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Nathan Moreau - One of the best experts on this subject based on the ideXlab platform.
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Gabapentinoid prescription in Oral Medicine and Oral Surgery practice. Part II − a systematic scoping review of the literature
Journal of Oral Medicine and Oral Surgery, 2020Co-Authors: Arek Sulukdjian, Richard L'homme, Audrey Chanlon, Nathan MoreauAbstract:Introduction: Gabapentinoids, pregabalin and gabapentin, neuronal voltage-gated calcium channel inhibitors are first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions). Nevertheless, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. A previous article, the first of a two-part series, presented the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in orofacial conditions. This second article aimed to explore the scientific literature on the subject. Material and methods: A systematic scoping review was conducted on multiple relevant databases (MEDLINE® , Cochrane® , Agence Nationale de Securite du Medicament et des produits de sante, Haute Autorite de Sante) and journal archives (JOMOS, JSOMFS) to assess the indications, non-indications and contraindications of gabapentinoids in an Oral Medicine/Oral Surgery context. Results: Out of 131 records selected during the initial screening, 34 matched the inclusion criteria and were used for subsequent analyses. Gabapentinoids were prescribed in three clinical contexts: orofacial pain management (32 studies), anxiolysis (1 study) and prevention of postoperative nausea/vomiting (1 study), with variable quality of evidence: high (6 studies), moderate (3 studies), low (5 studies) and very low (20 studies) quality studies (GRADE scale). Untoward effects of gabapentinoids were reported in 16 studies, mainly neurological (vertigo, drowsiness, sedation) and gastro-intestinal (nausea, vomiting, diarrhea, constipation). Gabapentinoids were ineffective in preemptive and postoperative analgesia and for the management of mucositis-related pain. Discussion: There is some evidence supporting the use of gabapentinoids in Oral Medicine/Oral Surgery in adherence with current practices observed in France and other countries (practices often extrapolated from their use in other non-orofacial painful conditions). The methodological quality of the studies included in this scoping review is often poor and publication bias is most probable in this field. Therefore, any conclusion drawn from such studies must be subject to circumspection. Conclusion: Data obtained from the present scoping review suggests the potential use of gabapentinoids as second-line treatments for anxiolysis, prevention of postoperative nausea/vomiting and the management of trigeminal neuralgia and masticatory myalgia. Other potential indications of gabapentinoids in Oral Medicine/Oral Surgery practice include cranial neuralgias, post-traumatic trigeminal neuropathies, first bite syndrome, burning mouth syndrome and migraine prophylaxis, when other treatment options are inefficient or unavailable.
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Gabapentinoid prescription in Oral medicine and Oral Surgery practice. Part I − Experience from a French Orofacial pain clinic
Journal of Oral Medicine and Oral Surgery, 2020Co-Authors: Arek Sulukdjian, Richard L'homme, Audrey Chanlon, Nathan MoreauAbstract:Gabapentinoids, pregabalin and gabapentin, are neuronal voltage-gated calcium channel inhibitors mainly prescribed for the treatment of partial epilepsy and neuropathic pain. Although their efficacy as first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions) has been well established in general medical practice, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. This didactic article, the first of a two-part series, aims to present the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in Orofacial pain conditions that fall within the scope of the Oral surgeon's practice.
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gabapentinoid prescription in Oral medicine and Oral Surgery practice part ii a systematic scoping review of the literature
Journal of Oral Medicine and Oral Surgery, 2020Co-Authors: Arek Sulukdjian, Audrey Chanlon, Richard Lhomme, Nathan MoreauAbstract:Introduction: Gabapentinoids, pregabalin and gabapentin, neuronal voltage-gated calcium channel inhibitors are first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions). Nevertheless, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. A previous article, the first of a two-part series, presented the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in orofacial conditions. This second article aimed to explore the scientific literature on the subject. Material and methods: A systematic scoping review was conducted on multiple relevant databases (MEDLINE® , Cochrane® , Agence Nationale de Securite du Medicament et des produits de sante, Haute Autorite de Sante) and journal archives (JOMOS, JSOMFS) to assess the indications, non-indications and contraindications of gabapentinoids in an Oral Medicine/Oral Surgery context. Results: Out of 131 records selected during the initial screening, 34 matched the inclusion criteria and were used for subsequent analyses. Gabapentinoids were prescribed in three clinical contexts: orofacial pain management (32 studies), anxiolysis (1 study) and prevention of postoperative nausea/vomiting (1 study), with variable quality of evidence: high (6 studies), moderate (3 studies), low (5 studies) and very low (20 studies) quality studies (GRADE scale). Untoward effects of gabapentinoids were reported in 16 studies, mainly neurological (vertigo, drowsiness, sedation) and gastro-intestinal (nausea, vomiting, diarrhea, constipation). Gabapentinoids were ineffective in preemptive and postoperative analgesia and for the management of mucositis-related pain. Discussion: There is some evidence supporting the use of gabapentinoids in Oral Medicine/Oral Surgery in adherence with current practices observed in France and other countries (practices often extrapolated from their use in other non-orofacial painful conditions). The methodological quality of the studies included in this scoping review is often poor and publication bias is most probable in this field. Therefore, any conclusion drawn from such studies must be subject to circumspection. Conclusion: Data obtained from the present scoping review suggests the potential use of gabapentinoids as second-line treatments for anxiolysis, prevention of postoperative nausea/vomiting and the management of trigeminal neuralgia and masticatory myalgia. Other potential indications of gabapentinoids in Oral Medicine/Oral Surgery practice include cranial neuralgias, post-traumatic trigeminal neuropathies, first bite syndrome, burning mouth syndrome and migraine prophylaxis, when other treatment options are inefficient or unavailable.
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gabapentinoid prescription in Oral medicine and Oral Surgery practice part i experience from a french orofacial pain clinic
Journal of Oral Medicine and Oral Surgery, 2020Co-Authors: Arek Sulukdjian, Audrey Chanlon, Richard Lhomme, Nathan MoreauAbstract:Gabapentinoids, pregabalin and gabapentin, are neuronal voltage-gated calcium channel inhibitors mainly prescribed for the treatment of partial epilepsy and neuropathic pain. Although their efficacy as first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions) has been well established in general medical practice, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. This didactic article, the first of a two-part series, aims to present the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in Orofacial pain conditions that fall within the scope of the Oral surgeon's practice.
Dimova Cena - One of the best experts on this subject based on the ideXlab platform.
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Second generation platelet concentrate (platelet-rich fibrin) in its application in Oral Surgery
Consulting and Training Center KEY, 2020Co-Authors: Evrosimovska Biljana, Dimova Cena, Veleska-stefkovska Daniela, Menceva ZaklinaAbstract:The development of bioactive surgical additives, which are being used to regulate the inflammation and increase the speed of healing process, is one of the great challenges in Oral Surgery. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate who was defined as an autologous leukocyte and PRF biomaterial, in which, platelets and leukocytes are collected with high efficiency such that the growth factors will able to release gradually during at least 1 week. The biologic effect of this fibrin matrix is: angiogenesis, immune control, harnessing the circulating stem cells, and wound protection by epithelial cover. The following article attempts to summarize our clinical cases regarding the technique of using PRF, focusing on its preparation, advantages of using it in Oral Surgery. Three cases with different clinical diagnoses were taken for this study in order to show the possible ways of application of PRF in the surgical field. In the first case, it is a 53 year-old female patient who has been diagnosed with osteonecrosis of the alveolar ridge during the examination in the projection of the first lower right molar. In the second case, PRF application was administered to a 41 year-old female patient diagnosed with radicular cyst on the upper left second incisor. The third case involved a 47 year-old male patient with diagnosed gangrenous roots in the upper right first and second premolars ant the second molar in which the PRF application was intended to achieve alveolar bridge augmentation. PRF was prepared with blood drawn from individuals using technique du to PRF protocol. Both types of PRF (I and A-PRF) were applied independently in the first case, and in the second and third cases a bone graft was placed together with PRF. The soft and bone tissue management in all our cases show process of neovascularization through the PRF clot and the epithelial covering development. In spite of the infectious and inflammatory statement of such sockets, rapid healing of the wound was observed without pain, dryness, or purulent complications. The results of the observed cases showed that biologic effect of PRF was revealed trough achieved angiogenesis, immune control, harnessing the circulating stem cells, and wound protection by epithelial cover. PRF alone or in combination with other biomaterials seems to have several advantages and indications in Oral Surgery, due it is a minimally invasive technique with low risks and satisfactory results. Key words: Platelet-rich fibrin, Blood platelet, Bone regeneration, Soft tissue regeneration
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Various suturing material and wound healing process after Oral Surgery procedure - a review paper
Consulting and Training Center KEY, 2020Co-Authors: Dimova Cena, Popovska Mirjana, Evrosimovska Iljana, Zlatanovska Katerina, Papakoca Kiro, Petrovski Mihajlo, Ivanovska-stojanovska Marija, Spasovski SpiroAbstract:The most Oral surgical interventions require primary wound closure with stitches after previously raised mucoperiosteal flap. Different suture materials are used for this purpose which are classified upon their origin (organic and synthetic) or according to their durability in host tissues (absorbable and non-absorbable). The aim of the review paper was to emphasize the all-important properties of suture material include knot safety, stretch capacity, tissue reactivity, and wound safety. MEDLINE and PubMed databases were explored from the 1970 up to 2018 using the keywords in different combinations: Oral Surgery, suture material, flap, dental implants, nylon, periodontal, polyglecaprone, polytetrafluoroethylene, polyglycolic acid, polylactic acid, silk. Normal wound healing after Oral Surgery procedures requires multiple finely tuned processes that occur in a specific sequence as well as proliferation, regeneration and organization (differentiation). The final stage of the wound healing process is named the contraction phase, which begins following sufficient collagen formation in the granular tissue. Traditionally, silk has been the mostly used as suture material for Oral surgical procedures, with rarely including others as: nylon, polyester, cat gut, polytetrafluoroethylene (ePTFE), polyglycolic acid (PGA) etc. Surgery with silk sutures increases the risk of infections because they react with the connective tissue, causing adhesion of dental plaque and bacteria adherence around the stitch. On the other hand, a specific form of wound healing occurs around placed dental implants. Usually the implants are placed directly under or at the same level as the bone surface at biphasic dental implant procedures. In conclusion, besides the carefully used surgical and suturing technique, and properly Oral hygiene in the postoperative period, the choice of suture material may also influence the healing of the incised soft tissues. Thus the selection of the suture material should be brought under consideration during treatment planning for Oral surgical interventions, periodontal Surgery and dental implantation. Key words: Oral, Surgery, Periodontal, Implants, Flap, Suture, Silk, Nylon
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Oral Surgery Treatment of Radicular Cysts
2019Co-Authors: Rogoleva Sonja, Dimova CenaAbstract:Abstract: Cysts are pathological formations that develop in the bone tissue or in the soft tissues of the upper and lower jaw. Reasons for their formation are many and varying, depending on the type. Cysts are usually caused due to root infection involving tooth decay. Untreated dental caries then allow bacteria to reach the level of the pulp, causing infection. The bacteria gains access to the periapical region of the tooth through deeper infection of the pulp, traveling through the roots. The resulting pulpal necrosis causes proliferation of epithelial rests of Malassez which release toxins at the apex of the tooth. The body's inflammatory response will attack the source of the toxins, leading to periapical inflammation. The main condition for their formation is presence of epithelial tissue on the place where the new cyst will be developed. Radicular cyst treatment and the access to them can be very variable and it depends on many different factors. The most important of them are the patient’s condition, the therapy opportunities and the intraoperative parameters.The methods of treatment and the type of surgical procedure that will be chosen depend on the size of the cyst, its location and also the pathological formation. Radicular cysts and other bone lesions in many cases cause huge bone loss therefore risk of bone fracture. Also some of the bone lessions are biologically active and they can cause bone destruction if they are not removed correctly and on time. That's why these days bone grafts are used when the defect is big. About the Oral Surgery treatment, a survey was conducted to define the modern surgical techniques for radicular cysts remove. This study was conducted to evaluate the contemporary Oral surgical treatments that are used for treating radicular bone cysts. The study has taken place in a specialized dental office for Oral Surgery, using questionnaire, clinical examinations and paraclinical examination techniques. The results have shown that radicular cysts are mostly developed in the older adults and more often on the teeth in the transcanine sector. About the symptoms found in the patients, they had experienced mostly pain and swell, rarely fistula and tooth discoloring. The analyze of the data has shown that most often treatment options for radicular cysts are cystectomy with apicotomy and cystectomy with extraction. In the cases treated with apicotomy, intraoperative canal filling was also used. Bone grafting was used rarely, dependently on the patients’ requests. Postoperative, patients have experienced pain and swelling in the first 24 hours after the treatment. The survey and the results collected from it can be used to makea better evaluation and better therapy planning for the radical cysts. Firstly to achieve better results in the tissue consolidation, also to have bigger satisfaction of the treated patients that depends on the postoperative parameters such as pain, swelling or some others consequences of the treatment. Keywords: cysts, cystectomy, apicotomy, intraoperative canal filling, Oral surgical treatment
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Various suturing material and wound healing process after Oral Surgery procedure - a review paper
2019Co-Authors: Dimova Cena, Popovska Mirjana, Evrosimovska Iljana, Zlatanovska Katerina, Papakoca Kiro, Petrovski Mihajlo, Ivanovska-stojanovska Marija, Spasovski SpiroAbstract:The most Oral surgical interventions require primary wound closure with stitches after previously raised mucoperiosteal flap. Different suture materials are used for this purpose which are classified upon their origin (organic and synthetic) or according to their durability in host tissues (absorbable and nonabsorbable). The aim of the review paper was to emphasize the all-important properties of suture material include knot safety, stretch capacity, tissue reactivity, and wound safety. MEDLINE and PubMed databases were explored the from 1970 up to 2018 using the keywords in different combinations: Oral Surgery, suture material, flap, dental implants, nylon, periodontal, polyglecaprone, polytetrafluoroethylene, polyglycolic acid, polylactic acid, silk, Normal wound healing after Oral Surgery procedures requires multiple finely tuned processes that occur in a specific sequence as well as proliferation, regeneration and organization (differentiation). The final stage of the wound healing process is named the contraction phase, which begins following sufficient collagen formation in the granular tissue. Traditionally, silk has been the mostly used ас suture material for Oral surgical procedures, with rarely including others: nylon, polyester, cat gute, polytetrafluoroethylene (ePTFE), polyglycolic acid (PGA) etc. Surgery with silk sutures increases the risk of infections because they react with the connective tissue, causing adhesions of dental plaque and bacteria adherence around the stitch. On the other hand, a specific form of wound healing occurs around placed dental implants. Usually the implants are placed directly under or at the same level as the bone surface at biphasic dental implant procedures. In conclusion, besides the carefully used surgical and suturing technique, and properly Oral hygiene in the postoperative period, the choice of suture material may also influence the healing of the incised soft tissues. Thus the selection of the suture material should be brought under consideration during treatment planning for Oral surgical interventions, periodontal Surgery and dental implantation. Key words: Oral, Surgery, periodontal, implants, flap, suture, silk, nylon
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Clinical preparation and evaluation of local haemostasis effectiveness following Oral Surgery treatment in thrombotic patients
2007Co-Authors: Dimova CenaAbstract:The Oral Surgery procedures in Oral anticoagulated patients has always been very controversial due to the dilemma between the high risk of haemorrhage versus the possibility of embolism should the Oral anticoagulated treatment be suspended. The risk of thromboembolism depends on several factors, including the clinical indications for anticoagulation. Various protocols have been suggested for treating these patients, including substituting heparin for Oral anticoagulants, decreasing the level of anticoagulation preoperatively, temporarily stopping the Oral anticoagulants, and not altering the anticoagulant regimen at all. The first goal of this doctOral thesis was to emphasize the clinical preparation (clinical and laboratory examinations) of Oral anticoagulated patients before Oral Surgery procedures. The main objective was to demonstrate that it is possible to perform safe Oral Surgery on Oral anticoagulated patients without having to suspend treatment beforehand. The second goal was to compare three local agents that aid haemostasis, following minor Oral Surgery in therapeutically anticoagulated patients. The study was performed over a five-year period (2002-2006) and elaborated in the Clinic for Oral Surgery, Faculty of dentistry, Skopje. A longitudinal study was performed in Oral anticoagulated treatment patients that required some type of Oral surgical procedures. In order to realize the aims of the investigation, 260 subjects have been examined. The indications for Oral surgical interventions have been based on the findings of anamneses, extra-Oral and intra-Oral clinical examination, as well as, the findings and analyses of X-ray examinations. According to the thrombotic diagnosis, 240 patients were divided into four groups: each one of 60 subjects. The group of 20 healthy subjects served as a control group. The patient underwent Surgery after the laboratory examinations (an INR control, PT, AT III, protein C, protein S, fibrinolysis activators and inhibitors, factor XIII) which were previously controlled in the Department of haemostasis and thrombosis, Institute of blood transfusion, Faculty of Medicine, Skopje. According to the applied various methods of local haemostasis, each group was divided in three subgroups (20 subjects): A - with compressive haemostatic gauze – Surgicel; B - with fibrin glue (TachoComb); C - with 5% tranexamic acid (Transamin). The obtained results, their statistical analysis, and the evaluation of the coefficients of the correlation are the elaborated values of the examined parameters from the clinical and para clinical examinations. The overall analysis included: ▫overview of subjects by gender and age, type of Oral anticoagulants, elapsed therapy time, antibioprofilaxis, ▫laboratory examinations: number of thrombocytes, PT - prothrombin time, an INR control, AT III, protein C, protein S, activators and inhibitors of fibrinolysis, factor XIII, ▫patients categorizations: ▪risk of prolongated bleeding - low and high risk, and ▪potential risk for thromboembolism - low and high risk, ▫urgency of Oral Surgery interventions, risk factors of prolongated bleeding during and after the interventions, ▫completed Oral Surgery procedures (diagnosis, therapy, number of extracted teeth, number of sessions and tooth type), ▫control examinations (to confirm presence of edema, haematoma, dry socket etc., after 24 and 48 hour, seven and ten days ), ▫according to bleeding index, presence of prolonged haemorrhage after the interventions (24 and 48 hour, seven and ten days). The results obtained lead to the following conclusions: Dental extractions can be performed without modification of Oral anticoagulant treatment. Local haemostasis with absorbable oxidized cellulose, fibrin glue, and tranexamic acid (used as a mouthwash) are local modalities of haemostasis (methods of choice) for the treatment in Oral anticoagulated patients. It is not necessary to suspend Oral anticoagulant treatment before Surgery; as long as there is multidisciplinary approach for patient’s control. Certainly, there is an evident need to make a protocol for Oral Surgery procedures in the patients with Oral anticoagulant t therapy. Key words: tooth extraction, Oral Surgery, Oral anticoagulant treatment, Oral anticoagulants, local haemostasis, haemostatic gauze (absorbable oxidized cellulose), fibrin glue, tranexamic acid
Gavin N. C. Kenny - One of the best experts on this subject based on the ideXlab platform.
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Reaction time-monitored patient-maintained propofol sedation: a pilot study in Oral Surgery patients.
Anaesthesia, 2013Co-Authors: C. O’brien, C. S. Urquhart, S. Allam, K. J. Anderson, Jason Leitch, A. Macpherson, Gavin N. C. KennyAbstract:Summary Previous volunteer studies of an effect-site controlled patient-maintained sedation system using propofol have demonstrated a risk of oversedation. We have incorporated a reaction time monitor into the handset to add an individualised patient-feedback mechanism. This pilot study assessed if the reaction time-feedback modification would prove safe and effective in 20 healthy patients receiving sedation while undergoing Oral Surgery. All patients successfully sedated themselves without reaching any unsafe endpoints. All 20 maintained verbal contact throughout. The mean (SD) lowest peripheral blood oxygen saturation was 98.0 (2.1)% breathing room air. No patient required supplementary oxygen. The mean (SD) maximum effect-site propofol concentration reached was 1.6 (0.5) μg.ml−1. The present system was found to be safe and effective, allowing Oral Surgery treatment under conscious sedation, but preventing oversedation.
Arek Sulukdjian - One of the best experts on this subject based on the ideXlab platform.
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Gabapentinoid prescription in Oral Medicine and Oral Surgery practice. Part II − a systematic scoping review of the literature
Journal of Oral Medicine and Oral Surgery, 2020Co-Authors: Arek Sulukdjian, Richard L'homme, Audrey Chanlon, Nathan MoreauAbstract:Introduction: Gabapentinoids, pregabalin and gabapentin, neuronal voltage-gated calcium channel inhibitors are first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions). Nevertheless, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. A previous article, the first of a two-part series, presented the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in orofacial conditions. This second article aimed to explore the scientific literature on the subject. Material and methods: A systematic scoping review was conducted on multiple relevant databases (MEDLINE® , Cochrane® , Agence Nationale de Securite du Medicament et des produits de sante, Haute Autorite de Sante) and journal archives (JOMOS, JSOMFS) to assess the indications, non-indications and contraindications of gabapentinoids in an Oral Medicine/Oral Surgery context. Results: Out of 131 records selected during the initial screening, 34 matched the inclusion criteria and were used for subsequent analyses. Gabapentinoids were prescribed in three clinical contexts: orofacial pain management (32 studies), anxiolysis (1 study) and prevention of postoperative nausea/vomiting (1 study), with variable quality of evidence: high (6 studies), moderate (3 studies), low (5 studies) and very low (20 studies) quality studies (GRADE scale). Untoward effects of gabapentinoids were reported in 16 studies, mainly neurological (vertigo, drowsiness, sedation) and gastro-intestinal (nausea, vomiting, diarrhea, constipation). Gabapentinoids were ineffective in preemptive and postoperative analgesia and for the management of mucositis-related pain. Discussion: There is some evidence supporting the use of gabapentinoids in Oral Medicine/Oral Surgery in adherence with current practices observed in France and other countries (practices often extrapolated from their use in other non-orofacial painful conditions). The methodological quality of the studies included in this scoping review is often poor and publication bias is most probable in this field. Therefore, any conclusion drawn from such studies must be subject to circumspection. Conclusion: Data obtained from the present scoping review suggests the potential use of gabapentinoids as second-line treatments for anxiolysis, prevention of postoperative nausea/vomiting and the management of trigeminal neuralgia and masticatory myalgia. Other potential indications of gabapentinoids in Oral Medicine/Oral Surgery practice include cranial neuralgias, post-traumatic trigeminal neuropathies, first bite syndrome, burning mouth syndrome and migraine prophylaxis, when other treatment options are inefficient or unavailable.
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Gabapentinoid prescription in Oral medicine and Oral Surgery practice. Part I − Experience from a French Orofacial pain clinic
Journal of Oral Medicine and Oral Surgery, 2020Co-Authors: Arek Sulukdjian, Richard L'homme, Audrey Chanlon, Nathan MoreauAbstract:Gabapentinoids, pregabalin and gabapentin, are neuronal voltage-gated calcium channel inhibitors mainly prescribed for the treatment of partial epilepsy and neuropathic pain. Although their efficacy as first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions) has been well established in general medical practice, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. This didactic article, the first of a two-part series, aims to present the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in Orofacial pain conditions that fall within the scope of the Oral surgeon's practice.
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gabapentinoid prescription in Oral medicine and Oral Surgery practice part ii a systematic scoping review of the literature
Journal of Oral Medicine and Oral Surgery, 2020Co-Authors: Arek Sulukdjian, Audrey Chanlon, Richard Lhomme, Nathan MoreauAbstract:Introduction: Gabapentinoids, pregabalin and gabapentin, neuronal voltage-gated calcium channel inhibitors are first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions). Nevertheless, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. A previous article, the first of a two-part series, presented the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in orofacial conditions. This second article aimed to explore the scientific literature on the subject. Material and methods: A systematic scoping review was conducted on multiple relevant databases (MEDLINE® , Cochrane® , Agence Nationale de Securite du Medicament et des produits de sante, Haute Autorite de Sante) and journal archives (JOMOS, JSOMFS) to assess the indications, non-indications and contraindications of gabapentinoids in an Oral Medicine/Oral Surgery context. Results: Out of 131 records selected during the initial screening, 34 matched the inclusion criteria and were used for subsequent analyses. Gabapentinoids were prescribed in three clinical contexts: orofacial pain management (32 studies), anxiolysis (1 study) and prevention of postoperative nausea/vomiting (1 study), with variable quality of evidence: high (6 studies), moderate (3 studies), low (5 studies) and very low (20 studies) quality studies (GRADE scale). Untoward effects of gabapentinoids were reported in 16 studies, mainly neurological (vertigo, drowsiness, sedation) and gastro-intestinal (nausea, vomiting, diarrhea, constipation). Gabapentinoids were ineffective in preemptive and postoperative analgesia and for the management of mucositis-related pain. Discussion: There is some evidence supporting the use of gabapentinoids in Oral Medicine/Oral Surgery in adherence with current practices observed in France and other countries (practices often extrapolated from their use in other non-orofacial painful conditions). The methodological quality of the studies included in this scoping review is often poor and publication bias is most probable in this field. Therefore, any conclusion drawn from such studies must be subject to circumspection. Conclusion: Data obtained from the present scoping review suggests the potential use of gabapentinoids as second-line treatments for anxiolysis, prevention of postoperative nausea/vomiting and the management of trigeminal neuralgia and masticatory myalgia. Other potential indications of gabapentinoids in Oral Medicine/Oral Surgery practice include cranial neuralgias, post-traumatic trigeminal neuropathies, first bite syndrome, burning mouth syndrome and migraine prophylaxis, when other treatment options are inefficient or unavailable.
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gabapentinoid prescription in Oral medicine and Oral Surgery practice part i experience from a french orofacial pain clinic
Journal of Oral Medicine and Oral Surgery, 2020Co-Authors: Arek Sulukdjian, Audrey Chanlon, Richard Lhomme, Nathan MoreauAbstract:Gabapentinoids, pregabalin and gabapentin, are neuronal voltage-gated calcium channel inhibitors mainly prescribed for the treatment of partial epilepsy and neuropathic pain. Although their efficacy as first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions) has been well established in general medical practice, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. This didactic article, the first of a two-part series, aims to present the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in Orofacial pain conditions that fall within the scope of the Oral surgeon's practice.
Bilal Al-nawas - One of the best experts on this subject based on the ideXlab platform.
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Oral Surgery during therapy with anticoagulants—a systematic review
Clinical Oral Investigations, 2015Co-Authors: Peer W. Kämmerer, Bernhard Frerich, Jan Liese, Eik Schiegnitz, Bilal Al-nawasAbstract:Objectives Oral anticoagulation therapy (OAT) with vitamin K inhibitors protects the patients from thromboembolic events. It may however lead to excessive hemorrhage during and after an Oral Surgery procedure. The aim of this systematic review was to evaluate the justifications to reduce, withdraw, or alter OATs prior to minor Oral Surgery procedures to manage bleeding events. Materials and methods A systematic MEDLINE search was conducted for clinical studies in English or German language from 1994 to 2014 comparing patients treated with OAT, without OAT, as well as patients with altered OAT for Oral Surgery purposes. Relevant outcome parameters were: postoperative local hemostasis, bleeding episodes, occurrence of thromboembolic events, and other complications due to the anticoagulation medication. A hand search for references cited in the identified publications completed the review. Results After screening of 1755 abstracts, 16 clinical studies were identified according to the selection criteria. Due to the heterogeneity of the obtained data, aggregation and synthesis were not possible. There was no significant difference in bleeding events comparing patients under continued OAT to those with reduced, altered, and/or discontinued OAT medications. Minor bleeding events in the test and control groups were successfully stopped with local measures. However, no superiority of a single hemostatic measure could be identified. Neither the international normalized ratio (INR), within the therapeutic range (2–4), nor the extent of the minor Oral Surgery procedure had an influence on postoperative bleeding episodes. Discussion There is strong evidence that OAT patients undergoing minor Oral Surgery should not discontinue their medication in order to prevent thromboembolic complications. Clinical relevance Nonetheless, INR should be less than 4, local hemostatic measures are of high importance and patients need to be instructed and closely monitored as minor bleedings might occur more often in OAT patients.