Introduction
Oral surgery
Dental extractions in patients maintained on oral anticoagulant therapy: comparison of INR value with occurrence of postoperative bleeding
Blinder D, Manor Yet al. Int J Oral Maxillofac Surg2001; 30: 518–521
The International Normalized Ratio was not related to postoperative bleeding.
Currently, it is disputed whether anticoagulant therapy needs to be modified for dental extractions. In an Israeli hospital, 249 patients on anticoagulants for various reasons received 543 dental extractions without modification of therapy, and 30 experienced postoperative bleeding. This was all controlled with tranexamic acid or gelatin sponge and sutures.
In 59 patients of preoperative INR 1.5–1.99, there were 151 extractions and 3 subjects bled; in 78 with INR 2.0–2.49, respective figures were 167 and 10; in 59 with INR 2.5–2.99, 127 and 9; in 30 with INR 3.0–3.49, 55 and 5; and in 23 with INR 
3.5, 43 and 3. Mean INR for subjects who bled in each group was similar to that for those who did not. There were no significant differences, and the authors recommend local haemostasis with gelatin sponge and sutures after removal of any granulation tissue.
Conservative dental surgery
Relationship between crown placement and the survival of endodontically treated teeth
Aquilino SA, Caplan DJJ Prosthet Dent2002; 87: 256–263
In this retrospective study, loss of teeth which were not crowned after RCT was 6 times greater than for teeth which were.
Some previous studies have reported higher retention rates after RCT for teeth which were crowned. In this study, a treatment database at a US dental school was used to identify 734 subjects who had received RCT in 1985-7 and subsequently had been followed up at least every 2 years until 1995-6. A random sample of 400 teeth was selected from a total 1089 treated, and after excluding abutments and other complicating factors, 203 were evaluated.
After RCT, 129 teeth were crowned, of which 14 were extracted during the follow-up period, compared with 28 of 74 with other restorations. The final multivariate regression model showed that whilst crowning was the main factor affecting tooth loss (hazard ratio = 6.0), there were also significant effects for second molars (3.9 times more likely to be lost than other RCT teeth), and for caries at the time of access (2.8 times).
Cardiology: invasive dental treatment
Changing profile of infective endocarditis. Results of a 1-year survey in France
Hoen B, Alla Fet al. JAMA2002; 288: 75–81
Incidence remained similar over 8 years, but there were important changes, and dental involvement reduced.
Data from 1999 were collected in all hospitals in 6 French regions comprising 26% of the population. Duke criteria were used for diagnosis in the present survey, but not in the 1991 survey in 3 French regions with which findings were compared. Incidence in 1999 was 31 cases/million, except in New Caledonia, where it was 161/m, probably because of low economic status and persistent rheumatic fever.
In 47% of all cases there was no previously known heart disease. The incidence of the disease in patients with known heart disease decreased from 21/m. to 15/m. Oral streptococci accounted for 17% of cases, a significant reduction on 1991. In only 8% of cases was a dental portal of entry identified. There was an increase in cases due to Group D streptococci: these organisms and Staph. aureus each accounted for 1/4 of all cases. Early valvular surgery was performed for 49% of patients, and in-hospital mortality was reduced from 22% to 16%.
Periodontics
Comparative study of Emdogain® and coronally advanced flap technique in the treatment of human gingival recessions. A prospective controlled clinical study.
Hägewald S, Spahr Aet al. J Clin Periodontol2002; 29: 35–41
There was no advantage in using enamel matrix derivative (EMD) in this study.
In 36 patients aged 22-62, paired buccal recession areas of 3mm+ were treated with coronally positioned flaps. After preparing the flap, EMD or placebo was placed on the root surface according to a randomization code. This was not performed as a blind procedure.
Mean baseline recession of 3.7 mm at EMD sites showed a gain of 2.8 mm after 12 months, with 80% root coverage; for control sites, respective scores were 3.9 mm, 2.9 mm and 79%. There were no differences in probing attachment level, probing depth, plaque control or recession width. However, EMD gained 0.7 mm on a mean 2.1 mm of keratinized tissue, compared with 0.3 mm on 2.4 mm for controls (P = 0.003). The authors point out that it is not possible to know the nature of the clinical attachment gain in such a study.
