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A rare case of Diffuse Alveolar Hemorrhage (DAH) due to Warfarin Toxicity

Abstract

Introduction: Warfarin is one of the most frequently used anticoagulant agents in the clinic. The most important adverse effect of warfarin is hemorrhage of vital organs, such as lung and brain. Diffuse Alveolar Hemorrhage (DAH) is a rare clinical condition which occurs due to variety of medical disorders. Although it’s rarely reported, DAH can be a result of coagulopathy prompted by warfarin therapy. In this study we present a case of DAH, caused by warfarin toxicity which referred to the hospital with non-specific respiratory symptoms.

Case Presentation: A 41-year-old female patient referred to the hospital complaining of shortness of breath, cough and dizziness. She had been taking warfarin due to mitral valve replacement for the past 10 years. Her recent symptoms began shortly after taking amoxicillin, a few days before admission. Early clinical examination and paraclinical studies reveal DAH as the cause of respiratory symptoms. The patient was then intubated and received Fresh Frozen Plasma, Packed Cells and oral vitamin K. Laboratory findings apart from increased INR, PT, ESR and CRP were all within normal range. After the initiation of treatment patient’s INR decreased and her clinical condition improved. Follow-up CT-Scan and bronchoscopy also confirmed resolving DAH.

Conclusions: The usage of warfarin in anticoagulation should be closely monitored due to its narrow therapeutic window and other factors, including its interaction with other medications such as antibiotics. Warfarin toxicity can lead to DAH, a life-threatening condition which can be presented with non-specific symptoms and deteriorate patient’s clinical condition in a short time. Therefore, it is of utmost importance to watch closely for primary symptoms of such rare incident in patients under warfarin therapy and initiate treatment as soon as possible, to prevent mortality.

Open access
Aesthetic Treatment of Dental Fluorosis in a 9-Year-Old Girl: Case Report

Summary

Background/Aim: Dental fluorosis is a specific disturbance of tooth formation caused by excessive intake of fluoride. The discoloration of teeth is the most common reason for parents to seek treatment. The purpose of this paper is to describe the therapeutic management performed in a 9-year-old girl with fluorosis.

Case report: A clinical case of a 9-year-old girl diagnosed with fluorosis is reported. The treatment of this clinical case was achieved using microabrasion, which is a minimally invasive method. This technique improves the aesthetics of the teeth without causing significant loss of dental tissue; a characteristic making microabrasion applicable to children as well. Its implementation involved the combined use of 18% hydrochloric acid and pumice on the enamel surface of upper incisors. The improved appearance of the teeth was aesthetically pleasing and, consequently, the patient gained in self-confidence.

Conclusions: In the literature, several treatment choices are proposed, depending on the severity of the fluorosis. In our case, microabrasion was applied and the aesthetic outcome satisfied both the patient and the dentist.

Open access
Analysis of Bone Density in a Group of Patients with Dental Inclusion

Summary

Background/Aim: Genetic and environmental etiologic factors have been described for maxillary canine impaction, except for the trabecular bone characteristics in the impacted area. The aim of this study was to evaluate the surface area and bone density using cone-beam computed tomography (CBCT) images of patients with maxillary impacted canines.

Material and Methods: The sample comprised preorthodontic treatment, CBCT images of 24 participants with unilateral maxillary impacted canines, using the impacted side as study group and the non-impacted side as control group. CBCT images were acquired in portrait mode (17 × 23 cm high field of view) at 120 kV, 5 mA, 8.9 seconds exposure time, and 0.3 mm voxel size. Each root was divided into three levels (cervical, intermediate, and apical) to determine whether the bone density change varied with the tooth level. Moreover, each level was divided into four regions (palatal, distal, mesial, and buccal sides). Bone density was measured using Hounsfield Units. Comparisons were made using paired t tests and linear regression. Repeated measurements were obtained randomly from about 20% of the sample.

Results: In subjects with unilateral impactions, the maxillary bone density was higher in the impacted side, with a mean difference of 350 HU. Bone density increases in the corono-apical direction of about 100 HU in the impaction site and about 50 HU in the site of the erupted canine. The repeated measurements showed similar results.

Conclusions: The maxillary alveolar bone area and bone density are increased in the impacted side compared with the nonimpacted side.

Open access
Assessment of the Pain, Stress and Emotional Factor Related to the Occurrence of Bruxism

Summary

Background/Aim: Bruxism is a parafunctional habit that has multiple etiology. Globally it is a widespread problem. The purpose of this study was to assess the presence of pain, stress and to understand the emotional factor and their relations to the occurrence of bruxism.

Material and Methods: For the purpose of this paper, 40 patients with partial edentuloissness and bruxism were treated prosthetically and with night dentures. They were assessed for the degree of the pain they feel and were given questionnaires for the level of stress they feel and for their psychological situation. The control group consisted of 40 patients who were not treated but were diagnosed with the same methods like the previous group.

Results: Patient feel pain from the consequences of bruxism, disregarding the statistical significance related to gender. Stress pays a major role as we live in a dynamic and demanding society. The more competitive and ambitious the person is the more there are possibilities for occurrence of bruxism. Emotions are a very complex matter that unconsciously can be connected to the presence of bruxism.

Conclusions: Besides prosthetic rehabilitation, sometimes a multidisciplinary approach is needed. Dentists should be aware of their role as psychiatrist and need to be educated of the principles of a patient’s analysis and of the cognitive behavioral therapy.

Open access
Diagnostic and Therapeutic Approach to HIVKaposi’s Sarcoma Patients-Case Report

Summary

Background/Aim: The Acquired Immune Deficiency Syndrome (AIDS) is an immunologic entity, which is due to an RNA virus. AIDS is relatively easy transmitted and has a poor prognosis. The main mechanism of this Syndrome is characterized by the destruction and diminishing of T4 lymphocytes or helper/suppressor T-cells. Kaposi’s sarcoma is a neoplasm due to human herpes HHV-8. Kaposi’s sarcoma is one of the entities that determines the disease of AIDS. Kaposi’s sarcoma appears as skin lesions and attacks the oral cavity and lymph nodes.

Case report: A male patient, with HIV-syndrome, was referred to the Special Infection Clinic of the University Hospital with a chief complaint of having two lesions, in the oral cavity and in the right ear. The histological report revealed the diagnosis of vascular tumor having morphological and immuno-histochemical characteristics compatible with Kaposi’s sarcoma.

Conclusions: The doctor must be suspicious when lesions are observed, particularly in the oral cavity. A biopsy must be taken in order to obtain the correct diagnosis and examine the possibility of the presence of Kaposi’s sarcoma or AIDS.

Open access
Geographic Tongue - Does Candida Play a Role in its Pathogenesis

Summary

Background/Aim: Geographic tongue (GT), a benign self-limiting condition (inflammation) is commonly seen in practice. Although quite easy for clinical diagnosis, in clinical practice it is commonly misdiagnosed and treated as Candida infection. The main aim of this study was to compare the prevalence of Candida spp. on tongue in patients with GT and subjects with clinically healthy oral mucosa. Additional aims were to evaluate subjective symptoms, uncontrolled usage of prescribed or non-prescribed antifungal topical medications and the presence of the cancerophobia or other health concerns in patients with GT.

Material and Methods: A total of 70 subjects were divided into two groups: Group B- patients with diagnosed Geographic tongue and group A - aged and gender matched controls with clinically health oral mucosa. Anamnestic charts designed for this study included information about symptoms (measured by Visual Analogue Scale), previous knowledge or fear about presence of GT and received therapy for this condition. Detection of Candida spp. from tongue was done using sterile cotton swab and Sabouraud dextrose agar.

Results: At the time of this study, 18 (52.94%) of subjects with GT were aware of having this condition and even 12 of them (66.7%) used topical antifungal drugs prescribed by physician. Also, 66.7% of them experienced fear about the presence of GT at some moment. Detection of Candida spp. was similarly distributed in both groups (22.2% in group A and 17.6% in group B).

Conclusions: Geographic tongue has frequently been treated by topical antifungal drugs. In this study, GT was not associated with presence of Candida spp.

Open access
How Do Differences of Dental Implants’ Internal Connection Systems Affect Stress Distribution? A 3-Dimensional Finite Element Analysis

Summary

Background/Aim: A factor affecting the success rate of dental implants, which has been used successfully for many years, is the implant-abutment connection system. The purpose of this study was to evaluate the stress distribution of different implant-abutment connection systems under different forces.

Material and Methods: This in vitro study included a finite element analysis. In the study, the cylindrical and screwed dental implants available in 3 different diameters from 4 different companies were categorized into 12 different models. Two different scenarios of force application were conducted on each model in this study. In the first scenario, 100 N force and 100 N moment were applied in a vertical direction onto a point considered as the center of each tooth. In the second scenario, a 100 N force and moment were applied at a 45° angle in an oblique direction.

Results: As a result of the forces applied to dental implants of different diameters from different companies, octagon implant-abutment connection systems had less stress accumulation than hexagon implant-abutment connection systems. In addition, when stress accumulation ratios were evaluated according to the diameter of the implants used, it was observed that 3 mm diameter implants accumulated more stress in bone than 4 mm diameter implants; there was no significant difference between 4 mm diameter implants and 5 mm diameter implants.

Conclusions: Implant-abutment connection system is important for the longevity of implants under the forces. Therefore, this factor should be considered during implant selection.

Open access
In Vitro Assessment of Erosive Effects of Some Common Soft Drinks on Dental Hard Tissues

Summary

Background/Aim: The chemical nature of soft drinks is acidic, so they possess the capacity to cause hard tissue erosion. The aim of this study is to assess the potentially erosive effect linked to pH and titratable acidity of some common soft drinks on dental hard tissues in prolonged time exposure.

Material and Methods: Seven types of soft drinks in Romanian market were selected for this study. The pH and Titratable acidity were determined. Twenty one human dental hard tissue specimens were immersed in 5 ml solution each for 336h. Every 48h weight loss was determined for each specimen and after 336h volume changes were calculated. Enamel microhardness was determined using a Microhardness Tester model HV-1000 and compared to normal enamel microhardness.

Results: The pH values of beverages ranged from 2.37 to 3.1, showing no significant differences. All specimens presented color and surface texture modifications, weight loss and volume reduction. There were found significant differences between the mean values of weight loss and enamel microhardness of each type of specimens and type of beverages tested. The most representative findings were achieved by indentations done in specific zones on Sprite® immersed specimen. This result suggest that microhardness near the eroded surface was significant lower than in other zones.

Conclusions: Data obtained have shown that all the soft drinks tested had an erosive effect, causing dental hard tissue dissolution. For prolonged time exposure titratable acidity may be a major predictor for erosive potential. Dental erosion may affect different levels of enamel causing decreased enamel microhardness.

Open access
Influence of Endodontic Procedure on Postoperative Pain – Evidence from Systematic Reviews

Summary

Pain control, during and after root canal treatment is one of the important issues in endodontic practice. Occurrence of pain after intervention often presents considerable distress to both patient and dentist. In many studies influence of different endodontic treatment factors on incidence of postoperative pain has been investigated. However, different and inconsistent results between studies and growth in number of published papers each year made professional updating and clinical-decision making challenging. Systematic reviews synthesized and combined data from relevant studies to find the answer to a research question providing the highest level of scientific evidence. Thus, their use may facilitate decision making in clinical practice. The aim of this article was to present results from systematic reviews about the influence of endodontic treatment on postoperative pain.

Open access
Salivary Theranostics in Pediatric and Special Care Dentistry

Summary

Saliva as a microfluidic system offers numerous advantages for both general and oral health diagnostic and therapeutic procedures since its assembly is quick, stress-free, inexpensive and non-invasive. Moreover, saliva is frequently referred to as a mirror of the body due to the fact that it can reflect the physiological and pathological state of the body. More than a decade ago the term “Salivaomics” has been introduced with the aim of emphasizing the development of research, knowledge and applications of five salivary constituents: proteome, transcriptome, micro-RNA, metabolome, and microbiome. Contemporary oral health care delivery in pediatric and special care dentistry is focused toward the development of new diagnostic and therapeutical procedures that are essentially noninvasive due to common issue of intolerability to invasive procedures among these patients, with the possibility of increasing participation rates. Besides the criteria of being easily and non-invasive collected, there are additional standards that should be met before routine application in everyday clinical practice; the existence of specific biomarkers for a disease, and ability of having its biomarkers detected using present-day equipment. For example, there are recent suggestions that a salivary RNA panel could objectively differentiate children with autism spectrum disorder from their neurotypical peers. In addition, due to the ease of the administration, the oral cavity is an attractive site for the drug delivery systems development because through this route it is possible to realize mucosal and transmucosal, systemic effect. All these contemporary advances extended the salivary diagnostic approach from the oral to general health pointing towards a promising future of salivary diagnostics for personalized medicine devices.

Open access