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Resumen Los pacientes que se encuentran bajo tratamiento de anticoagulantes orales, presentan alteraciones en distintas etapas de la hemostasia, lo que conlleva a tener implicancias y consideraciones médico/quirúrgicas durante su atención. En la actualidad, no existe un consenso en relación con el manejo odontológico de estos pacientes que serán sometidos a procedimientos quirúrgicos, llevando a protocolos clínicos que siguen diversas posturas, como la de disminuir la ingesta farmacológica del anticoagulante, sustituir con heparina y la de mantener el tratamiento bajo control. Objetivo Establecer el manejo estomatológico del paciente que se encuentra en tratamiento de anticoagulante oral mediante una revisión profunda de la literatura Materiales y método Se realizó una búsqueda de revisión bibliográfica manualmente de artículos indexados a las bases de datos de PUBMED y EBSCO que correspondiesen a las palabras "cirugía bucal", "anticoagulantes", "atención dental" y "hemorragia oral". En cuanto a los criterios de inclusión, se consideraron revisiones bibliográficas, estudios observacionales, ensayos clínicos, guías, revisiones sistemáticas y metaanálisis publicados entre noviembre de 2005 y 2022, en idiomas inglés o español. Conclusiones Existen múltiples protocolos para la atención del paciente anticoagulado que será sometido bajo procedimiento de cirugía oral menor. Es importante considerar el anticoagulante utilizado, motivo, control de este, el procedimiento a realizar en el paciente y medidas hemostáticas tanto intra como postoperatorias por realizar, tras analizar lo anterior, se advierte que disminuir la ingesta del fármaco para realizar el procedimiento, puede ser más perjudicial al paciente como al clínico, por lo tanto se sugiere mantener el tratamiento antitrombótico y realizar un correcto manejo médico/quirúrgico.

Abstract Patients undertaking oral anticoagulant treatment may experience alterations in different stages of hemostasis, which lead to medical/surgical implications and considerations during their care. Currently, there is no consensus regarding the dental management of these patients, as they go through surgical procedures. This leads to clinical protocols that follow numerous approaches, such as reducing the pharmacological intake of the anticoagulant, replacing it with heparin, and maintaining the controlled treatment. Objective: To establish the stomatological management of the patient undergoing oral anticoagulant treatment through an in depth review of the literature. Materials and Method: A manual bibliographic review search of articles indexed to the PUBMED and EBSCO databases corresponding to the words "oral surgery", "oral bleeding", "anticoagulants" and "dental management" was performed. Regarding the inclusion criteria: bibliographic reviews, observational studies, clinical trials, guidelines, systematic reviews, and meta-analyses published between November 2005 and 2022, in English or Spanish, were considered. Conclusion: There are multiple protocols for the care of the anticoagulated patient who will undergo a minor oral surgery procedure. It is important to reflect on the anticoagulant used, the reason for it, its supervision, the surgical procedure that will be undertaken by the patient, and both intraoperative and postoperative hemostatic measures to be implemented. After analyzing the above, it is noted that reducing the intake of the drug to perform the surgical procedure may be harmful to the patient and to the clinician, therefore it is suggested to maintain the antithrombotic treatment and carry out a correct medical/surgical management.

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O número de pacientes em tratamento com anticoagulantes necessitando de tratamento odontológico cresceu consideravelmente nos últimos anos. Dessa forma, os clínicos que trabalham com Implantodontia devem estar preparados para esses pacientes e possíveis complicações. O presente estudo objetiva fazer um relato de caso sobre o manejo clínico de paciente de 70 anos de idade com histórico de hemorragia severa associada ao uso do anticoagulante rivaroxabana, mostrando como o uso da cirurgia guiada pode simplificar e viabilizar reabilitações com implantes dentários em pacientes com essa condição. Para isso, foi realizado escaneamento intraoral e planejamento virtual em software específico para instalação de dois implantes Straumann em região posterior direita, onde já havia sido realizado um levantamento de seio maxilar. O procedimento cirúrgico transcorreu de forma rápida e sem complicações, com alta aceitação por parte do paciente, que recebeu a reabilitação protética final aproximadamente 3 meses após a instalação dos implantes. Concluiu-se que a cirurgia guiada é uma excelente alternativa para reduzir morbidade e risco de hemorragia em pacientes fazendo uso de rivaroxabana (AU).

The number of patients receiving anticoagulants requiring dental treatment has increased considerably in recent years. Thus, clinicians working with Implantology should be prepared to treat these patients and possible complications. This study aims to present a case report on the clinical management of a 70-year-old patient with a history of severe hemorrhage associated with the use of rivaroxaban anticoagulant, showing how the use of guided surgery can simplify and enable rehabilitation with dental implants in patients with this condition. In order to do this, we performed intraoral scan and virtual planning in specific software for the placement of two Straumann implants in the right posterior region, where a maxillary sinus lift had already been performed. The surgical procedure was performed quickly and without complications, with high acceptance by the patient, who received the final prosthetic rehabilitation approximately 3 months after implant placemenet. It is concluded that guided surgery is an excellent alternative to reduce morbidity and risk of hemorrhage in patients taking rivaroxaban (AU).

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OBJECTIVES: The present work is a controlled, blinded, and randomized clinical trial comparing hemostatic measures for the control of post-tooth extraction hemorrhage in patients on anticoagulation therapy with warfarin. MATERIALS AND METHODS: The sample consisted of 37 patients (37.8% male and 62.2% female) with a mean age of 45.5 years. After randomization, 20 patients were allocated to the control group (conventional hemostasis measures) and 17 to the study group (addition of local tranexamic acid). All variables that could influence the outcome were similar between the groups and no significant difference was seen (p > 0.05). RESULTS: In the assessment of immediate hemostasis, for the control group, the time to achieve cessation of bleeding was 9.1 (± 3.6) minutes. For the study group this was much lower, and this difference (6.018 / confidence interval of 95%, 4.677 to 7.359) was statistically significant (p < 0.001). In evaluating the control of intermediate hemorrhage, the use of tranexamic acid was more significantly associated with the absence of bleeding, especially in the first 24 h. CONCLUSIONS AND CLINICAL RELEVANCE: Thus, this measure of local hemostasis in topical form with gauze compression and irrigation was shown to be more effective in reducing the time to attain immediate hemostasis, and in preventing intermediate hemorrhage.

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O objetivo deste trabalho foi apresentar um caso clínico de hemorragia transoperatória na região anterior de mandíbula. Um paciente do sexo masculino, 77 anos de idade e portador de hipertensão arterial foi indicado para reabilitação com implantes osteointegráveis na região anterior de mandíbula. No transoperatório, após fresagem para preparação do leito para instalação dos implantes, observou-se hemorragia oriunda do assoalho de boca, ocasionando aumento severo da base de língua associado ao aumento de pressão arterial do paciente. A utilização de medicação anti-hipertensiva e ansiolítica foi a manobra inicial realizada para controle da hemorragia. Na sequência, foram realizadas duas incisões bilateralmente no assoalho de boca, com o intuito de drenar o sangue. O paciente foi mantido em observação por um período de duas horas, com monitorização de seus sinais vitais, estes mantendo-se dentro da normalidade e sem evolução do edema. O paciente foi liberado com as devidas orientações, visto que este acidente foi de difícil controle e os implantes osteointegrados não foram instalados naquele momento. Existe um eminente risco de hemorragias, quando há intervenção na região anterior da mandíbula para a instalação de implantes osteointegráveis. Porém, pacientes com comprometimentos sistêmicos e/ou que fazem uso de medicamentos anticoagulantes são mais predispostos. A fenestração da cortical lingual pode ser uma situação clínica que pode levar a um quadro hemorrágico. Saber aplicar condutas de emergência é um fator que pode salvar a vida dos pacientes, e alterações anatômicas locais podem favorecer o acidente hemorrágico.

The aim of this paper is to describe a clinical case of transoperative bleeding in the anterior mandibular region. A 77 years-old male patient having arterial hypertension was scheduled for dental implant placement. After the osteotomy for implant preparation, abundant bleeding was observed at the fl oor of the mouth, with severe tongue swelling and an increase on blood pressure. The basic management consisted of anti-hypertensive and anxiolytic medication, with two lateral incisions to drain blood, vital signs monitoring. The edema subsided and no airway obstruction or speech problems were observed thereafter. The patient was discarded with appropriate recommendations, and the implants were not installed in the same surgical consultation. There is a considerable risk of bleeding in the anterior mandibular region. However, patients with systemic diseases or under anti-coagulation therapy are more prone. Fenestration of the lingual cortical plate could be a possible reason for profuse bleeding. The clinician must know how to manage these situations to save the patient since local anatomic changes can favor the hemorrhagic accident.

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OBJECTIVES: The liver pretransplant phase requires the interaction of -multidisciplinary teams for optimal patient outcomes, including dental -professionals. In this study, we sought to estimate the prevalence of complications related to dental extraction in liver transplant candidates. MATERIAL AND METHODS: This study is a case series of patients eligible for liver transplants referred for dental treatment between 2012 and 2014. Eligible patients for this study underwent at least one tooth extraction, had a complete blood count at the time of the procedure, and were candidates for liver transplantation. RESULTS: Forty-three patients, 12 women (28%) and 31 men (72%), with an -average age of 50.9 ± 11.4 years, had received a total of 116 dental extractions. The prevalence of postoperative complications was 1.7% including two bleeding episodes in the same patient. Seven patients presented a platelet count below 50 × 10³/µL and received platelet transfusions preoperatively. CONCLUSIONS: Postoperative complications following dental extractions in liver transplant candidates are unusual. CLINICAL RELEVANCE: Low postoperative complications prevalence indicates that dental surgical procedures may be safety performed in patients eligible for liver transplantation after careful -preoperative evaluation.

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Hemorrhagic bullous angina (HBA) is described as the sudden onset of one or more bullous lesions in the oral cavity, not attributable to other vesiculobullous diseases, blood dyscrasias, or autoimmune and vascular diseases. These lesions occur almost exclusively in the oral cavity, particularly in the soft palate, and do not affect the masticatory mucosa. Here we present the case of a 57-year-old male who had a spontaneously ruptured hemorrhagic bulging in his soft palate diagnosed as HBA, along with discussion of the literature. In conclusion, HBA is a rare, benign, oral disease with low complication rates. Diagnosis is essentially clinical, and treatment consists of local hygiene and prevention of oral trauma.

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El granuloma telangiectásico bucal es una hiperplasia reactiva inflamatoria que afecta lamucosa y el tejido gingival de la cavidad oral. Se presenta como una reacción del tejidoconectivo a estímulos como traumas, irritación local por placa dental, procesos infecciososy factores hormonales. Es una patología muy frecuente en la región suramericana, que sedescribe clínicamente como una lesión tumoral de color rojo, tamaño variable, superficielisa o rugosa, de base pediculada con mayor frecuencia, consistencia blanda y tendenciaa sangrar cuando es manipulado. La remoción quirúrgica es el tratamiento de elección. Sereporta el caso clínico de un paciente con diagnóstico de granuloma telangiectásico degran tamaño, que acudió a la clínica odontológica de la Corporación Universitaria RafaelNúñez en Cartagena, Colombia. Se describen las características clínicas e histopatológicas,así como su tratamiento...

Oral granuloma telangiecticum is a reactive inflammatory hyperplasia that affects oralmucosa and gingival tissues. It is a reaction of the connective tissue to trauma, dentalplaque-induced irritation, infections and hormonal factors. This pathology is often found inthe South American region and is clinically described as a red tumorous lesion with variablesize, smooth or rough surface, frequently pedicled, soft consistency, and tends to bleedwhen it is manipulated. Treatment consists of surgical enucleation. This is a case report ofa patient with diagnosis of large-sized granuloma telangiecticum who attended the dentalclinics of Corporación Universitaria Rafael Núñez in Cartagena Colombia. Clinical characteristics,histopathology, and treatment provided are described...

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The aim of this work is to present a case of a 39-years-old man with a 2cm sized purple pedunculated tissue on the soft palate, next to upper right retromolar area, asymptomatic, with one day time evolution and vascular appearance. There was no trauma history or systemic diseases. Based on the clinical findings our previous diagnosis was traumatic granuloma, hemangioma or blood coagulum formation after local trauma. After one week, intraoral examination revealed absence of the lesion, which disappeared completely. This case illustrates that the absence of trauma history and atypical clinical characteristics can be a diagnostic defiance in the clinical routine.

El objetivo de este trabajo es presentar un caso de un hombre de 39 años de edad, con un tejido de 2 cm pediculado color púrpura en el paladar blando, junto al área retromolar superior derecha, asintomático, con un día de evolución y de aspecto vascular. No había historia de trauma o enfermedades sistémicas. Con base en los hallazgos clínicos nuestro diagnóstico previo fue granuloma traumático, hemangioma o la formación de coágulos sanguíneos, después de un traumatismo local. Luego de una semana, el examen intraoral reveló ausencia de la lesión, la que desapareció por completo. Este caso ilustra que la ausencia de historia de trauma y las características clínicas atípicas, puede ser un desafío diagnóstico en la rutina clínica.

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