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16 Visit: http://image.idakunnamkulam.com/ Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders Periodontal pockets host a veriety of different bacteria, the majority of them being anaerobic. Regular oral hygiene prevents these bacteria from causing gingival inflammation. In patients with severe gingival inflammation, in particular those who are immune compromised; the use of an antimicrobal agent may be indicated Metronidazole is considered the drug of choice due to its action against anaerobic organisms. It may be used in conjunction with either penicillin or erythromycin. However, antimicrobial therapy is no substitute for oral hygiene treatment. Topical treatment The most common forms of topical treatment involve the use of an antibacterial mouthwash. These have value as an adjunct to hygiene phase treatment. The most common treatments are: * Chlorhexidine gluconate: Chlorhexidine is available as a mouthwash, spray, and toothgel. It is most commonly used as a twice a day mouthwash with the patient rinsing their mouth with the solution for 30-60 seconds. The toothgel may be used in addition to the mouthwash. Chlorhexidine has a tendency to stain teeth so the length of each course of treatment should be limited. * Providine-iodine: providine-iodine is available as a mouthwash and can be used for the treatment of acute periodontal problems. In addition,it may be useful to irrigate the periodontal pockets. It must be used with caution during pregnancy. Dental emergencies Dental emergencies can occur at any time; however, it is important to remember that no treatment should be carried out without prior planning as this could result in additional problems. The most common dental problems are pain due to caries and bleeding from the periodontal tissues. Pain related to caries can usually be trated with either antibiotics or pulpectomy in order to allow time for the planning of the extraction. Bleeding from the periodontal tissues can usually be controlled with antibiotics until an appointment with a hygienist can be arranged. Visit : http://image.idakunnamkulam.com/ Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders
17 Visit: http://image.idakunnamkulam.com/ Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders The management of dental trauma is more complex as it usually involves both the gingiva and the teeth. Local measures will usually control gingival bleeding and temporary splinting can be used for fratured or loose teeth. With dental trauma, it is important to remember that we are part of the comprehensive hemophilia care team treating these patients. Treatment planning for an emergency requires input from the whole team to reduce the risk of further problems. ORAL AND MAXILLOFACIAL SURGICAL MANAGEMENT However where extractions, deep scaling, and/or inferior dental nerve (lower jaw) injections deep into the tissue are anticipated, then a 50% factor rise would be the legal of choice. Where the procedures intended are much more extensive, or become more extensive as the procedure develops, such as a surgical extraction, 100% rise may be necessary. This might necessitate an increase in the rise from 50% to 100% immediately post- operatively, if the treatment being undertaken becomes more extensive than was originally planned. Surgical extractions should not be undertaken lightly. They should only be undertaken when the circumstances absolutely demand it. In all cases of patients undergoing dental treatment involving blood clotting, the patient should be prescribed tranexamic acid. The adult dose is 500mg. one tablet four times a day to be taken for 10days post operatively to prevent the breakdown of any clot that forms. for children, the above dose must be modified for their size and age. If no extractions or periodontal treatment is undertaken , only restorations, then the tranexamic acid should be taken for 3 to 7 days. While the use of sutures following extractions can be warranted there is normally no necessity for these to be in place longer than about 24 hours. Visit : http://image.idakunnamkulam.com/ Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders
Page 1 and 2: DENTAL MANAGEMENT OF PERSONS WITH H
Page 3 and 4: INDIAN DENTAL ASSOCIATION, KERALA S
Page 5 and 6: IDA KERALA STATE CDE CHAIRMANíS ME
Page 7 and 8: IDA KERALA STATE EDITORíS MESSAGE
Page 9: EDITORIAL Dental Surgeons face blee
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