Today's dilemma in oral surgery: patients on new oral anticoagulant drugs

111 than the surgical removal group (19.75 ± 7.89 min; P < 0.05). Incidence of early postoperative complications were low in both groups. Incidence of transient inferior alveolar nerve injury was 2.3% in the surgical removal group. Incidence of early postoperative infection was 2.3% in the germectomy group. Conclusion: Delaying the removal of impacted mandibular third molars until a problem developed, subjects the patient to unnecessary pain, more complex and costly operations with higher risk for postoperative complications. Germectomy is a simple procedure, shorter duration of procedure, leading to a reduction in the incidence of complications. http://dx.doi.org/10.1016/j.ijom.2017.02.390 The anatomical relationship between the roots of the mandibular third molar and the mandibular canal: a study among Malaysian patients M. Mah ∗ , M.H. Mamnor, M.P. Jusoh, S. Ganapathy, A. Adnan University Teknologi MARA (UiTM), Selangor, Malaysia Objectives: To investigate the location and determine the nearest distance between the mandibular canal to the roots of mandibular third molar in Malaysian patients of Malay ethnicity. Methods: This retrospective study included patients who had a cone-beam computed tomography (CBCT) done at the Faculty of Dentistry, University Teknologi MARA from 1 January 2011 to 9 January 2015. CBCT images were used to identify and measure the closest proximity and the buccolingual position of the mandibular canal to the roots of the mandibular third molar. Findings: A total of 161 patients were included in this study and 192 CBCT images were evaluated. The mean closest distance of mandibular canal to roots of mandibular third molar was 1.56 mm (standard deviation = 2.49 mm) in coronal view. Direct contact between the mandibular canal to the roots were seen in 104 cases (54.1%) in coronal view whereby 52 cases (50%) of the canal were located inferior to the tooth roots, 33 cases (31.7%) located buccal to and 19 cases (18.3%) located lingual to the roots. There is no significant difference between the mean closest distance of the mandibular canal to lower third molar roots when compared between tooth 38 and 48, gender and all types of mandibular third molar impaction. Conclusion: Mean closest distance of mandibular canal to the roots of mandibular third molar was 1.56 mm with a 54.1% case of direct contact. Therefore, CBCT is beneficial for assessing the three-dimensional anatomical relationship and the proximity between the mandibular third molar roots to the mandibular canal. http://dx.doi.org/10.1016/j.ijom.2017.02.391 Today’s dilemma in oral surgery: patients on new oral anticoagulant drugs S. Mehta ∗ , N.A. Nasser Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom Background: In recent years, new oral anticoagulant (NOAC) drugs have become increasingly popular. It is important to consider the effects of these drugs when carrying out oral surgery procedures. These drugs are often preferred to warfarin as they

are easier to manage from a patient perspective. However, how easy are they to manage from a clinician perspective? Case series: We present a series of three patients who were taking NOAC drugs, had simple extractions under local anaesthesia and returned to casualty due to extensive bleeding. These patients were either taking rivaroxaban or apixaban. Two patients were managed effectively with local haemostatic agents. One patient required admission for three days and received a twounit blood transfusion. Discussion: National Health Service guidelines suggest stopping the NOAC agent prior to surgery and liaison with the appropriate clinician before stopping the drug. In emergency situations, it is challenging to reverse the effect of these drugs as they cannot be reliably monitored. Comparatively, warfarin can be monitored via an international normalised ratio and reversed with vitamin K. Conclusion: We recommend liaison with the clinician managing the patient’s anticoagulation and discussion about stopping the NOAC drug 48 h prior to the procedure. Moreover, these patients can be reviewed after the procedure and should be aware of measures to take in case of bleeding, including out-of-hours. We encourage general dental practitioners to refer these patients to a hospital setting, as necessary. http://dx.doi.org/10.1016/j.ijom.2017.02.392 Third molar surgery outcomes: a comparison between intravenous sedation and general anaesthetic S.W. Ong ∗ , D.C. Tong, W.M. Thomson, R.K. De Silva, H.L. De Silva Faculty of Dentistry, University of Otago, Dunedin, New Zealand Background: The surgical extraction of third molar teeth (wisdom teeth) is one of the most common surgical procedures carried out in dentistry. Some wisdom teeth can be extracted under local anaesthesia alone, while more complex impactions may require intravenous sedation (IV) or general anaesthesia (GA). Each of the latter has advantages and disadvantages over the other, and determining which is suitable for the patient can be complex. Objective: To explore the differences between IV sedation and GA in terms of patient recovery, oral-health-related quality of life, anxiety, level of satisfaction and postoperative pain. Methods: A clinical convenience sample of patients aged 16–35 years, requiring the removal of two mandibular third molar teeth were recruited. Each completed a questionnaire before surgery and 10–14 days afterwards. Findings: Of the 125 patients, 73 (58.4%) were in the IV group and 52 (41.6%) underwent GA. Patients opting for GA scored more highly on negative affectivity and dental anxiety at baseline. Post surgery, they reported taking more days off before returning to normal activities, as well as having higher incidence of sore throat and nausea. Conclusion: Patients with negative affectivity and higher anxiety opt for third molar surgery carried out under GA but this results in more nausea, sore throat and days off normal activities. http://dx.doi.org/10.1016/j.ijom.2017.02.393