1. The document discusses dental management considerations for patients with hemophilia. Proper evaluation including medical history and coagulation factor testing is important prior to invasive dental procedures.
2. Factor VIII replacement therapy is often required before surgery or other procedures to maintain adequate hemostasis. Local hemostatic measures and drugs like tranexamic acid and desmopressin may also be used.
3. Routine dental treatment can generally be provided for hemophiliacs with care taken to minimize trauma and control bleeding. Invasive procedures require maintaining sufficient coagulation factor levels.
Dentists play an important role in the diagnosis and management of desquamative gingivitis. The importance of being able to recognise and properly diagnose this condition is accentuated by the fact that a serious and life threatening disease may initially manifest as desquamative gingivitis.
One of the most painful but easy-to-treat dental emergencies is a dry socket.
• Dry socket symptoms are experienced after a tooth extraction.
• This condition requires follow-up care by the doctor who performed the surgery, an oral surgeon or a dentist who is familiar with how to treat it.
For more information, contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
#drysocket #management #thirdmolarextraction #extractioncomplications
Splinting is one of the oldest forms of aids to periodontal therapy. By redistribution of forces on the affected teeth the splint minimizes the effects caused by loss of support. Splinting teeth to each other allows weakened teeth to be supported by neighbouring teeth. This presentation reviews the rationale, techniques, advantages and ill effects of stabilization of teeth by splinting as an aid to periodontal therapy. With the acceptance and clinical predictability of adhesive procedures, the use of conservative bonding techniques to splint teeth offers a useful alternative to more invasive restorative procedures. Loss of tooth-supporting structures results in tooth mobility. Increased tooth mobility adversely affects function, aesthetics, and the patient’s comfort. Splints are used to overcome all these problems. When faced with the dilemma of how to manage periodontally compromised teeth, splinting of mobile teeth to stronger adjacent teeth is a viable option. This prolongs the life expectancy of loose teeth, gives stability for the periodontium to reattach, and improves comfort, function and aesthetics.
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
Success of any dental procedure is determined by a good isolation. Here is a seminar on how to isolate the oral cavity from fluids and maintain a good dry field while working on a patient
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Dentists play an important role in the diagnosis and management of desquamative gingivitis. The importance of being able to recognise and properly diagnose this condition is accentuated by the fact that a serious and life threatening disease may initially manifest as desquamative gingivitis.
One of the most painful but easy-to-treat dental emergencies is a dry socket.
• Dry socket symptoms are experienced after a tooth extraction.
• This condition requires follow-up care by the doctor who performed the surgery, an oral surgeon or a dentist who is familiar with how to treat it.
For more information, contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
#drysocket #management #thirdmolarextraction #extractioncomplications
Splinting is one of the oldest forms of aids to periodontal therapy. By redistribution of forces on the affected teeth the splint minimizes the effects caused by loss of support. Splinting teeth to each other allows weakened teeth to be supported by neighbouring teeth. This presentation reviews the rationale, techniques, advantages and ill effects of stabilization of teeth by splinting as an aid to periodontal therapy. With the acceptance and clinical predictability of adhesive procedures, the use of conservative bonding techniques to splint teeth offers a useful alternative to more invasive restorative procedures. Loss of tooth-supporting structures results in tooth mobility. Increased tooth mobility adversely affects function, aesthetics, and the patient’s comfort. Splints are used to overcome all these problems. When faced with the dilemma of how to manage periodontally compromised teeth, splinting of mobile teeth to stronger adjacent teeth is a viable option. This prolongs the life expectancy of loose teeth, gives stability for the periodontium to reattach, and improves comfort, function and aesthetics.
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
Success of any dental procedure is determined by a good isolation. Here is a seminar on how to isolate the oral cavity from fluids and maintain a good dry field while working on a patient
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This seminar consists of a brief description about various systemic diseases along with their oral manifestations and treatments along with the special considerations to be followed
As per AJCC 7th Ed, a pictorial review with prediction for change in future edition.
Presented at "Oral Oncology-An update" CME conducted by Shri Mata Vaishno Devi Narayana Superspecialty Hospital, Katra at Fortune Inn Riviera Hotel, Jammu on 21st Jan, 2017.
An overview of various pathological processes affecting the Jaw Bones- Maxilla and Mandible including odontogenic cysts and tumours including their radiological findings!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
3. • Hemostasia is a defense mechanism that
protects vascular integrity, avoids blood
loss, and maintains blood fluidity
throughout the circulatory system. When a
blood vessel is damaged, rupture of the
endothelial lining exposes the blood to
proteins within the subendothelial tissue;
this in turn triggers three different but
overlapping mechanisms:
1. Vascular phase
2. Platelet phase
3. Plasmatic phase
Jover-Cerveró A, Poveda-Roda R, Bagán JV, Jiménez-Soriano Y.
Dental treatment of patients with coagulation factor alterations:
An update.Med Oral Patol Oral Cir Bucal 2007;12:E380-7.
4.
5. • Dentists must be aware of the impact of
bleeding disorders on the management of
their patients. Proper dental and medical
evaluation of patients is therefore
necessary before treatment, especially if
an invasive dental procedure is planned.
• Patient evaluation and history should
begin with standard medical
questionnaires.
Gupta A, Epstein JB, Cabay RJ. Bleeding Disorders of importance
in dental care and related patient management. JCDA. 2007;
73(1): 77-83a.
6. A clinically significant bleeding episode is
one that:
• continues beyond 12 hours
• causes the patient to call or return to the
dental practitioner or to seek medical
treatment or emergency care
• results in the development of hematoma or
ecchymosis within the soft tissues or
• requires blood product support.
Lockhart PB, Gibson J, Pond SH, Leitch J. Dental management
considerations for the patient with an acquired coagulopathy.
Part 1 Coagulopathies from systemic disease. Br Dent J 2003;
195(8):439–45.
8. - Bleeding time: This test assesses the vascular and
platelet phases of blood clotting. Although it is a
functional test of limited sensitivity, it remains a
good screening option.
- Activated partial thromboplastin time (aPTT): This
test evaluates the intrinsic and common pathways
of blood coagulation
- Prothrombin time (PT): This parameter evaluates
the extrinsic and common pathways
- International Normalized Ratio (INR): is the ratio
between the PT of the patient in seconds and a
control PT standardized by means of the so-called
International Sensitivity Index(ISI)
- Specific factor tests
Jover-Cerveró A, Poveda-Roda R, Bagán JV, Jiménez-Soriano Y.
Dental treatment of patients with coagulation factor alterations:
An update. Med Oral Patol Oral Cir Bucal 2007;12:E380-7.
9. BLEEDING
TIME APTT PT
APTT
PT
NORMALLOW
NORMAL NORMAL NORMAL
NORMAL
NORMAL
PROLONGED
PROLONGED
PROLONGED
PLATELET
COUNT
FACTOR XIII DEF.,
DRUGS &
OTHERS
FACTOR VII
DEFICIENCY
HEMOPHILIAS,
FACTOR XI & XII
DEFICIENCY
LIVER DISEASE,
ANTICOAGULANTS,
DIC, OTHERS
DISORDERS OF
PLATELET
FUNCTION
von WILLEBRAND’S DISEASE
THROMBOCYTOPENIAS
Naveen Kumar J, Anil Kumar R, Varadarajan
R, Sharma N. Specialty dentistry for the
hemophiliac: Is there a protocol in place? Indian
J Dent Res 2007;18:48-54.
10. GENERAL CONSIDERATIONS
Hemophilia is the most common hemorrhagic
diathesis across the globe with an
occurrence of 1 per every 10,000 people.
The severity of hemophilia is variable, but
correlates well with the Factor VIII level of
the plasma.
Normal plasma contains 1 unit of Factor VIII
per ml, a level defined as 100%.
Naveen Kumar J, Anil Kumar R, Varadarajan R, Sharma N.
Specialty dentistry for the hemophiliac: Is there a protocol in
place? Indian J Dent Res 2007;18:48-54.
11. FACTOR ACTIVITY SEVERITY OF HEMOPHILIA
<1% Severe hemophilia
1-5% Moderate hemophilia
>5% Mild hemophilia
12. PREVENTION OF DENTAL
PROBLEMS
• Brushing twice daily with a fluoride
toothpaste.
- 1,000-ppm fluoride toothpaste for children
under 7 years of age.
- 1,400-ppm fluoride toothpaste for people
over 7 years of age.
• The use of fluoride toothpaste depends on
the fluoride concentration in the water
supply as well as the use of additional
fluoride supplements. It should not be
used if fluoride supplements are taken or if
the water supply has a fluoride content of
1ppm or more.
13. • The toothbrush should have medium
texture bristles because hard bristles can
cause abrasion of the teeth and soft
bristles are inadequate to remove plaque.
• Interdental cleaning aids, such as floss,
tape, and interdental brushes, should be
used to prevent the formation of dental
caries and periodontal disease.
• Fluoride supplements may be used, but
are not recommended if the water supply
has a fluoride content of 1 ppm or more.
• The consumption of foods and drinks with
a high sugar or acid content should be
limited to mealtimes. Three exposures per
day is the recommended maximum.
14. • Artificial sweeteners can be used as an
alternative to sugars in food and drinks.
Examples are aspartame, sorbitol,
acesulfamate, etc.
• Regular dental visits, usually every 6
months, will help identify problems early,
reinforce prevention, and emphasize the
importance of reducing the intake of food
and drink containing high levels of sugar
or acid.
Brewer A, Correa ME. Guidelines for dental treatment of patients
with inherited bleeding disorders. Treatment of hemophilia.
2006; 40.
15. GENERAL MANAGEMENT
Factor VIII must be replaced to a level
adequate to ensure hemostasis if bleeding
starts or is expected. Replacement of
missing factor is achieved with porcine
Factor VIII or recombinant Factor VIII.
16. One unit of Factor VIII concentrate per
kilogram of body weight raises the Factor
VIII level by 2% and hence an average 70
kg individual would require infusion of
3500 units to raise the factor level from
less than 1% to 100%. Thus a simple
formula may be derived as:
Dose to be infused (Units) =
{Weight (Kg) x Increment needed (U/dl)}/2
Hoffbrand VA, Catovsky D, Edward GD, Tuddenham. Post graduate
haematology, 5th ed. Blackwell Publishing: London; 2005.
17. • Cover for surgery, other than very minor
procedures or for mild hemophiliacs,
requires maintenance of normal Factor VIII
levels for approximately one week,
followed by a period of reduced dosage
during convalescence. This can be
achieved either by repeated bolus
injections every 12 hours (paying
particular attention to trough levels) or by
continuous infusion. It must be noted that
the doses required during the immediate
postoperative period may be considered
more than expected.
Naveen Kumar J, Anil Kumar R, Varadarajan R, Sharma N.
Specialty dentistry for the hemophiliac: Is there a protocol in
place? Indian J Dent Res 2007;18:48-54.
18. • In mild hemophlia, desmopressin and
antifibrinolytics such as tranexamic acid
may be adequate.
• Desmopressin, a synthetic analogue of
vasopressin is available for intranasal
spray and intravenous infusions. It
provides adequate transient increases in
coagulation factors in some patients with
mild to moderate hemophilia avoiding the
need for plasma concentrates.
• Tranexamic acid is a synthetic derivative
of lysine, available for topical and systemic
usage. However, nausea is a common
adverse effect.
• The anti-fibrinolytic agent Epsilon amino
caprioic acid (EACA) given orally of IV is a
potent inhibitor of initial clot dissolution.
19. • A regimen of 50 mg/kg body weight EACA
given orally as a 25% oral rinse every six
hours for seven to ten days appears
adequate as an adjunct.
• Still tranexamic acid is 10 times more
potent than EACA with fewer side-effects.
Naveen Kumar J, Anil Kumar R, Varadarajan R, Sharma N.
Specialty dentistry for the hemophiliac: Is there a protocol in
place? Indian J Dent Res 2007;18:48-54.
21. Difficulties in the management of a
hemophiliac dental patient include the
following:
1. Dental neglect necessitating frequent
extractions
2. Trauma and surgery
3. Factor VIII inhibitors (recombinant FVIIa is
an alternative Solution)
4. Hazards of anesthesia and injections
5. Risk of hepatitis B and liver disease and
HIV infection
6. Aggravation of bleeding by drugs
7. Anxiety and drug dependence
Scully C, Cawson RA. Medical problems in dentistry. 5th ed.
Elsevier: London; 2005.
22. • The bleeding tendency can be aggravated
by NSAIDs. Safer alternatives for pain
control are acetaminophen, codeine and
Cox-2 inhibitors.
• Local anesthetic regional blocks, lingual
infiltrations or injections into the floor of the
mouth must not be used in the absence of
Factor VIII replacement because of the
risk of hemorrhage hazarding the airway
and being life-threatening. If FVIII
replacement therapy has been
given, regional LA can be used provided
the FVIII level is maintained above 30%.
• Infiltrations, intraligamentary, intraosseous
or intrapulpal injections are still safer.
Naveen Kumar J, Anil Kumar R, Varadarajan R, Sharma N.
Specialty dentistry for the hemophiliac: Is there a protocol in
place? Indian J Dent Res 2007;18:48-54.
23. RESTORATIVE PROCEDURES
• Restorative treatment can be undertaken
routinely providing care is taken to protect
the mucosa. There is a risk of bleeding
with the use of matrix bands or wooden
wedges. This can be controlled by local
means or the application of topical agents.
• Cotton rolls should be wetted before
removal.
• High-speed vacuum aspirators and saliva
ejectors can cause hematomas.
• Trauma from the saliva ejector can be
minimized by resting it on a gauze swab in
the floor of the mouth.
Brewer A, Correa ME. Guidelines for dental treatment of patients
with inherited bleeding disorders. Treatment of hemophilia.
2006; 40.
24. Batawi HYE. Minimizing the risk of perioperative bleeding in a child with
hemophilia A during dental rehabilitation under general anesthesiia: a case
report. Int J Clin Ped Dent 2013; 6(3): 217-222.
25. ENDODONTICS
• Avoiding instrumentation through the
periapex is of prime importance in
endodontic therapy.
• The presence of bleeding in the canal is
indicative of pulp tissue remaining in the
canal.
• Sodium hypochlorite should be used for
irrigation in all cases, followed by the use
of calcium hydroxide paste to control the
bleeding.
• Formaldehyde-derived substances may
also be used in cases where there is
persistent bleeding or even before the
pulpectomy.
Brewer A, Correa ME. Guidelines for dental treatment of patients
with inherited bleeding disorders. Treatment of hemophilia.
2006; 40.
26. RUBBER DAM ISOLATION
• Isolation with rubber dam provides
retraction of gingiva and improves visibility.
• It also minimizes the potential for
laceration of the buccal mucosa and lips.
• Notches may be placed in buccal and
lingual surfaces with a fissure bur into
which clamp prongs will fit tightly.
27.
28. SURGICAL ENDODONTICS
• Mild hemophiliacs requiring surgeries can
be managed usually without factor
replacements.
• Desmopressin and tranexamic acid are
primary alternatives.
29. SURGICAL ENDODONTICS
• Desmopressin can be as a slow
intravenous infusion over 20 min of 0.3-0.5
µg/kg, 30 to 60 min prior to the surgical
procedure. This results in a two- to
threefold rise in Factor VIII activity with a
mean half-life of 9.4h. Intranasal
administration as a spray of 1.5 mg per ml
with each 0.1 ml pump spray is an
alternative, but it requires a tenfold higher
dose of desmopressin to achieve a
maximal twofold increase in Factor VIII
activity after 90 min, limiting treatment to
those hemophiliac patients whose basal
factor levels are sufficiently high.
30. SURGICAL ENDODONTICS
• Tranexamic acid significantly reduces
blood loss and can be given topically or
systemically.
Borea G, Montebugnoli L, Capuzzi P, Magelli C. Tranexamic acid as
a mouthwash in anticoagulant-treated patients undergoing oral
surgery. An alternative method to discontuing anticoagulant
therapy. Oral Surg Oral Med Oral Pathol 1993; 75: 29-31.
31. SURGICAL ENDODONTICS
• Systemically, its given in a dose of 1g (30
mg/kg) orally qid starting atleast 1h
preoperatively for surgical procedures.
• Tranexamic acid infusions can be given as
10 mg/kg in 20 ml normal saline over 20
min, then 1g tds orally for five days
(children: 20 mg/kg)
• Stubbs M, Llyod J. A protocol for the dental management of von
Willebrand’s disease, haemophlia A and haemophilia B. Aus
Dent J 2001; 46(1): 37-40.
32. PERIODONTAL TREATMENT
• Healthy periodontal tissue is essential to prevent bleeding
and tooth loss.
• If oral hygiene is poor treatment must start as soon as
possible after the patient has had a dental examination and
treatment plan formulated to prevent additional damage to
the periodontal tissues.
• In cases of severe periodontal disease, it may be necessary
to carry out supragingival scaling initially along with oral
hygiene education.
• Subgingival scaling can start as soon as the inflammation
has decreased. The treatment may need to be carried out
over several visits to prevent excessive blood loss.
• In addition, chlorhexidine gluconate mouthwash can be
used to control periodontal problems.
• Antibiotics may be required to help reduce the initial
inflammation.
Naveen Kumar J, Anil Kumar R, Varadarajan R, Sharma N. Specialty dentistry for the
hemophiliac: Is there a protocol in place? Indian J Dent Res 2007;18:48-54
33. • A case was reported wherein local
treatment with 30% trichloroacetic acid
combined with tranexamic acid was used
to stop the bleeding in 51 year old patient
with moderate hemophilia.
• Delgado EG, Sottilotta G. Dental treatment with 30%
tricholoracetic acid in a patient with moderate hemophilia A.
Open J Blood Dis. 2013; 3: 13-14.
34. REMOVABLE
PROSTHODONTICS
• Patients with bleeding disorders can be
given dentures as long as they are
comfortable.
• If a partial denture is provided it is
important that the periodontal health of the
remaining teeth is maintained.
Brewer A, Correa ME. Guidelines for dental treatment of patients
with inherited bleeding disorders. Treatment of hemophilia.
2006; 40.
35. ORTHODONTIC TREATMENT
• Fixed and removable orthodontic
appliances may be used along with regular
preventive advice and hygiene therapy.
Special care should be taken when
treating patients with a severe bleeding
disorder to ensure that the gingiva is not
damaged when fitting the appliance.
• Brewer A, Correa ME. Guidelines for dental treatment of
patients with inherited bleeding disorders. Treatment of
hemophilia. 2006; 40.
36. ANESTHESIA AND PAIN
MANAGEMENT
• Dental pain can usually be controlled with
a minor analgesic such as paracetamol
(acetaminophen). Aspirin should not be
used due to its inhibitory affect on platelet
aggregation. The use of any non-steroidal
anti-inflammatory drug (NSAID) must be
discussed beforehand with the patient's
hematologist because of their effect on
platelet aggregation.
37. ANESTHESIA AND PAIN
MANAGEMENT
• A buccal infiltration can be used without
any factor replacement. It will anesthetize
all the upper teeth and lower anterior and
premolar teeth.
38. POST-EXTRACTION
HEMORRHAGE
• Contact the hemophilia unit and consider using
additional factor concentrate.
• Inspect the site of the bleed. If there is any evidence of a
tear in the gingiva or other obvious bleeding point this
should be treated using local measures.
• Instruct the patient to sit up and bite on a damp gauze
swab for at least 10 minutes.
• Use a 10% solution of tranexamic acid or EACA to
dampen the swab or as a mouthwash if the bleeding is
difficult to stop.
• Monitor the patient’s blood pressure as it may increase
due to worry and pain.
Brewer A, Correa ME. Guidelines for dental treatment of patients with
inherited bleeding disorders. Treatment of hemophilia. 2006; 40.
39. FIBRIN GLUE
• In some hemophilia centres, fibrin glue is
used as a local hemostatic measure, along
with an oral antifibrinolytic agent, to
achieve hemostasis and reduce the need
for clotting factor replacement therapy. All
fibrin glue contains human or animal
components, which has made a number of
physicians and patients being hesitant to
use this treatment particularly for patients
who are receiving recombinant factor
concentrates or have never received blood
products derived from humans.
• Brewer A, Correa ME. Guidelines for dental treatment of patients with
inherited bleeding disorders. Treatment of hemophilia. 2006; 40.
40. SPLINTS
• Soft vacuum-formed splints can be used to
provide local protection following a dental
extraction or prolonged post-extraction
bleed.
• If the splint is to be used to stop a post-
extraction hemorrhage, the impression
must be thoroughly cleaned and
disinfected before it is transported to the
laboratory.
• Brewer A, Correa ME. Guidelines for dental treatment of patients with
inherited bleeding disorders. Treatment of hemophilia. 2006; 40.
41. MANAGEMENT OF ORAL
INFECTIONS
• The initial treatment usually starts based on the normal
oral pathogens, Streptococcus viridans, anaerobic gram-
positive cocci and anaerobic gram-negative rods.
• Antibiotic regimes should cover all of these groups of
organisms.
• Penicillin is a first-line antibiotic used to treat dental
infections.
• Metronidazole is extremely effective in treating
anaerobes and is often used in combination with
penicillin to give good coverage of both the aerobic and
anaerobic bacteria present in the oral cavity.
• Erythromycin and clindamycin have been prescribed to
patients who are allergic to penicillin.
• Brewer A, Correa ME. Guidelines for dental treatment of patients with inherited
bleeding disorders. Treatment of hemophilia. 2006; 40.
42. CONCLUSION
• Early dental care is of prime importance in
such patients to avoid invasive procedures
at a future date.
• A thorough understanding of the condition,
helps the dental professional to perform a
systematic evaluation and anticipate
potential hazards rather than being caught
unawares with meager and desperate
local haemostatic measures.
• A protocol should be followed while
treating these cases to continue with
specialty dental procedures without major
risks.