This case report describes the dental treatment of a 4-year-old boy with severe hemophilia A under general anesthesia. The treatment included endodontic therapy, preventive laser diode pulpotomy, indirect pulp capping, fillings, and sealants. Close cooperation between the dental surgeon, hematologist, and anesthesiologist ensured the treatment was performed safely. The diode laser was effective for hemostasis during pulpotomy and should be widely used for managing bleeding in hemophilia patients. Three months post-treatment, the patient had no complaints or signs of complications.
hypomineralization of systemic origin of one to four permanent first molars frequently associated with affected incisors and these molars are related to major clinical problems in severe cases
Hi, I am Dr Komal Ghiya, a pediatric dentist by profession and I am here to upload some of my own presentations regarding dentistry for educational purposed for all the dental students, both undergraduates and postgraduates as well as dentists. I hope you like the presentation. All the best!
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
hypomineralization of systemic origin of one to four permanent first molars frequently associated with affected incisors and these molars are related to major clinical problems in severe cases
Hi, I am Dr Komal Ghiya, a pediatric dentist by profession and I am here to upload some of my own presentations regarding dentistry for educational purposed for all the dental students, both undergraduates and postgraduates as well as dentists. I hope you like the presentation. All the best!
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
Periodontal changes in ortho treatment/certified fixed orthodontic courses by...Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Combined endodontic periodontic treatment of a palatal groove/ dental implant...Indian dental academy
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.
Orthodontic-periodontic interactions are mutually beneficial. Orthodontic treatment can be justified as a part of periodontal therapy if it is used to reduce plaque accumulation, correct abnormal gingival and osseous forms, improve aesthetics, and facilitate prosthetic replacement.
The management of impacted canines is important in terms of esthetics and function. Clinicians must formulate treatment plans that are in the best interest of the patient and they must be knowledgeable about the variety of treatment options. When patients are evaluated and treated properly, clinicians can reduce the frequency of ectopic eruption and subsequent impaction of the maxillary canine. The simplest interceptive procedure that can be used to prevent impaction of permanent canines is the timely extraction of the primary canines. This procedure usually allows the permanent canines to become upright and erupt properly into the dental arch, provided sufficient space is available to accommodate them. In the present article, an overview of the incidence and sequelae, as well as the surgical, periodontal, and orthodontic considerations in the management of impacted canines is presented.
Endodontic - orthodontic relation /certified fixed orthodontic courses by In...Indian dental academy
Welcome to Indian Dental Academy
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.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Case history & diagnosis in periodontics /certified fixed orthodontic course...Indian dental academy
Welcome to Indian Dental Academy
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.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Salvation of severely fractured anterior tooth: An orthodontic approachAshok Ayer
Restoration of severely fractured teeth presents a challenge to the endodontist and may require an interdisciplinary approach for proper management. When the available crown structure is less, orthodontic forced extrusion is the option where the coronal root structure is exposed for proper restoration. This report describes the management of severely fractured maxillary right lateral incisor with extensive loss of coronal structure and fracture line extending below gingival margin. Endodontic treatment of the fractured tooth was followed by controlled orthodontic extrusion to expose fracture margin and providing sufficient coronal tooth structure to support the prosthesis. Orthodontic extrusion may be considered as a viable option for the salvation of fractured anterior teeth.
Ortho endo-prostho relationship /certified fixed orthodontic courses by India...Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Long term effects of orthodontic treatment /certified fixed orthodontic co...Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Periodontal changes in ortho treatment/certified fixed orthodontic courses by...Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Combined endodontic periodontic treatment of a palatal groove/ dental implant...Indian dental academy
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.
Orthodontic-periodontic interactions are mutually beneficial. Orthodontic treatment can be justified as a part of periodontal therapy if it is used to reduce plaque accumulation, correct abnormal gingival and osseous forms, improve aesthetics, and facilitate prosthetic replacement.
The management of impacted canines is important in terms of esthetics and function. Clinicians must formulate treatment plans that are in the best interest of the patient and they must be knowledgeable about the variety of treatment options. When patients are evaluated and treated properly, clinicians can reduce the frequency of ectopic eruption and subsequent impaction of the maxillary canine. The simplest interceptive procedure that can be used to prevent impaction of permanent canines is the timely extraction of the primary canines. This procedure usually allows the permanent canines to become upright and erupt properly into the dental arch, provided sufficient space is available to accommodate them. In the present article, an overview of the incidence and sequelae, as well as the surgical, periodontal, and orthodontic considerations in the management of impacted canines is presented.
Endodontic - orthodontic relation /certified fixed orthodontic courses by In...Indian dental academy
Welcome to Indian Dental Academy
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.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Case history & diagnosis in periodontics /certified fixed orthodontic course...Indian dental academy
Welcome to Indian Dental Academy
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.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Salvation of severely fractured anterior tooth: An orthodontic approachAshok Ayer
Restoration of severely fractured teeth presents a challenge to the endodontist and may require an interdisciplinary approach for proper management. When the available crown structure is less, orthodontic forced extrusion is the option where the coronal root structure is exposed for proper restoration. This report describes the management of severely fractured maxillary right lateral incisor with extensive loss of coronal structure and fracture line extending below gingival margin. Endodontic treatment of the fractured tooth was followed by controlled orthodontic extrusion to expose fracture margin and providing sufficient coronal tooth structure to support the prosthesis. Orthodontic extrusion may be considered as a viable option for the salvation of fractured anterior teeth.
Ortho endo-prostho relationship /certified fixed orthodontic courses by India...Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Long term effects of orthodontic treatment /certified fixed orthodontic co...Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
This presentation is a review of MANDIBULAR MOLAR ROOT RESECTION VERSUS IMPLANT THERAPY A RETROSPECTIVE NONRANDOMIZED STUDYZ
afiropoulos GG, Hoffmann O, Kasaj A, Willershausen B, Deli G, Tatakis DN.Journal of Oral Implantology, 2009
This seminar deals with implant-related complications that lead to implant failure.this also discus diagnostic criteria and preventive methods for an implant failure.
Full body is the most of I don't have a lot more then I have been on my phone is a new one number and my heart is a new phone is it possible to be fine and I have a good day of the year and I am a good time with my family and I have to do not know what you do not know how to do with your family is a good day of
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 31st publication IJAR 1st name
Crestal bone loss around dental implants after implantation of Tricalcium pho...Dr. Anuj S Parihar
Background and Aims: Bone loss around dental implants is generally measured by monitoring changes in marginal bone level using radiographs. After the first year of implantation, an implant should have <0.2 mm annual loss of marginal bone level to satisfy the criteria of success. However, the success rate of dental implants depends on the amount of the crestal bone around the implants. The main aim of this study was to evaluate and compare the crestal bone loss around implants placed with particulate β‑Tricalcium Phosphate Bone Graft and platelet concentrates. Methods: 50 individuals received hundred dental implants. Each individual received one dental implant in the edentulous site filled with β‑Tricalcium Phosphate Bone Graft along (β‑TCP) with Platelet‑ Rich Plasma (PRP)
(Group A) and another in edentulous site filled only with β‑Tricalcium Phosphate Bone Graft (Group B) in the posterior edentulous region. All the 100 implants were prosthetically loaded after a healing period of three months. Crestal bone loss was measured on mesial, distal, buccal and lingual side of each implant using periapical radiographs 3 months, 6 months and 9 months after implant placement. Results: The average crestal bone loss 9 months after the implants placement in Group A and Group B was 2.75 mm and 2.23 mm respectively, the value being statistically significant (P < 0.05). In both Group A and Group B, the average crestal bone loss was maximum on the lingual side followed by buccal, distal and mesial sides. Conclusion: β‑TCP is a promising biomaterial for clinical
situations requiring bone augmentation. However, the addition of PRP results in decreased bone loss around the dental implants.
Mouth preparation refers to procedures that must be accomplished before fixed prosthodontic treatment can be properly performed.
Rarely are crowns or fixed prosthodontic treatment provided without initial therapy because what causes the need for the fixed prosthesis also promote other pathological processes (caries and periodontal disease are the most common).
Failure of fixed prosthesis often results from inadequate or incomplete mouth preparation.
DENTAL AVULSION- IMMEDIATE REPLANTATION: 8- YEAR FOLLOW UP CASEAbu-Hussein Muhamad
Avulsion of permanent front teeth is a rare accident , mostly affecting children between seven and nine year s of age.
Replanted and splinted, these teeth often develop inflammat ion, severe resorption or ankylosis affect ing alveolar bone
development and have to be extracted sooner or later . This repor t proposes a discussion on the var ious pecul iar ities of a
tooth avulsion case with immediate replantation, such as a long retent ion per iod, root canal fil ling with MTA, or thodontic
treatment.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Pulpotomy management using laser diode in pediatric patient-JOURNAL CLUB
1. Pulpotomy management using
laser diode in pediatric patient
with severe hemophilia A under
general anesthesia—A case
report
Vo Truong Nhu Ngoc, PhD;1 Trinh Do Van Nga, DDS;2 Dinh-Toi Chu, PhD;3,4* Le Quynh
Anh, DDS1
Spec Care Dentist XX(X): 1-5, 2018
PMID: 29537665.
IMPACT factor 1.13
DR.RACHAEL GUPTA
POSTGRADUATE
2. Introduction
Hemophilia - a common bleeding disorder
- results from mutations of X-chromosome genes
- This inherited disease occurs in about 1 in every 10 000 people and 1
in every 5000 males.
Srivastava A, Brewer AK, MauserBunschoten EP, 2013
Peisker A, Raschke GF, Schultze-Mosgau S 2014
- It includes 3 types, namely,
hemophilia A (deficiency in coagulation factor VIII),
hemophilia B (lack of factor IX),
hemophilia C (shortage of factor XI).
The most common type, hemophilia A, accounts for 80% to 85% of all hemophilic cases.
3. Introduction
In healthy people, factor quantification ranges from 50 to 100 IU/ dL
Based on the amount of coagulation factor VIII in a patient’s plasma, hemophilia
A is classified into 3 levels of severity.
Mild, moderate, and severe hemophilia cases have a plasma clotting factor
concentration of
Mild- 6 to 50 IU/dL (6% to 50% of normal),
Moderate- 2 to 5 IU/dL (2% to 5% of normal), and
Severe- <1 IU/Dl (less than 1% of normal)
Nogami K, Shima M. Pathogenesis and treatment of hemophilia. In: Ishii E, ed.
Hematological Disorders in Children: Pathogenesis and Treatment. Singapore:
Springer Singapore; 2017:189-204
4. Introduction
Hemophilia A -mostly occurs in male patients, while female ones are
often asymptomatic carriers
Medical interventions may range from
- oral tranexamic acid prescription,
- to clotting factor infusion,
- to immune tolerance therapy (severe cases with inhibitors)
5. Hemophilia patients, especially hemophilia A ones, may suffer from several oral
and dental health problems
- uncontrolled gum or
- socket bleeding after dental surgeries, and
- traumatic hematoma in buccal space.
Hemophilia patients are at high risk of incurring the 2 most common oral
diseases—gingivitis/ periodontitis and dental caries.
However, our knowledge of dental and oral health care for hemophilia A patients
is currently limited, for only a very few studies have been conducted.
6. Hemophilia patients, especially hemophilia A ones, may suffer from several oral and dental
health problems
N
o
Case Dental problems T/T references
1 Mild Hemophilia A Uncontrolled postsurgical
bleeding to expose 2
central incisors
Tranexamic acid,
vitamin K and saline
infusions
Martínez-Rider et al
2 Mild Hemophilia A Secondary bleeding post
extraction of tooth 14
Pressure on the
socket, locally
tranexamic injection,
and intravenous
vitamin K
Mamtha et al
3 Moderate Hemophilia A A Bleeding following steel
crown restoration
Intravenous factor
VIII administration
Lòpez-Villareal et al
4 Severe Hemophilia A with
inhibitor
Traumatic hematoma in
buccal space
Intravenous factor
VIII infusion
combined with
immune tolerance
therapy
Durham et al
7. Case report
A 4-year-old boy presented at School of Odonto Stomatology, hanoi Medical University
C/O - of provoked pain at meals
He had H/O severe hemophilia A detected at 6 months old because of multiple bluish
patches on his lower limbs
He was referred to and managed at National Institute of Hematology and Blood
Transfusion.
Nervous and scared of getting hurt at his first dental visit, he could hardly point out his
decayed tooth
8. • The pretreatment
panoramic film showed
multiple translucent lesions
of varying sizes, in different
sites and stages in relation
to pulp chambers.
• Tooth 85 with a deep
carious lesion into the pulp
chamber, no periapical
lesion was found.
9. To avoid unexpected injuries and bleeding caused by the lack of patient
coordination,
especially pediatric patients like this case, dental treatment under general anesthesia
was the best of choice.
T/T was supposed to save the boy from mealtime toothache, as well as keep his
deciduous dentition in healthy conditions for chewing and preserving space
functions.
The child’s conditions & T/T plan were explained to his parents
Sent to hematologist whether child could undergo t/t or not and which medication
was needed
10. His blood investigations
- a normal full blood count
- prolonged activated partial thromboplastin time (APTT) (>150 s)
- factor VIII concentration in plasma was 0.2% of normal (severe hemophilia)
with negative coagulant inhibitors;
-microbiological tests (HIV, HBsAg) were negative;
- physicochemical analyses (glutamic-oxaloacetic transaminase [GOT],
glutamic-pyruvic transaminase [GPT], urea, and creatinine) were in normal
ranges.
-Electrocardiogram (ECG),
ear – nose – throat (ENT), and chest x-ray examinations
were also normal.
11. General anesthesia was processed using a 4.0-mm nasal-cuffed endotracheal
tube, reinforced to minimize nasal mucosa trauma.
Ointment was applied on lips before a silicone bite was used to keep the patient’s
mouth open and prevent oral mucosa injuries due to hard instruments.
Cotton rolls were used to isolate tooth instead of rubber dam placing for the
same reason.
12. After supragingival scaling and lesion assessment,
confirmatory diagnoses, including
irreversible pulpitis in tooth 85
reversible pulpitis in teeth 55, 74, 75, and 84
2.3 cavity in tooth 65
1.1 cavity in teeth 54 and 64;
3.2 cavity in teeth 73 and 83 (Mount’s cavity classification)
Treatments included
- A complete endodontic therapy for tooth 85;
- Preventive diode laser pulpotomy for teeth 55, 74, 75, and 84;
- indirect pulp capping with Biodentine for tooth 65,
- glass-ionomer cement (GIC) fillings for teeth 73 and 83;
- composite sealants for teeth 54 and 64;
- local fluoride varnish application
13. Tooth 85:
- After accessing pulp chamber,
- working lengths were established by using Propex II apex locator to prevent periapical
damage due to over-instrumentation.
- The root canals were then shaped and irrigated with sterile saline before being obturated
with ZOE paste.
- The post-treatment crown was restored with GIC (Fuji IX, GC)
- preformed metal crown (stainless steel crown [SSC]) of 3M company
14. Teeth 55, 74, 75, and 84
- treated with laser diode pulpotomy as follows:
a pulp chamber was first removed by highspeed burs,
then by continuous diode laser beam 810 nm at 0.5 W energy level (AMD Lasers from Dentsply
Sirona (Dentsply International), USA) until the floor chamber was visible, going into orifices.
Saline-damped cotton pellets were used to clean up and check for bleeding status.
As hemostasis accomplished, the pulp chamber was filled up with layers of Biodentine
(Septodont) and GIC (Fuji IX, GC) .
The crown was then covered with a preformed metal crown (SSC) of 3M company.
Diode laser pulpotomy for tooth 55. (A) Complete hemostasis by laser. (B) Biodentine layer.
(C) GIC restoration
15. Tooth 65:
-This tooth showed the pink color of its pulp chamber right beyond.
-After carious tissue removal, indirect pulp capping with Biodentine (Septodont) was
performed, and the GIC (Fuji IX, GC) was built up.
-Then, all these endodontically treated teeth were each protected with a preformed
SSC (3M company), conformed to by a finishing line polished and in proper contact
with gingiva.
Teeth 73 and 83 were filled with GIC (Fuji VII, GC)
Teeth 54 and 64 had pit and fissure composite sealants.
Finally, all exposed teeth were applied with fluoride varnish (MI Varnish, GC)
16. As soon as the boy woke up from the procedure,
he was able to eat without any complaint.
Up till now, after 3 months of follow-up, all clinical signs and functions have proved to be
normal; no sign of toothache or swelling was diagnosed.
Posttreatment intraoral and panoramic images. (A)
Upper teeth. (B) Lower teeth. (C) Panoramic
image.
17. Discussion
General anesthesia is considered to be used for pediatric patients with multiple dental
problems and inability to undergo dental treatment.
Those patients are too young to overcome the fear of high-speed bur noises and many
types of dental hand pieces in their mouths, and they cannot continuously keep their
mouths open during the entire treatment
This may lead to unexpected dangerous accidents, such as lacerating soft tissues,
swallowing endodontic files, or breaking instruments.
Hemophilia A cases, especially severe ones, have a constant high risk of bleeding.
18. In case of unconscious patients (due to general anesthesia), this is of critical
importance because they cannot express any feelings of hurt or injury during
the operation.
Therefore, endotracheal anesthesia was designed to ensure those patients’
safety while being operated by keeping their respiratory and circulatory systems
under constant control.
This method helps prevent patients from choking or getting exposed to trace gas
contamination.
19. Anesthesiologists also choose a smaller sized tracheal tube to avoid damaging
the mucosa of the upper respiratory tract.
The inner diameter of the uncuffed endotracheal tube is commonly calculated
based on the Cole’s formula: age/4.0+4.0.
Kline recommended that for children under 2 years old, the suitable formula
should be age/4.0+3.0,
According to Motoyama, age/4.0+3.5 should be applied for those at least 2
years old.
In the case of our 4-year-old patient, we used a 4.0-mm flexible cuffed tube,
smaller than calculated, to protect his mucosa.
20. The inner metal spiral support prevents the tube from distortion
while keeping it flexible enough to fit his respiratory tract.
In this case study, patient suffered from hemophilia A bleeding
disorder – any invasive procedures like tooth extraction should be
avoided.
Due to his tooth status and general condition, we only used
conservative methods, namely, endodontics, tooth fillings and
sealants, as well as local fluoride application
21. Lasers have been widely applied in dental procedures, including pulpotomy.
In particular, diode lasers have become more frequently used in pulpotomy because of
their reliability and handiness.
Favorable results of diode laser are at least as equal to those of other therapies such as
ferric sulfate, NaOCl, mineral trioxide aggregate (MTA), Biodentine,or even better.
Niranjani K, Prasad MG, Vasa AA, Divya G, Thakur MS, Saujanya K. Clinical evaluation of
success of primary teeth pulpotomy using mineral trioxide Aggregate®, laser and
BiodentineTM - an in vivo study. J Clin Diagn Res 2015;9(4):ZC35-ZC7
22. In hemophilic cases, diode lasers are highly effective in hemostasis and should be widely applied as
a preventive method for pulp bleeding, especially in hemophilia patients.
One important aspect of dental care in hemophilic patients is the cooperation between
hematologists and dental surgeons.
Hematologists thoroughly examine both hematological statuses and oral conditions of the patients
in order to determine the hemophilic ,so the doctors can make a plan for hemostatic management
before, during, and after operation
23. Good oral hygiene is always highly recommended to patients with hemophilia or
other bleeding disorders, since it is the simplest and easiest way to prevent
periodontitis and dental caries that could lead to gingival bleeding and more
invasive treatments.
Parents should be well informed about oral health and its importance to
pediatric hemophilia patients.
hemophilic children should be examined regularly, starting at the time of
eruption of milk teeth (or primary teeth).
The patient has been treated for about 3 months, and we have so far no negative
signs or symptoms
24. Conclusion
Haemophilia A patients can have their dental treatment safely performed under general
anaesthesia as long as the dental surgeon, haematologist, and anaesthesiologist
cooperate well with one another.
To reduce trauma, any treatment, including preventive therapies, should be carefully
conducted with minimal invasion.
For dental patients with haemophilia A, the diode laser technology is an excellent
nonchemical method of haemostasis during the pulpotomy procedure, and therefore, it
should be widely applied.
25. References
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Haemophilia 2013;19(1):e1-e47.
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and B: a report of 58 extractions. Med Oral Patol Oral Cir Bucal 2014;19(1):e55-e60.
3. Nogami K, Shima M. Pathogenesis and treatment of hemophilia. In: Ishii E, ed. Hematological Disorders in
Children: Pathogenesis and Treatment. Singapore: Springer Singapore; 2017:189-204.
4. Brewer A, Correa ME. Guidelines for Dental Treatment of Patients with Inherited Bleeding Disorders. Québec,
Canada: World Federation of Hemophilia; 2006
5. Nogami K, Shima M. Pathogenesis and Treatment of Hemophilia. Berlin/New York: Springer; 2017.
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Guillén A. Dental management of a child with incidentally detected hemophilia: report of a clinical case. Case
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hemophiliac patient with inhibitor: case report. Pediatr Dent 1993;15(4):282-87.
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pediatric endotracheal tube size by ultrasonography. Anesthesiology 2010;113(4):819-24.
13. Kotlow LA. Lasers in pediatric dentistry. Dent Clin 2004;48(4):889-922.
14. Nazemisalman B, Farsadeghi M, Sokhansanj M. Types of lasers and their applications in
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15. Kuo HY, Lin JR, Huang WH, Chiang ML. Clinical outcomes for primary molars treated by
different types of pulpotomy: a retrospective cohort study. J Formos Med Assoc 2018;117:24-33.
16. Niranjani K, Prasad MG, Vasa AA, Divya G, Thakur MS, Saujanya K. Clinical evaluation of
success of primary teeth pulpotomy using mineral trioxide Aggregate®, laser and BiodentineTM -
an in vivo study. J Clin Diagn Res 2015;9(4):ZC35-ZC7.
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Editor's Notes
Hemophilia is a bleeding problem. People with hemophilia do not bleed any faster than normal, but they can bleed for a longer time. Their blood does not have enough clotting factor. Clotting factor is a protein in blood that controls bleeding.
Anemia,hemophilia,thrombocytopenia other bleeding disorders
Vlll antihemophilic factor
Ix plasma thromboplastin component,Christmas f
Xll Hageman factor
Abnormal bleeding and poor blood clotting
INTERNATIONAL UNIT /DECILITER
Recessive
Tranexamic acid antifibrinolytic
With immune tolerance induction (ITI) therapy, factor concentrate is given regularly over a period of time until the body is trained to recognize the treatment product without reacting to it. When immune tolerance induction is successful, the inhibitors disappear and the patient’s response to factor concentrates returns to normal. The majority of people who undergo ITI therapy will see an improvement within 12 months, but more difficult cases can take two years or longer.
a solid swelling of clotted blood within the tissues.
c/f of hemophila?
(including endodontics, tooth fillings and sealants, and local fluoride application)
Aptt normal timin and definition 30 40 s
Hbsag surface antigen for hep b
Got and gpt liver blood test