DISORDERS OF BLOOD

DISORDERS OF BLOOD

Coagulation Disorders :
Hemophilia Hemophilia A Hemophilia B Hemophilia C Von willebrands disease

DISORDERS OF BLOOD

HAEMOPHILIA..

Dental Care
Pulp treatment of primary teeth, if indicated is to be done to avoid extractions.
Primary teeth when shed in normal way cause little or no hemorrhage. However, if very mobile, extraction may be necessary.

DISORDERS OF BLOOD

HAEMOPHILIA

Dental Care..

Never give Inferior dental nerve blocks as bleeding in Pterygomandibular region may result in Asphyxia. Haemostatic agents to be administered during periodontal procedures.

DISORDERS OF BLOOD

HAEMOPHILIA

Dental Care..

Extraction -adequate replacement therapy and careful monitoring of factor VIII and factor IX levels. Acrylic Splint To maintain Clot in place.

DISORDERS OF BLOOD

HAEMOPHILIA

Dental Care..

Surgical procedures : Factor VIII : at least 30% Factor IX : at least 30-50%

Factor VIII : Parenteral 1-deamino 8-D arginine vasopressin Factor IX : Purified prothrombin complex concentrates.

DISORDERS OF BLOOD

HAEMOPHILIA

Dental Care

Routine therapy with Anti-fibrinolytic agents: Tranexamic acid Epsilon Aminocaproic acid Prior to and for a few days following the procedure.

DISORDERS OF BLOOD

HAEMOPHILIA

Dental Care..

Medications containing aspirin (salicylates) must not be prescribed. Paracetamol compounds safe. Non-steroidal anti-inflammatory drugs are contraindicated. Avoid Saliva Ejectors.

DISORDERS OF BLOOD

HAEMOPHILIA

Dental Care..

Preventive treatment is important.

Topical / Systemic fluorides at regular intervals.

DISORDERS OF BLOOD

HAEMOPHILIA..

Dental Care..

Bite wing radiographs should be taken at regular intervals .

Careful application of matrix bands and

retainer.

DISORDERS OF BLOOD

THROMBOCYTOPENIA

Reduction in number of platelets (Normal range : 1.5 - 4.0 lac/mm3)

DISORDERS OF BLOOD

THROMBOCYTOPENIA

Characterized by :
Petectial Hemorrhages Haematemesis Hematuria

Malena

Sub mucosal hemorrhage in palate

DISORDERS OF BLOOD

THROMBOCYTOPENIA

Dental Care
Platelet count should be estimated.

Scaling & Root planing 60,000/mm3

Surgical Procedures 80,000/mm3 Corticosteroids (Prednisolone) Increase platelet count.

DISORDERS OF BLOOD

THROMBOCYTOPENIA

Dental Care

Infiltration anesthesia, Scaling, Root planing : INR < 3.0

Block anesthesia, Minor surgery, Extractions : INR < 2.0

Major surgery : INR < 1.5

DISORDERS OF BLOOD

THROMBOCYTOPENIA

Dental Care

Surgical treatment should be as Atraumatic as possible. Local Hemostatic measures should be applied.

Platelet transfusion may be required before surgery.

DISORDERS OF BLOOD

SICKLE CELL ANAEMIA

Clumped together, blocking small blood

vessels, reduction in blood supply and thereby necrosis of tissue supplied.

DISORDERS OF BLOOD

SICKLE CELL ANAEMIA

Dental Care
Level of Haemoglobin should be investigated before extraction or surgery.

Level of Haemoglobin S should be less than 30%.

DISORDERS OF BLOOD

SICKLE CELL ANAEMIA

Dental Care

Poor healing may ensure after surgical dental procedures.

L.A should be used in preference to G.A .

Prophylactic Antibiotics.

DISORDERS OF BLOOD

THALASSAEMIA
Disorder of Haemoglobin synthesis.

Expansion of medullary cavities of facial bones, which gives rise to expansion of maxilla, creating protrusion of middle third of face.

DISORDERS OF BLOOD..

THALASSAEMIA

Dental Care

Gradual expansion of maxilla obviously has repercussions as far as orthodontic management is concerned.
HIV screening is must.

DISORDERS OF BLOOD

LEUKEMIA

Malignant disease in which there is widespread proliferation of WBCs.

Spontaneous haemorrhage from gingiva.

DISORDERS OF BLOOD

LEUKEMIA

Dental Care
No treatment should be carried out until the patient is in remission unless there is an emergency.

DISORDERS OF BLOOD

LEUKEMIA

Dental Care

Swabbing the mouth with an antibacterial solution may help to prevent ulcers. Mouth washes with local anaesthetic properties may be beneficial.

DISORDERS OF BLOOD

LEUKEMIA

Dental Care..

Inferior

dental blocks are contra indicated as there is possibility of deep hemorrhage. time and platelet count should be checked before extractions or extensive scaling.

Bleeding

DISORDERS OF BLOOD

LEUKEMIA

Dental Care..
Susceptible

to infections - maintained on prophylactic antibiotics. viral infections such as Herpetic gingival stomatitis develop, then IV or Oral Acyclovir. Candidial infections occur, Treat with Amphotericin B, Nystatin or Fluconazole.

If

If

Mousavi , nayyereh DMD4D