of... (Review)
Review
PURPOSE OF REVIEW
An increasing number of patients are receiving oral anticoagulants. Since non-vitamin K antagonist oral anticoagulants (NOACs) were approved, primary prevention of ischemic stroke has become simpler. However, managing ischemic stroke and intracerebral hemorrhage while on oral anticoagulation (OAC) has become more complex. This review covers the latest developments in managing ischemic and hemorrhagic stroke in patients receiving vitamin K antagonists (VKA) and NOACs.
RECENT FINDINGS
Testing coagulation in patients with acute ischemic stroke and receiving NOACs is complex, and observational data challenge guideline recommendations. Initial registry and cohort data support the safety of endovascular therapy despite OAC. In intracerebral hemorrhage, rapid reversal of VKA can be achieved better with prothrombin complex concentrates than with fresh frozen plasma. Furthermore, rapid reversal seems to be associated with less hematoma expansion and better functional outcome. In addition, new evidence strongly supports resuming OAC after intracerebral hemorrhage. The unfavorable properties of NOAC-related intracerebral hemorrhage are similar to those associated with VKA.
SUMMARY
Translation of recent findings might improve both outcome in acute ischemic and hemorrhagic stroke in patients on oral anticoagulants and help refine clinical management. Data from randomized clinical trials are scarce.
Topics: Administration, Oral; Anticoagulants; Brain Ischemia; Cerebral Hemorrhage; Fibrinolytic Agents; Humans; Stroke
PubMed: 27906754
DOI: 10.1097/WCO.0000000000000406