USE OF BLOOD COAGULATIONS IN DENTAL TREATMENTS AND PROCEDURES

1. BLOOD COAGULATION
PRESENTER: DR KARANDEEP SINGHVIRK(M.D.S)1ST yr
Department ofOral Medicine and Radiology

2. CONTENTS
• HAEMOSTASIS OVERVIEW
• PLATELET PLUG FORMATION
• BLOOD COAGULATION
• DISORDERS OF
COAGULATION
• DENTAL MANAGEMENT

3. HEMOSTASIS
• DEFINITION
- Heme = blood
- stasis = to halt
• Process of forming clots in the wall of
damaged blood vessels & preventing blood
loss while maintaining blood in a fluid state
with in the vascular system.
• Spontaneous arrest of bleeding by
physiological process.

4. 4
Mechanism
Haemostasis involves 4 main
steps:
1. Vascular spasm
2. Platelets reaction
3. Formation of platelet plug
4. Blood coagulation

5. 5
I-Vascular spasm
Reduces flow of blood from injured vessel.

6. II- Platelet plug formation

7. Secondary hemostasis
• “Cascade of reactions” by
Macfarlane, R.G.,1967
‘Inactive’ enzymes: activated
‘activated’ enzymes activates other inactive
enzymes until final step is reached.

8. ENZYME CASCADE SEQUENCE
STAGE 1: FORMATION OF PROTHROMBIN
ACTIVATOR
STAGE 2: CONVERSION OF PROTHROMBIN
THROMBIN
STAGE3: CONVERSIONOF FIBRINOGEN
FIBRIN

9. 21
Blood Coagulation
• Plasma proteins synthesized by the liver (vitamin K is needed
for the synthesis of factor II, VII, IX and X).

11. FACTOR X CAN BE ACTIVATED
BY REACTIONS IN EITHER OF
2 SYSTEMS:
An Intrinsic system
An Extrinsic system
26

12. 27
Intrinsic pathway

13. Extrinsic Pathway

14. INVESTIGATIONS

15. • HEMOSTATIC FUNCTION
TESTS
-Bleeding time : Normal
bleeding time ; 1 – 5 min
-Clotting time:5-6 min
-Prothrombin time:10-15 sec

16. APPLIED

17. DISORDERS OF
COAGULATION
• Defective blood clotting
- deficiency of clotting factors (I, II, V, VIII,
IX, X)
- deficiency of Vit- K
-von Willebrand disease
- anticoagulantoverdose
• Defective capillary contractility
- Purpura
• Thrombosis

18. DEFICIENCY OF
FACTORS

20. Hemophilia
• Factor – VIII deficiency
• Inheritance – Sex linked,
-X-chromosome, females are carrier
• Diagnosis - CT increased, BT- normal
•ORAL MANIFESTATION:Gingival ,postextraction
•
• Treatment
- Fresh blood transfusion
- Injecting factor – VIII and IX
- Injecting thrombin or thromboplastin

21. Hemophilia - D
 Factor – XII
( Hageman factor) deficiency
44
Hemophilia - C
Factor – XI
(Plasma thromboplastin anticedent) deficiency.
Hemophilia – B
( Christmas disease)
 Factor – IX deficiency

22. Purpura
• Purple coloured petechial hemorrhages and
bruises in the skin,oral mucosa.
• spontaneous hemorrhages beneath the skin,
mucous membrane and internal organ.
• Types
-Primary (Idiopathic) –congenital or
heriditary , seen in children
- Secondary (Symptomatic)
- allergies, infections, drugs, cancer

23. • VON WILLEBRAND’S DISEASE
• Deficiency of VWF & amount of Factor VIII
• Factor VIII is bound to vWF while inactive in
circulation;
Factor VIII degrades rapidly when not bound to
vWF
• Lab Results - Prolonged BT, PTT

24. In dental examination

25. Oral findings

29. REFFERENCES
• Barret, K.E, etal(2010), Ganong’s Review of Medical
Physiology, 23rd edition, McGraw Company, USA
• Raftery, A.T(2008), Applied Basic Science for Basic Surgical
Training, 2nd edition, Elsevier, USA.
• Guyton AC, Hall JE : Textbook of Medical Physiology, 11th
Edition, Elsevier Saunders, 2006