Department of Oral and Maxillofacial Surgery, Medical-Dental Interaction, Academic Center for Dentistry, Gustav Mahlerlaan 3004, room 12N41, 1081 LA Amsterdam, the Netherlands.
J Am Dent Assoc. 2011 Dec;142(12):1376-82. doi: 10.14219/jada.archive.2011.0139.
For many years, international guidelines have advised health care professionals not to adjust oral antithrombotic medication (OAM) regimens before invasive dental procedures. The authors conducted a study to examine the opinions of Dutch general dentists regarding the dental care of patients receiving treatment with these medications.
The authors invited via e-mail 1,442 general dentists in the Netherlands to answer a 20-item Internet-based questionnaire that they developed. Survey items consisted of questions about medical history taking, number of patients in the dental practice receiving OAM therapy, frequency of consulting with medical and dental colleagues and suggested dental treatment of patients during various invasive dental procedures.
A total of 487 questionnaires were returned (response rate of 34 percent). The mean age of respondents was 47 years, and 77 percent were male. The majority of dentists responded that they obtain medical histories, but that they did not know how many of their patients were receiving OAM treatment. Dentists reported that they consult with medical colleagues frequently about antithrombotic medication. Ninety-one percent of respondents stated that they obtained their medical knowledge primarily in dental school. More than 50 percent of the dentists reported that they were not familiar with the international normalized ratio. The majority of dentists responded that they felt a need for clinical practice guidelines.
According to the results of our survey, most dentists remain cautious when performing invasive dental procedures in patients who are treated with OAMs. Moreover, survey respondents tended to estimate that the risk of bleeding during dental procedures when OAM therapy is continued is higher than the risk of rethrombosis when use of antithrombotic medication is interrupted.
A growing proportion of elderly patients and those with medically complex conditions are being treated in dental practices in the Netherlands. Consequently, more needs to be done to ensure that dentists are offered evidence-based guidance when treating patients who receive OAMs.
多年来，国际指南建议医疗保健专业人员在进行侵入性牙科手术前不要调整口服抗血栓药物（OAM）的治疗方案。作者进行了一项研究，以调查荷兰普通牙医对接受这些药物治疗的患者的牙科护理的意见。
作者通过电子邮件邀请荷兰的 1442 名普通牙医回答他们开发的 20 项基于互联网的问卷。调查项目包括有关病史采集、在牙科诊所接受 OAM 治疗的患者人数、与医疗和牙科同事咨询的频率以及在各种侵入性牙科手术期间建议的患者牙科治疗的问题。
共收回 487 份问卷（回应率为 34%）。受访者的平均年龄为 47 岁，77%为男性。大多数牙医表示他们会获取病史，但不知道有多少患者正在接受 OAM 治疗。牙医报告说，他们经常与医疗同事咨询抗血栓药物。91%的受访者表示，他们主要在牙科学校获得医学知识。超过 50%的牙医报告说他们不熟悉国际标准化比值。大多数牙医表示，他们感到需要临床实践指南。
根据我们的调查结果，大多数牙医在对接受 OAM 治疗的患者进行侵入性牙科手术时仍然持谨慎态度。此外，调查受访者倾向于估计继续 OAM 治疗期间牙科手术出血的风险高于中断抗血栓药物使用时再血栓形成的风险。
越来越多的老年患者和患有复杂疾病的患者在荷兰的牙科诊所接受治疗。因此，需要做更多的工作来确保在治疗接受 OAM 的患者时为牙医提供基于证据的指导。
