hand book for dental surgeons - Indian Dental Association ...

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Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders
The use of local anesthesia is contraindicated for these children except when pain is extreme and then it should
be used with caution. The mandibular block should be avoided, because this form of injection may cause
hemorrhage into the lateral pharyngel spaces, where it is difficult to apply controlling measures.
A carefully placed rubber dam will serve a twofold purpose in the dental treatment of the hemophilic.
Besides securing a dry field for the placement of restorative materials, it also will help protect the soft tissues
from accidental lacerations.
Tooth extraction for the hemophiliac should be considered only as a last resort, after the possibility of
maintaining the teeth by conventions pulpectomy or root canal therapy has been rejected.
Extreme precautionary measure should be practiced for all patients suffering from any type of
hemorrhagic disorder, as for example with the so-called pseudo hemophiliac, who may be a male or a female
with a characteristically prolonged bleeding time.
Removing Teeth
When extractions or other surgical procedures are unavoidable and excessive bleeding is anticipated, the
patient should be hospitalized for more adequate handling of any complications that might arise.
Prior to the patientís admission to the hospital, the dentist should organize a plan for dental treatment.
This plan, in conjunction with the patientís medical history, should be discussed by the dentist, the physician,
and the hospital staff to outline a medical work-up that will include a detailed blood analysis for determining the
type of bleeding problem, the coagulation and bleeding time, and the platelet count. After these steps are
completed, the hematologist should coordinate the medical management for the child.
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Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders