4. • CAN be caused by disease or drugs
• Health history
• h/o of bleeding after previous surgery or trauma
• Past or present drug history
• h/o of bleeding problems among relatives
• Illness associated with potential bleeding problems
8. • Bleeding disorders can be
• Coagulation disorders- haemophilia, von Willebrand’s disease
• Thrombocytopenic purpuras
• Non- thrombocytopenic purpuras
9.
10. Patients with liver disease
• Physician consultation
• Lab test: PT, bleeding time, platelet count, and PTT
• Conservative non-surgical periodontal therapy
• If surgery required
• PT INR<2 .For simple surgical procedures INR less than 2.5 is safe
• Platelet count more than 80,000
11. • pt: pts with prosthetic heart valve
• h/o MI , deep vein thrombosis(DVT), thromboembolism……
• Anticoagulant medication: dicumarol, warfarin
• These drugs- VIT K dependent coagulation factors are decreased….
12.
13. Traditional recommendation for perio RX
• Consult pt physician
• INR <3 : infiltration anaesthesia, Scaling and root
planning,
• INR<2-2.5:block anaesthesia, minor periodontal
surgery and simple extraction
• INR<1.5-2: complex surgeries, implant placement
• Anticoaguant is discontinued 2-3 days before
perio Rx and INR checked on day of therapy…. If
within normal range perform … Rx and resume
anticoagulant immediately…
• Control haemorrhage.. –tranexamic acid, oxidised
cellulose, pressure pack….
27. RENAL TRANSPLANT PATIENT
ARE INFECTION PRONE….
AS THEY TAKE IMMUNOSUPPRESSIVE
DRUGS …….……….
PERIODONTAL ABSCESS….. LIFE
THREATENING SITUATION…
REMOVE ALL INFECTED TEETH
PRIOR TO TRANSPLANTATION
