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
Premedication of the hemophiliac is indicated when lengthy procedures are planned or when the patient is
apprehensive or unruly. Preoperative plasma transfusion may be recommended if excessive bleeding is
anticipated.
As mentioned earlier, local anesthesia is usually contra indicated for a child with hemophilia. A general,
anesthetic, administered by a trained anesthesiologist, who is cognizant of the bleeding problem, should be a
relatively safe procedure for the hemophiliac patient.
Before surgical treatment is attempted, all necessary restorative procedures should be completed with
strict adherence to the precautionary measures already described. The extractions and other surgical treatment
must be performed with the least possible trauma. Use of pressure packs for the initial control of hemorrhage
should be followed by packing the socket with Gelofoam or some other hemostatic agent that can be held in
nplace by gauze impregnated with petrolatum to prevent the incorporation of the gauze in the blood clot.
A follow-up transfusion schedule should be planned by the hematologist and the dentist. The duration
of this therapy depends on the approximation of the healing time for the surgical wounds. the patient should
receive nothing by mouth for 4 hours after the operation and should receive only liquids for the subsequent 24
hours. The important of then patientís diet and postoperative home care must be carefully explained to his
parents.
NITROUS OXIDE ANALGESIA
With the handicapped child, inhalation analgesia with nitrous oxide can be a safe and effective method
of decreasing apprehension or resistance to dental treatment. Except for children who have severe mental
retardation or emotional disturbance, there are few contraindications to its use.
A dentist experienced in administering nitrous oxide analgesia can combine this procedure with
premedication and local anesthesia to overcome many of the problems associated with handicapped children.
Nitrous oxide analgesia decreases the muscular spasticity and the uncoordinated movements of the cerebral
palsied child and lessens the physical stress and discomfort, thereby making it possible for him to tolerate
longer periods of treatment.
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Hand book for dental surgeons on dental management of persons with hemophilia and other haemostatic disorders