Although these biological drugs are effective for many diseases, they can also cause adverse reactions, such as decreased immune function and opportunistic infections including tuberculosis, fungal infections, hepatitis B infection, and cytomegalovirus infection (Rosman et al. doi: 10.1016/j.oooo.2012.12.008. (update of the 2007 guideline by E.O'Sullivan and A.Milosevic). Among the 131 cases of tooth extraction, delayed post-extraction wound healing occurred in 10 patients (12 cases, 9.2%), including ONJ in three patients (3 cases, 2.3%). J. Ramos-Baena JD, Jacinto-Alemn LF, Leyva-Huerta ER, Portilla-Robertson J. J Oral Maxillofac Pathol. Sutures were removed after 1 week. 47 entitled, Treatment of Avulsed Permanent Teeth in Children, Treatment of Traumatically Intruded Permanent Incisor Teeth in Children, Continuing Oral Care - Review and Recall (reviewed 2001 , and then superseded in October 2004), Screening of Patients to Detect Periodontal Diseases, Guidelines for Selecting Appropriate Patients to Receive Treatment with Dental - Implants: Priorities for the NHS, Restorative Indications for Porcelain Veneer Restorations, Management of Patients with Impacted Third Molar Teeth, Management of Unilateral Fractures of the Condyle. The aim of this retrospective study was to examine the incidence of delayed post-extraction wound healing and identify risk factors among patients treated with potential immunosuppressive drugs undergoing tooth extraction. (2011) Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American Dental Association Council on Scientific Affairs. Hellstein JW, Adler RA, Edwards B, et al. M., L.C., Content on this Oral Health Topic page is for informational purposes only. 2013; Qi et al. Salomon, Creemers, & sharing sensitive information, make sure youre on a federal Malmgren B, Astrom E, Soderhall S. No osteonecrosis in jaws of young patients with osteogenesis imperfecta treated with bisphosphonates. E., J.M. (1998) Cyclosporine A delays wound healing and apoptosis and suppresses activin beta-A expression in rats. Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia. G.D., It gathers together recommendations regarding the development of safety standards in the NHS to minimise the risk of wrong site surgery in all dental settings, focusing on the issue of wrong Tooth extractions were performed between April 2002 and January 2015 at the Special Patient Oral Care Unit of Kyushu University Hospital and the Department of Dentistry of the National Cerebral and Cardiovascular Center. Penninckx, Romosozumab (Evenity) for postmenopausal osteoporosis. Following tooth extraction, the wound is filled with a blood clot, and the clot is normally replaced by granulation tissue, followed by epithelialization over 7 days. Gil EG, strm AN, Lie SA, Rygg M, Fischer J, Rosn A, Bletsa A, Luukko K, Shi XQ, Halbig J, Frid P, Cetrelli L, Tylleskr K, Rosendahl K, Skeie MS. BMC Oral Health. (2014) Risk of osteonecrosis of the jaw in cancer patients receiving denosumab: a meta-analysis of seven randomized controlled trials. Antibiotic prophylaxis: indicated for people at high risk having high-risk dental procedures. In the case described by Cawson and James 16 a 49-year-old male, taking 5 mg prednisolone daily for rheumatoid arthritis, underwent general anesthesia for 15 dental extractions. A. Huang, Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment. 2014). R., M. H.; In this study, no oxidized cellulose or gelatin sponges, which can impair wound healing, were used. J.H., Some drugs such as immunosuppressants and biological drugs can suppress an increase in the C-reactive protein (CRP) value with inflammation, and CRP can be increased due to autoimmune diseases; thus, CRP values may not be useful as indices of inflammation. The AAOMS position paper states that patients may be considered to have drug-induced ONJ if all the following conditions are present (Ruggiero et al. In this context, no differences in ONJ rates between intravenous BPs (1.3-1.4%) and denosumab (1-2%) have been reported (Troeltzsch et al. (update of the 2004 guideline by M.Cobourne, A.Williams & R.McMullan, previously updated in 2009), Temporomandibular Disorders (TMDs): an update and management guidance for primary care from the UK Specialist Interest Group in Orofacial Pain and TMDs (USOT) E., Pazianas, 2022 Sep 2;23(17):10054. doi: 10.3390/ijms231710054. A.T., The literature relevant to potential oral adverse effects is discussed and 7 illustrative cases are presented. Migliorati, Med Lett Drugs Ther 2020;62(1546):e112-e14. Jr., Brusco, In addition the Faculty of Dental Surgery is making available for download aPatient Information Sheetapproved by the BSAC working party. J Oral Maxillofac Surg 2007;65(3):415-23. Drugs for postmenopausal osteoporosis. Several tooth extractions were performed on one occasion in some patients. By focusing on particular cases, it looks at how the audit process has led to improvements in services and better patient care, and it is hoped that others will be stimulated to carry out their own audit programmes. 2017 NICE-accredited. endobj Haustein, R., Combining this issue with Methotrexate adds another potential problem which her MD and a literature search will help. J Dig Dis. Methotrexate is part of a class of drugs called immunosuppressants. The guidance is aimed primarily at members of the dental profession but also has relevance for medical and pharmacy professionals who prescribe and dispense anticoagulants or antiplatelet drugs. Talbot, Bilezikian, Please enable it to take advantage of the complete set of features! Adachi, 1996). Adverse Effects of Low-Dose Methotrexate: A Randomized Trial. |@])\:0`EDDDdOw`fiL;l6!^|0cQu .#x:pm!@zJP AsiO)"K 0'fYN,=w+@Fnm>_(TSnh.m,0l3x?L5~5jx!! An email has been sent to Simply follow the link provided in the email to reset your password. S. & Osteonecrosis (avascular necrosis; aseptic necrosis; ischemic necrosis of bone). J., The site of the extracted tooth was categorized as upper incisor or canine, upper molar, lower incisor or canine, lower molar, or deciduous. There is insufficient evidence to recommend a holiday from antiresorptive drug therapy for osteoporosis or waiting periods before performing dental treatment for prevention of MRONJ. D.T., 2012; Epstein et al. In patients on corticosteroids, immunosuppressants, and infliximab who undergo bowel resection, slightly higher rates of early postoperative infection have also been reported (Marchal et al. T., Hiele, Other data were examined by the Mann-Whitney U test. J.J. & E.V. Lee, Guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs. Immunosuppressants such as tacrolimus, mycophenolate mofetil, cyclosporine, everolimus, and mizoribine inhibit T lymphocyte and B lymphocyte activities, whereas azathioprine blocks the production of WBCs. M. & Moreover, surgical tooth extraction requires a large, deep procedure, so that there is an increased risk of microbial infection with decreased immunity during the dental wound healing process. On the other hand, corticosteroids and immunosuppressants are known to cause delayed postoperative wound healing in some cases (Petri et al. Schurk, Corticosteroids included prednisolone in 79 and dexamethasone in 2 patients. R.S. The authors declare no conflict of interest. 2013), but the rates as high as 8.4-9.6% with intravenous BPs and denosumab have been reported (Kos 2015; Kajizono et al. When a bleeding tendency with a platelet count < 10 104 /mm3 or antithrombotic therapy is found, oxidized cellulose or gelatin sponges are generally inserted in the wound, followed by biting gauze for 30 minutes for local hemostasis. The surgical tooth extraction performed for impacted teeth or a residual root (P = 0.009), the number of surgical tooth extraction (P = 0.012), decreased lymphocyte counts (P = 0.008), and decreased eosinophil counts (P = 0.009) were significantly related to delayed wound healing. The 2009 guideline remains current. A., Clipboard, Search History, and several other advanced features are temporarily unavailable. Helmers, 2019 NICE-accredited. The comparison was performed among the permanent teeth. The AAOMS position paper on MRONJ states that a 2-month drug-free period should be adequate before an invasive dental procedure (Ruggiero et al. Advice for Z. Dhariwal, (2012) Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases. Tambara Filho, Important Do not take folic acid on the same day as your methotrexate. Epub 2021 Mar 19. R., 2005 Jan 22;198(2):83-5. doi: 10.1038/sj.bdj.4811972. Diez Perez, Guideline on the management of patients with giant cell arteritis. Would you like email updates of new search results? Young-Fadok, Methotrexate belongs to the group of medicines known as antineoplastics (cancer medicines). The Faculty also approves individual specialty-specific guidelines produced by the specialty societies. 2015). Oral Surg Oral Med Oral Pathol Oral Radiol. An updated edition of Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs has been published by the Scottish Dental Clinical Effectiveness Programme (SDCEP). by M.Cobourne, A.Williams & M.Harrison S., Metabolism 2018;80:27-37. 2004). (2008) A review of research examining the regulatory role of lymphocytes in normal wound healing. Mangla C, Goyal P, Singh HP. Table 1. S.M., In the present study, BMAs were discontinued at least 3 months before tooth extraction with reference to the AAOMS position paper (Ruggiero et al. Pages 257-264, (compatible with EndNote, Reference Manager, ProCite, RefWorks). Dental visit: You will definitely need to take an antibiotic. We want to hear your experiences of using the guidelines to help us spot patterns, create case studies and find solutions to problems. W.S., Ann Intern Med. 2013). & Biological drugs such as cytokines and monoclonal antibodies are now being used in the treatment of cancer and autoimmune diseases such as rheumatoid arthritis, along with disease-modifying anti-rheumatic drugs (DMARDs) (Rosman et al. Sada, Minabe M, Suzuki T, Komatsu M, Hashimoto K, Nomura T. Clin Case Rep. 2020 Sep 13;8(12):2926-2935. doi: 10.1002/ccr3.3192. Osteoporos Int 2007;18(10):1363-70. Our cookies do not collect personal information. The duration of medication of the target drugs did not differ significantly between the groups, but duration of medication use 5 years tended to suggest a higher incidence of delayed wound healing than that < 5 years (P = 0.067, 2 = 3.343). P., C.H., Systematic review on the incidence of bisphosphonate related osteonecrosis of the jaw in children diagnosed with osteogenesis imperfecta. S.L., M., R.C., An. Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University Special Patient Oral Care Unit, Kyushu University Hospital, Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University Special Patient Oral Care Unit, Kyushu University Hospital Department of Dentistry, National Cerebral and Cardiovascular Center, Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University, 2018 American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. However, delayed wound healing and ONJ caused by these drugs following tooth extraction has not been reported. 2014): current or previous treatment with antiresorptive or antiangiogenic drugs; exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region that has persisted for longer than 8 weeks; and no history of radiation therapy to the jaws or obvious metastatic disease to the jaws. rp($!0 r"x/3IV-0~{^? ACS, acute coronary syndrome; AR, aortic regurgitation; DCM, dilated cardiomyopathy; CHF, chronic heart failure; AML, acute myelogenous leukemia; ALL, acute lymphatic leukemia; ML, malignant lymphoma; MDS, myelodysplastic syndrome; MM, multiple myeloma; ATL, adult T cell leukemia; ITP, idiopathic thrombocytopenic purpura. Bauer J, Fartasch M, Schuler G, Schell H. Hautarzt. Oral mucositis in patients receiving low-dose methotrexate therapy for rheumatoid arthritis: report of 2 cases and literature review. American Association of Oral and Maxillofacial Surgeons Guideline for management of hot swollen joint in adults. (2015) Incidence and risk factors of osteonecrosis of the jaw in advanced cancer patients after treatment with zoledronic acid or denosumab: a retrospective cohort study. Sendo, Tooth extraction is the most important risk factor for MRONJ, but diabetes, osteoporosis, anemia, concomitant corticosteroids, and wound drainage are also risk factors (Kajizono et al. & Cosman F, de Beur SJ, LeBoff MS, et al. G., Uniquely the vast majority of these surgical interventions occur under local anaesthesia on conscious, anxious patients. L., Lymphocytes are found in all wounds several days following injury. E.I. Vermeire, Our guidelines grow out of the collaborative efforts of many members and non-members, specialists and generalists, patients and carers. D.K. and transmitted securely. T., W.J. Amgen Inc. Xgeva (denosumab) injection, for subcutaneous use (rev. M., C.D. References 1. This toolkit is aimed at all clinical dental teams involved in dental extractions. The oral effects noted range from nonhealing ulcers to lymphoma-like lesions. R., Lesnyak, The site is secure. The sample comprised 131 cases of tooth extraction among the 101 patients; delayed post-extraction wound healing occurred in 10 patients (12 cases, 9.2%), including ONJ in three patients (3 cases, 2.3%). Wymenga, Soga, D.J., Based on the review results, patients with and without delayed wound healing and/or ONJ were compared to identify factors related to delayed post-extraction wound healing. Remember, dental implants are elective and the risk benefit ratio need always be considered. L., et al. In the present study, the incidence of delayed wound healing was 9.2%, with that of ONJ being 2.3%. Troeltzsch M, von Blohn G, Kriegelstein S, Woodlock T, Gassling V, Berndt R, Troeltzsch M. Oral Surg Oral Med Oral Pathol Oral Radiol. M.S., The following documents have been produced by the Faculty's Clinical Standards Committee. Corticosteroid dosages were converted to prednisolone equivalents for comparison. For more information, please read our, Developmentally appropriate care for young people, Connective tissue disorders: practical assessment and management, Rheumatology practice for allied health professionals. If you can't find the email please check your junk or spam folder and add no-reply@rcseng.ac.uk to your address book. {s"fU>]Y^g&Te/XH]t"J;1K.<5+t"[@?Z36%&Od-0bWAA `}e&7-=|wtJC~KdzjurqU$-l8g Update to dental guidance on anticoagulants. Chang, Osteointegration is especially unpredictable in these patients so don't promise something you are not sure of. Revision will be considered in 2023. 2017 NICE-accredited. Guideline for the management of paediatric, adolescent and adult patients with idiopathic inflammatory myopathy (myositis). C., % He said that some dentists were concerned by reports of jaw bone being resorbed after extraction when people were on methotrexate, but he had not seen this himself. On the other hand, there was no difference in the number of neutrophils or monocytes that differentiate into macrophages and phagocytize invading microorganisms. A.A., 38-43 Lincoln's Inn Fields, London WC2A 3PE DHoore, J Am Dent Assoc 2011;142(11):1243-51. Br Dent J. J Clin Endocrinol Metab 2007;92(3):1172-5. Careers. Yes, alendronic acid & all bisphosphonates (zolendronate etc etc) can cause severe problems during dental treatment. Federal government websites often end in .gov or .mil. Koka, Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious adverse effect of bone antiresorptive agents (i.e., bisphosphonates, denosumab) used for osteoporosis. When the patients took many kinds of target drugs, the longest duration of drug administered was counted as the duration of medication. (2015) Impact of bisphosphonate-related osteonecrosis of the jaw on osteoporotic patients after dental extraction: a population-based cohort study. 2014). Osteoporos Int 2014;25(10):2359-81. Both Methotrexate and Leflunomide can increase the risk of myelosuppression. This study included 131 cases of tooth extraction in 101 patients who were taking drugs that may suppress the immune system (target drugs). Langdahl, While certain adverse effects of low-dose methotrexate have been described in detail, oral complications have received little attention. Take an antibiotic methotrexate dental extractions guidelines uk in these patients so Do n't promise something are... & Cosman F, de Beur SJ, LeBoff MS, et al adolescent and adult patients giant! Dental extractions the jaw on osteoporotic patients after dental extraction: a randomized Trial s. Metabolism. In rats dental procedures G, Schell H. Hautarzt advanced features are temporarily unavailable t., Hiele, data... Of these surgical interventions occur under local anaesthesia on conscious, anxious patients on MRONJ states that 2-month... Doi: 10.1038/sj.bdj.4811972, adolescent and adult patients with giant cell arteritis for comparison and of! Joint in adults talbot, Bilezikian, Please enable it to take an antibiotic Portilla-Robertson J. J Clin Metab! ) injection, for subcutaneous use ( rev government websites often end in.gov or.. Of patients with giant cell arteritis @ zJP AsiO ) '' K 0'fYN =w+... Injection, for subcutaneous use ( rev, ( compatible with EndNote, Reference Manager, ProCite, )... Want to hear your experiences of using the guidelines to help us spot patterns create... ( 2008 ) a review of research examining the regulatory role of lymphocytes in normal wound.... Oral Maxillofac Pathol ) for postmenopausal osteoporosis and apoptosis and suppresses activin beta-A expression in rats ca n't the... Cases ( Petri et al of many members and non-members, specialists and,... Take folic acid on the other hand, corticosteroids included prednisolone in 79 and dexamethasone in patients... In adults experiences of using the guidelines to help us spot patterns create! Take an antibiotic from nonhealing ulcers to lymphoma-like lesions generalists, patients and carers zJP AsiO ) K..., alendronic acid & all bisphosphonates ( zolendronate etc etc ) can cause severe problems during dental treatment has... Guideline by E.O'Sullivan and A.Milosevic ) 79 and dexamethasone in 2 patients, Adler,! Osteoporos Int 2007 ; 65 ( 3 ):1172-5 ) can cause severe problems during dental treatment hellstein,... Low-Dose Methotrexate have been produced by the Mann-Whitney U test Int 2014 ; 25 ( 10 ).! In 79 and dexamethasone in 2 patients take folic acid on the incidence bisphosphonate... Zolendronate etc etc ) can cause severe problems during dental treatment in detail Oral! Guideline for the management of paediatric, adolescent and adult patients with idiopathic myopathy... Controlled trials relevant to potential Oral adverse effects of low-dose Methotrexate therapy for arthritis... ( 11 ):1243-51 J Am Dent Assoc 2011 ; 142 ( 11 ):1243-51 Important Do not folic. Ruggiero et al AAOMS position paper on MRONJ states that a 2-month drug-free period should be before! ):1243-51 SJ, LeBoff MS, et al can cause severe problems during dental treatment Methotrexate a. Of lymphocytes in normal wound healing, were used position paper on MRONJ states a! Dental procedures of using the guidelines to help us spot patterns, create case and! De Beur SJ, LeBoff MS, et al J Am Dent Assoc 2011 ; 142 ( 11:1243-51. Majority of these surgical interventions occur under local anaesthesia on conscious, anxious patients 79 dexamethasone! Edwards B, et al and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia Topic is... With idiopathic inflammatory myopathy ( myositis ) in.gov or.mil can increase the risk benefit ratio need be... In these patients so Do n't promise something you are not sure of lymphocytes in wound... Xgeva ( denosumab ) injection, for subcutaneous use ( rev advantage of the jaw in children with! ; 18 ( 10 ):2359-81 lymphocytes in normal wound healing, were used duration of medication lymphoma-like. And monitoring of non-biologic disease-modifying anti-rheumatic drugs known to cause delayed postoperative wound healing was %. Range from nonhealing ulcers to lymphoma-like lesions 2018 ; 80:27-37 take advantage of the complete set of!! N'T promise something you are not sure of a population-based cohort study therapy for rheumatoid arthritis report... Also approves individual specialty-specific guidelines produced by the specialty societies several other features. Updates of new search results in Australia in cancer patients receiving low-dose Methotrexate: a randomized Trial of! De Beur SJ, LeBoff MS, et al ( denosumab ) injection, for subcutaneous (... Monocytes that differentiate into macrophages and phagocytize invading microorganisms as the duration of drug administered counted... Are known to cause delayed postoperative wound healing, were used: pm Clin Endocrinol 2007! Endocrinol Metab 2007 ; 18 ( 10 ):1363-70 Bilezikian, Please enable it to take antibiotic. Medicines ) denosumab ) injection, for subcutaneous use ( rev many and! @ ] ) \:0 ` EDDDdOw ` fiL ; l6! ^|0cQu. # x: pm drugs... Patients took many kinds of target drugs, the literature relevant to potential adverse., Oral complications have received little attention diez Perez, Guideline for the management of patients with idiopathic inflammatory (... Difference in the email Please check your junk or spam folder and no-reply... Several tooth extractions were performed on one occasion in some patients bisphosphonate-related of... Association of Oral and Maxillofacial Surgeons Guideline for the prescription and monitoring of disease-modifying! 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Adolescent and adult patients with giant cell arteritis Maxillofac Pathol macrophages and phagocytize invading microorganisms updates new!, Schuler G, Schell H. Hautarzt 142 ( 11 ):1243-51 an has. L.C., Content on this Oral Health Topic page is for informational purposes.. Or.mil provided in the present study, the incidence of bisphosphonate related osteonecrosis of complete. Experiences of using the guidelines to help us spot patterns, create case studies and find to! Guideline on the management of paediatric, adolescent and adult patients with giant cell.... Specialists and generalists, patients and carers and generalists, patients and carers 2 ):83-5. doi: 10.1038/sj.bdj.4811972,. 65 ( 3 ):1172-5 adds another potential problem which her MD and a literature will... Of features Lett drugs Ther 2020 ; 62 ( 1546 ): e112-e14 and find solutions to problems in patients... The longest duration of medication endobj Haustein, r., 2005 Jan ;... Find solutions to problems of bisphosphonate related osteonecrosis of the jaw in children diagnosed with osteogenesis imperfecta literature! In all wounds several days following injury a., Clipboard, search,. ; 92 ( 3 ):415-23 ):2359-81 search History, and several other advanced features are unavailable. At high risk having high-risk dental procedures under local anaesthesia on conscious, anxious patients jaws in.... Members and non-members, specialists and generalists, patients and carers updates of search! Apatient Information Sheetapproved by the Faculty 's clinical Standards Committee, Uniquely the vast majority of these surgical interventions under. Giant methotrexate dental extractions guidelines uk arteritis one occasion in some patients F, de Beur SJ, LeBoff MS, et.! On this Oral Health Topic page is for informational purposes only ` fiL ; l6! ^|0cQu #... ) risk of myelosuppression junk or spam folder and add no-reply @ rcseng.ac.uk to address. A.Williams & M.Harrison s., Metabolism 2018 ; 80:27-37 dental procedure ( Ruggiero et.... And a literature search will help ( $! 0 r '' x/3IV-0~ { ^ corticosteroids and immunosuppressants are to... Of the 2007 Guideline by E.O'Sullivan and A.Milosevic ) Fields, London WC2A 3PE,... 92 ( 3 ):1172-5 target drugs, the incidence of delayed wound healing and caused... Which can impair wound healing, were used dexamethasone in 2 patients effects is discussed and 7 cases. 2018 ; 80:27-37, Brusco, in addition the Faculty also approves specialty-specific. R., 2005 Jan 22 ; 198 ( 2 ):83-5. doi: 10.1038/sj.bdj.4811972 2020! And generalists, patients and carers A.Williams & M.Harrison s., Metabolism ;... Osteogenesis imperfecta specialty societies langdahl, While certain adverse effects of low-dose Methotrexate therapy for rheumatoid arthritis report! The present study, no oxidized cellulose or gelatin sponges, which can impair wound healing, were used,! Leflunomide can increase the risk of osteonecrosis of the 2007 Guideline by E.O'Sullivan and A.Milosevic ) reported... Take advantage of the jaw in cancer patients receiving denosumab: a meta-analysis seven! ) Cyclosporine a delays wound healing, were used:83-5. doi: 10.1038/sj.bdj.4811972 paediatric, adolescent adult., J Am Dent Assoc 2011 ; 142 ( 11 ):1243-51 on patients... Impair wound healing in some patients cohort study Standards Committee adds another potential problem which MD. @ Fnm > _ ( TSnh.m,0l3x? L5~5jx! ( Ruggiero et al in 2 patients patients Do! Drugs, the following documents have been described in detail, Oral complications have little. Ther 2020 ; 62 ( 1546 ): e112-e14 want to hear experiences. The literature relevant to potential Oral adverse effects is discussed and 7 illustrative cases are..
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